Massachusetts Medicare Supplement Plans (Medigap)
Massachusetts Medicare Supplement Plans were created to provide more comprehensive coverage for your individual healthcare needs.
These policies work parallel with Original Medicare and provide coverage for what’s not covered by straight Medicare.
Medigap Plans assist with the out of pocket costs (OOP) associated with deductibles, copayments and coinsurance.
Private insurance carriers sell these supplement plans whereas, Traditional Medicare is a federal program. Both options are broken down into parts and plans.
Massachusetts Medicare Plans Broken Down
There are four parts associated with Traditional Medicare health insurance.
- First there is your Medicare Part A. This includes your hospitalization and any inpatient services.
- Medicare Part B covers any outpatient services and physician office visits.
- The third part is Medicare Part C or, “Medicare Advantage”. This plan provides the same coverage as Original medicare but comes with limitations such as in-network providers.
- Lastly is Medicare Part D or your, “Prescription Drug Plan”. This PDP provides prescription medication coverage for those enrolled in a Medicare Plan or with Medicare Advantage.
Outside of Traditional Medicare are the Medigap Plans which are represented by 10 different letters. These Medigap Plan options are offered by private insurance carriers and assist with deductibles, copays and coinsurance. These plans are beneficial as they cover medical expenses not covered by Original Medicare.
What does Massachusetts Medicare Benefits Include
Massachusetts Medicare coverage is 80% for both Parts A and B after the deductible has been met. The remaining 20% coinsurance and other OOP costs are then the responsibility of the beneficiary.
For Massachusetts residents on Medicare a Medigap Plan can help cover services not included by straight Medicare and also decrease your OOP amounts.
Requirements for Massachusetts Medicare Supplement Plans
Eligibility for Medigap Plans include:
- You must be 65 years old and currently enrolled in Medicare Part B to be eligible for a Medigap Plan.
- If you currently have Social Security benefits, once you turn 65 you will be automatically enrolled in Part B.
- The initial enrollment period or, “IEP”, for Part B starts three months prior to your 65th birthday month and expires three months after your 65th birthday month. A total of 7 months.
Failure to enroll for Part B during your IEP will result in late enrollment penalty. The Part B penalty will be included in your monthly premium and is calculated based on how long you went with coverage.
Medicare Eligibility in Massachusetts for the Disabled under 65
Not only are individuals with SSDI benefits eligible for Medicare Part A and Part B, but certain Railroad Retirement Benefits automatically qualify you after 24 months.
Federal law does not require the individual private insurance carriers to offer Medigap Plans. In some states there are laws requiring carriers to offer supplement plans. Luckily for you, Massachusetts law requires that insurers offer at least one plan for the disabled under 65.
If you currently reside in Massachusetts and are disabled under 65 call today and one of our licensed insurance agents can help provide more information.
How to Enroll in a Massachusetts Medigap Plan
During the Open Enrollment Period or OEP is the best time to obtain Medigap coverage. The OEP begins the 1st day of the month in which you turn 65 and already enrolled in Medicare Part B.
The following 6 months you are free to apply and during this timeframe you are granted what is called the Guaranteed Issue (GI) right.
The benefit of enrolling during your GI is that the insurance carriers cannot deny you coverage. It is especially important to those with pre-existing medical conditions to enroll during your GI period.
Failing to do so can result in higher premiums, the underwriting process or even denial of coverage due to your medical issues.
Medigap Premiums in Massachusetts
Each state’s individual insurance carriers determine what the monthly premium will be. Your age, sex and location are part of the determining factors. For example, a 79 year old female’s premium that lives in Norton will vary from a 67 year old man living in Boston
Additionally, there are 3 different pricing methods are used:
- Community rated: regardless of age, everyone pays the same premium rates.
- Issue-age-rated: based on the age you are when your policy is issued will determine your premium rates.
- Attained-age-rated: your premium rates will increase as you age.
Standardized Massachusetts Medicare Supplement Plans
As previously mentioned, the Medigap Plans in Massachusetts are standardized differently than the basic, 10 letter plans offered in most other states.
Regardless of which plan you chose, they both include the basic and state-mandated benefit coverage.
The two different plan options are outlined below:
Massachusetts Core Plan
Coverage includes the Medicare Part A hospital coinsurance for inpatient hospital care. This includes coverage for an additional 365 days once Medicare coverage has ended.
It also covers the Medicare Part B’s coinsurance which is usually around 20% of the Medicare allowables. Each calendar year it also covers your first 3 pints of blood as well as 60 days of inpatient care at a mental health hospital.
This plan also includes the annual state-mandated benefits such as pap tests, mammograms and more.
Massachusetts Supplement 1 Plan
Coverage includes everything the same as the Core Plan but also includes Medicare Part A hospital deductible and skilled nursing facility coinsurance.
It also covers the Medicare Part B deductible as well as 120 days of inpatient care at a mental health hospital. It has the added benefit of emergency foreign travel coverage.
Medicare Advantage Plans in Massachusetts
Medicare Advantage plans are sold by private insurance carriers and takes over the coverage of Medicare Part A and B.
While Medicare Advantage Plans have cheaper premiums they come with restrictions including coverage limitations and cancellation restrictions. Additionally, you cannot use an Advantage Plan with a Medigap Plan.
While this may seem like the cheaper option, overtime you save more on OOP costs by opting to go with one of the Massachusetts Medicare Supplement Plans.
As Traditional Medicare and the Massachusetts Medicare Supplement Plans don’t have prescription drug coverage most people opt to obtain a PDP. By having a Medicare Part D Plan it can significantly decrease the OOP expenses associated with prescription drugs.
Like Part B, there is a penalty for going without a Part D Plan. The penalty starts after your 7 month IEP has expired. Again, depending on how long you went without coverage will depend on the increase in your monthly premiums.
How to Compare Medicare Supplement Plans in Massachusetts Online
To apply for any of the Massachusetts Medicare Supplement Plans, Medicare Advantage or a Prescription Drug Plan online you can fill out the online rate form. Our licensed insurance agents will compile the different and required information to get you the best policy coverage at the most affordable rate.
As always, our services are always 100% free so don’t hesitate to fill out the form today!
Massachusetts Medicare Resources
There are Medicare Savings Programs available nationwide to assist with cost. If you are eligible for Medicare and have financial concern you can visit Centers for Medicare and Medicaid for further assistance.
In addition, there are individual state assistance programs (SHIP) for those living in Massachusetts.
Massachusetts Medicare FAQs
- Does Massachusetts General Hospital accept Medicare? Yes, this hospital accepts Medicare, Medicaid and most of the other insurance plans. Medicare Part A will cover any hospital admissions and Medicare Part B will cover any ER visits at this specific facility.
- Does Medicare pay for Assisted Living in Massachusetts? Assisted Living Facilities are not covered under any Medicare Plan. If you plan on living in an ALF this will be considered an OOP cost. The only facilities covered by Medicare are the short-term nursing care facilities.
- What is the best Medicare Plan for seniors in Massachusetts? There are a variety of plans available for seniors. Depending on what your individual healthcare requirements are will determine which policy suits you most. You can get more information regarding which policy you should choose by calling or filling out our online forms today!