Massachusetts Medicare Supplement Plans (Medigap)
Medicare Supplement Plans in Massachusetts are slightly different than Medigap plans in other parts of the nation. Beneficiaries in all states will benefit from some supplemental coverage.
Medicare doesn’t cover 100% and beneficiaries don’t want responsibility for 20% of tens of thousands of dollars. So, the best way to ensure out of pocket savings is to enroll in Medigap coverage.
Massachusetts Medicare Supplement Plans
If Shawn has Medicare with no additional coverage, he could be at risk for high out of pocket costs. To prevent paying high deductibles, and 20% of medical bills, Shawn will need to enroll in Medigap coverage.
The Part A deductible is $1,364 per benefit period; so, Shawn could pay this deductible multiple times during the year or he could have a policy that pays it for him.
On top of the Part A deductible, Shawn must pay 20% of any remaining Part A balance. Which if you’ve googled the cost of a hospital stay, you know it can be upwards of $10,000 easily.
Then, the Part B deductible is only $185 annually. This deductible isn’t unbearable; however, it could still be an inconvenience. After the deductible is met, Shawn will pay 20% of any leftover expenses.
Now, if Shawn enrolls in the Massachusetts Supplement 1 Plan, he could have little to no out of pocket costs.
Medicare Eligibility in Massachusetts for the Disabled under 65
Federal law doesn’t require private insurance carriers to offer Medigap Plans; however, 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.
Medicare Advantage Plans in Massachusetts
Medicare Advantage plans are sold by private insurance carriers and take over the coverage of Part A and B.
Advantage Plans have cheaper premiums and come with restrictions including coverage limitations as well as cancellation restrictions. Beneficiaries with this coverage can change the policy only during the Annual Enrollment Period (AEP).
During the year beneficiaries will pay copayments and deductibles similar to Medicare. The policy has a list of doctors to follow, and referrals are usually a requirement.
Let’s say Shawn has an Advantage policy; well, the ambulance is going to cost a $200 copayment and the inpatient hospital costs $400 each day for days 1 through 5.
The out of pocket costs can be more than the annual Medigap costs. However, MA coverage can be more beneficial than traditional Medicare.
MA policies have Maximum Out Of Pocket (MOOP) coverage; so, the beneficiary has protection on how much they can spend in a calendar year. If Shawn’s MOOP is $6,700 then the most he can pay is $6,700 on services in the year.
Additionally, enrollment in both Advantage and Medigap is forbidden. The Medigap plan won’t pay any benefits if you have an MA policy.
Massachusetts Prescription Drug Plans for Medicare
The length of time you went without coverage will determine the increase in monthly premiums. Those that wait a long time will have a higher premium than those that don’t wait as long.
Part D can cost as low as $15 a month; however, a low premium isn’t always the best savings.
For beneficiaries that don’t take medication or have specific generics, the $15 policy could be beneficial. Although, beneficiaries with specialty drugs, brand name medications, or certain generics could save money with a higher premium policy.
Shawn has the $15 policy but he pays a $95 copayment for his medication; when he consults an agent the policy is $50 a month but his medication only costs $35 copayment. Shawn saves more by paying a higher premium.
The State Health Insurance Program (SHIP) is a service that helps people with benefits break downs. All beneficiaries can visit the CMS Newsroom for updates on Medicare topics. You can also see these state-specific plans on Medicare.gov.
Standardized Massachusetts Medicare Supplement Plans
As previously mentioned, the Medigap Plans in Massachusetts are different than the 10 letter plans offered in most other states. Also, Part B excess charges are forbidden because of state laws.
There are two policies available; a “Core” plan and a first dollar option. Both plans include basic benefit coverage.
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 Medicare Part B’s coinsurance which is usually around 20% of the Medicare allowable. 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 policy offers basic benefits much like Medigap Plan A.
Massachusetts Medicare Supplement 1 Plan
Coverage includes everything in the Core Plan; also, it includes the $1,364 Part A deductible and the skilled nursing facility coinsurance.
The plan covers the Medicare Part B deductible. Also, this covers 120 days of inpatient care at a mental health hospital.
Additionally, this policy has the benefit of emergency foreign travel coverage. This policy is first dollar coverage; beneficiaries with this plan will pay little to no out of pocket expenses.
|Medicare Supplement (Medigap) Benefits||Medicare Supplement (Medigap) Plans|
|Core Plan||Supplement 1|
|Part A: inpatient hospital deductible||No||Yes|
|Part A: skilled nursing facility coinsurance||No||Yes|
|Part B: deductible||No||Yes|
|Foreign travel emergency||No||Yes|
|Inpatient days in mental health hospitals||60 days per the calendar year||120 days per benefit year|
|State-mandated benefits (yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.)||No||Yes|
2020 First Dollar Medicare Supplement Plan Changes in Massachusetts
First dollar coverage won’t be for sale in 2020. Insurance companies must not cover the Part B deductible. Massachusetts, Minnesota, and Wisconsin offer coverage options that are much different from other states.
These states don’t have much information on the policies that will have availability in 2020. Although, all of the states must abide by the federal laws.
Massachusetts Medicare Supplement Plan Requirements
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
State laws require insurance companies to community rate policies; this means all plan members pay the same amount and premiums aren’t about age or enrollment.
The cost will depend on where you live and the best policy in your area.
Compare Medicare Supplement Plans in Massachusetts Online
Applying for a Medigap policy is simple and can be done over the phone. Beneficiaries will benefit from consulting our team of top brokers; with industry knowledge and experience we provide you with the best options.
As always, our services are always 100% free so don’t hesitate to call the number above or fill out an online rate form!
Having a Medigap plan can save you tens of thousands of dollars during the year. Medigap also protects your savings and retirement fund from expensive medical bills.
Call us today and get the coverage you need!