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Medicare Supplement Plans in Massachusetts


Summary: Medicare Supplement plans in Massachusetts offer additional coverage for Original Medicare enrollees. These plans help cover the costs traditionally left by Original Medicare for the beneficiary to pay. Estimated Read Time: 8 min

Medicare Supplement (Medigap) plans in Massachusetts are not your typical standardized plans available nationwide. In 47 of 50 states, Medicare standardizes 12-lettered Medigap plans. However, Massachusetts is one of the three states with a slightly different approach to Medicare Supplement coverage.

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Original Medicare (Part A and Part B) does not cover services 100%, and most people don’t want to pay thousands of dollars in coinsurance each year. So, the best way to ensure protection is to enroll in a Medicare Supplement plan.

Like the options throughout the rest of the country, Medigap plans in Massachusetts don’t involve networks or referrals, so you can use your plan’s coverage at any Original Medicare-accepting doctor or hospital nationwide. The names of the plans available in Massachusetts are the CORE Plan, Supplement1, and Supplement1A Plan.

Massachusetts Medicare Supplement Plans

Medicare Supplement plans in Massachusetts look a little different than the typical Medicare Supplement plan options. However, the Medigap plans in Massachusetts still must follow federal and state regulations regarding Medicare supplemental coverage.

There are three Medicare Supplement plans available in Massachusetts:

  1. CORE Plan
  2. Supplement1 Plan
  3. Supplement1A Plan
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Compare Medigap Plans in Massachusetts

Compare Medigap plans in Massachusetts

Medicare Supplement CORE Plan

Coverage from the CORE plan includes the Medicare Part A hospital coinsurance and extends 365 days beyond what Original Medicare provides.

The CORE Plan also covers Medicare Part B coinsurance. Each calendar year, coverage includes your first three pints of blood as well as 60 days of inpatient care at a mental health hospital.

The CORE policy offers basic benefits, much like Medicare Supplement Plan A.

Medicare Supplement1 Plan

Massachusetts’s Supplement1 Plan includes everything the CORE Plan offers, plus more. The Supplement1 Plan covers the Medicare Part A deductible and the skilled nursing facility coinsurance. It also covers the Medicare Part B deductible and coinsurance with 120 days of inpatient care at a mental health hospital.

Additionally, the Supplement1 Plan has the benefit of emergency foreign travel care.

The Supplement1 Plan is considered first-dollar coverage. Beneficiaries with this plan will pay little to no out-of-pocket costs. This plan is very comparable to Medicare Supplement Plan F.

Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), this plan will no longer be available to those new to Medicare.

Medicare Supplement1A Plan

The new Supplement1A Plan is equivalent to the standard Medigap Plan G. It will cover everything Supplement1 covers, minus the Part B deductible.

This means once you meet your deductible, the Supplement1A plan will cover 100% of your medical costs after Original Medicare pays its portion.

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Medicare Supplement Benefits CORE Plan Supplement1 Plan Supplement1A Plan
Basic Benefit (Medicare Part B coinsurance)
Medicare Part A inpatient hospital deductible
Medicare Part A skilled nursing facility (SNF) coinsurance
Medicare Part B deductible
Foreign travel emergency
Inpatient days in mental hospital 60 days per calendar year 120 days per benefit year 120 days per benefit year
Other Massachusetts mandated benefits
*Massachusetts cannot permit a Medicare Part B deductible rider to be issued to those who are newly eligible for Medicare on or after January 1, 2020, per MACRA. However, a Medicare Part B rider can be offered or renewed for those first eligible for Medicare prior to January 1, 2020.
*Supplement1 Plan is unavailable to those newly eligible for Medicare on or after January 1, 2020.

The best time to enroll in a Medigap plan in Massachusetts is during your six-month Open Enrollment Period. This enrollment period begins on the first day of the month you enroll in Medicare Part B. During this time, you can enroll in any Medicare Supplement plan of your choice. There are no enrollment restrictions based on pre-existing health conditions.

Failing to enroll in coverage during this time can result in higher premiums or even denial of coverage due to medical issues.

Who is Eligible for Medicare Supplement Plans in Massachusetts

In Massachusetts, eligibility for Medicare Supplement plans follow the federal guidelines for Medicare eligibility. To be eligible for a Medigap plan in Massachusetts, individuals must meet the following criteria:

  • You must be 65 years or older or under 65 with a qualifying disability or medical condition.
  • You must be enrolled in Original Medicare.
  • You must be a resident of Massachusetts.

It’s worth noting that eligibility for Medicare Supplement Plans can vary based on individual circumstances, and specific requirements may change over time. Therefore, it is recommended to consult with a licensed insurance agent to get accurate and up-to-date information on eligibility criteria for Medicare Supplement Plans in Massachusetts.

Medigap Plans Massachusetts Cost

The monthly premium for your Medicare Supplement plan depends on several factors. The rating method your state uses is one of the biggest determinants of your monthly premium price. Massachusetts state law requires insurance companies to use the community rating method for their Medigap policies. This means all members pay the same premium regardless of health or age.

Depending on your ZIP Code, the monthly premium for the CORE plan can be as low as $90, and the Supplement1 Plan can be as high as $350 or more per month, depending on the company you choose. Also, if you buy an additional rider, like dental coverage, you will pay more. The cost for which you are responsible depends on the plan and carrier in which you enroll.

Female, No Tobacco, Massachusetts ZIP Code 02110
Medigap Plan Monthly Premium Age 65 Monthly Premium Age 75
Medicare Supplement Plan F $206-$330* $206-$330*
Medicare Supplement Plan G $114-$204 $114-$204
Medicare Supplement Plan N $166-$320 $166-$320
Male, No Tobacco, Massachusetts ZIP Code 02110
Medigap Plan Monthly Premium Age 65 Monthly Premium Age 75
Medicare Supplement Plan F $206-$330* $206-$330*
Medicare Supplement Plan G $114-$204 $114-$204
Medicare Supplement Plan N $166-$320 $166-$320

* If on Medicare before 01/01/2020

Medigap Carriers in Massachusetts

While Medicare Supplement plans in MA may not be the same as other plans nationwide, carriers who offer these plans are similar to other states.

Some of the Medigap carriers that offer plans in Massachusetts include:

Medigap benefits between carriers are the same in Massachusetts. However, your monthly premium and additional perks may vary based on the carrier you choose to enroll through.

Medicare Supplement Eligibility Under 65 in Massachusetts

Federal law does not require carriers to offer Medicare Supplement plans to Medicare beneficiaries under age 65. However, Massachusetts law requires insurers to offer at least one Medigap option to those under 65 and on Medicare due to disability.

Generally, the plan available to those under 65 is the basic benefit CORE plan option. Some may find that while under age 65, it is more cost-effective to enroll in a Medicare Advantage plan until they age into Medicare.

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Medicare Supplement Rating Methods in Massachusetts

Massachusetts Medigap plans are community rated, meaning your monthly premium does not change based on your gender or age. Under this rating method, insurance companies charge the same premium to all individuals. The premium remains the same as long as the individual continues to pay for the plan and can only rise due to outside factors like annual inflation. This promotes pricing stability within the state and ensures that older individuals are not charged higher premiums based on their age.

Medigap Guaranteed Issue in Massachusetts

A unique Guaranteed Issue provision in Massachusetts allows individuals to have a year-round open enrollment period for Medicare Supplement plans. This means that Massachusetts residents may make changes to their Medigap plans at any time throughout the year, regardless of their health status or pre-existing conditions.

Under the Guaranteed Issue provision in Massachusetts, individuals who already have a Medigap plan can switch to a different plan or insurance company without being subject to medical underwriting.

When to Enroll in Medicare Supplement Plans in Massachusetts

The best time to initially enroll in a Medicare Supplement plan in Massachusetts is during your Initial Enrollment Period. This enrollment period offers you a 6-month window that begins when you enroll in Medicare Part B. During this period, you have guaranteed issue rights, which means that insurance companies must sell you any Medigap plan they offer without medical underwriting.

If you do not enroll in a Medigap plan during this time, you will need to go through medical underwriting to enroll in a Medigap plan. However, once you have enrolled in a Medicare Supplement plan, you are free to switch plans and carriers at any time without answering health questions while living in Massachusetts.

Additional Medicare Coverage in Massachusetts

In addition to Medicare Supplement plans, Massachusetts offers a variety of other insurance plans for seniors who are enrolled in Medicare. These plans include:

How to Apply for Medicare Supplement in Massachusetts

Applying for Medicare Supplement plans in Massachusetts is simple and can be done over the phone. When you consult our team of licensed agents with industry knowledge, you become educated on your options.

Call us today at the number above or fill out an online rate form to see the rates for Medigap plans in Massachusetts available to you now!

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Medigap in Massachusetts, Medicare. Accessed February 2022.
    https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-massachusetts
  2. Medicare Supplement Plans Offered in Massachusetts 2021, Mass.gov. Accessed February 2022.
    https://www.mass.gov/doc/medigap-guide-effective-010121/download
  3. Massachusetts Bulletin for People with Medicare, Mass.gov. . Accessed February 2022.
    https://www.mass.gov/doc/addendum2003pdf/download

Buddy Blouin

  • Content Strategist

Buddy Blouin is a healthcare writer helping seniors learn more about their coverage options. A graduate of Nicholls State University, Buddy helps educate people about complex health topics in a simple, digestible way.

10 thoughts on “Medicare Supplement Plans in Massachusetts

  1. I live in Massachusetts and have had a medigap plan (Medex Core) for several years since I turned 65. Can I keep my Massachusetts medigap plan if I move to Florida? I have pre-existing conditions that may be an issue if I have to get a new “underwritten” medigap plan in Florida.

    1. Roy, you should be able to move to Florida with your current plan with no problems! All you would need to do is update your address with the carrier as there could be a rate difference.However, I would check with your carrier beforehand to double check.

  2. I have had a Medicare Supplement plan for a year, can I switch to a different Medicare Supplement Plan that has better coverage or will the insurer be able to deny me the switch due pre-existing conditions?

    1. Patti, once enrolled in a Medicare Supplement, you must be able to pass medical underwriting to switch plan type or carrier.

  3. Dear Lindsay,

    I have coverage under my spouse’s retiree health plan from his employer. I will lose this when I divorce. What are my options for getting Medigap insurance? I live in MA. I am concerned about the enrollment period and if I can be guaranteed a policy because of the life changing event. I’m also confused about whether Medigap policies can provice Part D coverage. What resources should I look into to understand my situation? I began Medicare in September 2020. Thank you!

    1. Hi Simetria! Did you delay Part B since you had coverage through your spouse when you were first eligible? If so, you’ll be eligible for an 8-month SEP when you lose coverage to enroll in Part B without penalty. Once your Part B starts, your 6-month Medigap Open Enrollment Period will begin. During this time frame, you can enroll in a Medigap plan with guaranteed issue. Medigap plans do not cover prescription medications, you will need to enroll in a Part D plan for that. Essentially, you will need Part A, Part B, Medigap, & Part D to cover all your bases.

  4. What is the need for referrral for specialists/audiologists from PCP’s and the appeals process for the state of Massachusetts?

    1. Hi Lori. If you have a Medicare Advantage plan, the Advantage carrier will require you to get a referral from your PCP.

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