Massachusetts Medicare Supplement Plans

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Medicare Supplement Plans in Massachusetts are slightly different than Medigap plans in other parts of the nation. Yet, people in all states benefit from some supplemental plan.

Medicare doesn’t cover in full, and beneficiaries don’t want to pay tens of thousands of dollars in coinsurance. So, the best way to ensure protection is to enroll in Medigap.

Massachusetts is one of three states that has unique Medigap plans. These plans include the CORE Plan, Supplement1, and the new 1A Plan available to newly eligible beneficiaries starting in 2020.

Massachusetts Medicare Supplement Plans in 2020

Supplemental plans in Massachusetts have different names than the traditional options in other states. Also, doctors can’t request Part B excess charges.

There are three plans available:

  1. CORE Plan
  2. Supplement1 Plan
  3. 1A Plan


Coverage includes Part A hospital coinsurance and extends an additional 365 days past Medicare.

It also covers the Part B coinsurance. Each calendar year coverage includes your first 3 pints of blood as well as 60 days of inpatient care at a mental health hospital.

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

Supplement1 Plan

Supplement1 plan includes everything in the CORE Plan; but, it covers the Part A deductible and the skilled nursing facility coinsurance.

Further, the plan covers the Part B deductible. Also, this includes 120 days of inpatient care at a mental health hospital.

Supplement1 Plan has the benefit of emergency foreign travel care. The policy is first-dollar coverage.

Beneficiaries with this plan will pay little to no out of pocket costs. It’s basically Plan C since excess charges are forbidden.

MACRA will no longer allow Medigap plans to cover the Part B deductible. First dollar coverage won’t be available in 2020 for new beneficiaries.

1A Plan

The new 1A Plan is equivalent to the standard Plan G. It will cover everything minus the Part B deductible.

Meaning, once your deductible is met, the 1A plan will cover 100% of your medical costs after Medicare pays its portion.

Massachusettes Medigap Plan Outline of Coverage2020 First Dollar Coverage Plan Changes

Massachusetts, Minnesota, and Wisconsin offer options that are different from other states. Although, all of the states must abide by the federal laws.

For residents not eligible for Medicare until after 2020, the CORE plan is available since it doesn’t cover the Part B deductible.

The Supplement1 plan won’t be available. But, the new 1A Plan is an option.

How These Plans Work

We understand Massachusetts Medicare plans can be difficult to understand. Let’s take a look at a real-world example to display the details of coverage better.

If Shawn has Medicare with no Medigap, he could be at risk for high costs. To prevent paying high deductibles and 20% of medical bills, Shawn will need to enroll in Medigap.

Part A deductible is $1,408 per benefit period; so, Shawn could pay this deductible multiple times during the year, or he could have a policy that pays.

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.

Then, the Part B deductible is only $198 annually. The deductible isn’t unbearable; but, it could be an inconvenience. After the deductible is met, Shawn will pay 20% of any leftover costs.

Now, if Shawn enrolls in Supplement1 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 carriers to offer Medigap; but, Massachusetts law requires insurers to offer at least one Medigap option to those under 65.

Generally, the plan available is the basic benefits option. For those under 65, you may find an Advantage plan more sensible; at least until you turn 65.

If you currently reside in Massachusetts and are disabled under 65, call today, and one of our agents can help.

Medicare Advantage Plans in Massachusetts

Medicare Advantage in Massachusetts

In 2019, 22% of Massachusetts beneficiaries chose a Medicare Advantage plan.

Advantage plans take over the coverage of Part A and B.

Further, 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.

During the year, you’ll pay copayments and deductibles, similar to Medicare. The policy has a list of doctors to follow, and referrals are usually a requirement.

Real-World Example of Part C in Massachusetts

To make it easier to understand let’s see what Shawn’s costs would be if he has Medicare Advantage when he becomes really sick.

Let’s need a ride in an ambulance. Well, it’s going to cost a $200 copayment, and the inpatient hospital costs $400 each day for days 1 through 5.

The copay costs can be more than the annual Medigap cost. But, Advantage plans can be better than traditional Medicare.

These policies have a Maximum Out Of Pocket (MOOP); so, the beneficiary has a cap on annual spending.

If Shawn’s MOOP is $6,700, then the most he can pay is $6,700 on services in the year. Original Medicare doesn’t have this type of protection.

Massachusetts Prescription Drug Plans

Massachusetts Medicare Part D Prescription Drug PlansPart D covers prescriptions, and those that wait to enroll could incur a Part D late enrollment penalty. The penalty starts after the seven months Initial Enrollment Period has expired.

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; but, a low premium isn’t always the most savings.

For beneficiaries that don’t take medication or have specific generics, the $15 policy could be fine. Although, beneficiaries with specialty drugs, brand name medications, or certain generics could save money with a higher premium policy.

Let’s Look at a Real-World Part D Example

Shawn has the $15 policy, but he pays a $95 copayment for his medication. When he consults an agent, the plan is $50 a month, but his medication only costs $35 copayment.

Low premium plan: $15 + $95 = $110

Higher premium plan: $50 + $35  = $85

Savings: $110 – $85 = $25

Shawn saves $25 a month by paying a higher premium because he saves on the copayments.

Tip: Never judge a plan by its premium.

Massachusetts Medicare Supplement Plan Requirements

During the Open Enrollment Period is the best time to obtain Medigap. It begins the 1st day of the month in which you turn 65 and have Part B.

The benefit of enrolling during this time is that the insurance carriers cannot deny you. Those with pre-existing medical conditions should sign up as soon as possible.

Failing to do so can result in higher premiums or even denial of coverage due to medical issues.

Medigap Premiums in Massachusetts

State laws require companies to community rate policies; all members pay the same amount, and premiums don’t reflect age.

The cost for Supplement1 Plan could be around $200 or more depending on the company you choose. Also, if you buy an additional rider, like dental, you’ll pay more.

If a “rider” isn’t an option, you can always buy a stand-alone dental plan.

What is the Best Medicare Advantage Plan in Massachusetts?

Advantage plans vary in coverage across counties. Plus, the best Advantage plan for your neighbor might not be the most suitable for you.

Since Advantage plans have doctor networks, the “best plan” is the policy that makes the most sense for your situation. Further, you’ll want to ensure your medications have coverage through the plan.

What is the Best Medicare Supplement in Massachusetts?

The best Medigap plan is the one that will approve your application at a low-cost with a reputable company. If you’re new to Medicare, finding a plan is simple, you qualify for them all.

Although, there are other opportunities to avoid underwriting. Eligibility to change plans depends on your situation.

Does Medicare Advantage work with Medigap in Massachusetts?

Part C plans will handle claims in place of Medicare. Since Medicare no longer handles the claims, the Medigap plan won’t cover services.

Enrollment in both Advantage and Medigap is forbidden. It’s in your best interest to choose which option is most beneficial for your situation.

How to Compare Medicare Supplement Plans in Massachusetts

Applying for a Medigap policy is simple and can be done over the phone. When you consult our team of agents with industry knowledge you become educated on your options.

We don’t sell you a plan, we guide you through your plan options so you can make the final choice. Having a supplement plan can save you tens of thousands of dollars during the year.

Call us today at the number above or fill out an online rate form to see the rates in your area now!

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