Massachusetts Medicare Supplement Plans (Medigap)

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

Massachusetts Medicare Supplement Plans

Supplemental plans in Massachusetts is different than other states. Also, Part B excess charges are forbidden because of state laws.

There are three plans available:

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

CORE Plan

Coverage includes Part A hospital coinsurance for inpatient hospital care. This includes coverage for an additional 365 days once Medicare coverage has ended.

It also covers 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 Plan A.

Supplement1 Plan

Coverage includes everything in the CORE Plan; also, it includes the $1,420 Part A deductible and the skilled nursing facility coinsurance.

The plan covers the 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. It’s basically a standard Plan F.

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

1A Plan

The new 1A Plan is equivalent to the standard Plan G. It will cover everything minus the Part B deductible, which is $198 in 2020. That means that once your deductible is met, the 1A plan will cover 100% of your medical costs after Medicare pays its portion.

2020 First Dollar Coverage Plan Changes

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

For residents not considered eligible for Medicare until after 2020, the CORE plan will still be available to you since it does not cover the Part B deductible.

The Supplement1 plan will not be available to you. However, the new 1A Plan is an option for you.

How These Plans Work

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 $1,420 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 $198 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 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 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.

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.

These 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.

Massachusetts Prescription Drug Plans for Medicare

Part D covers prescriptions, and those that wait to enroll could incur a Part D late enrollment penalty. The penalty starts after the 7 months Initial Enrollment Period (IEP) 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; 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.

Medicare Resources

The Medicare Savings Program can assist beneficiaries with low-income. Those with income limits should apply for Extra Help paying for Part D.

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.

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 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 Guaranteed Issue is that the insurance carriers cannot deny you coverage. It is especially important to those with pre-existing medical conditions to enroll during your Guaranteed Issue 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.

Having a supplement plan can save you tens of thousands of dollars during the year. They also protect your savings and retirement funds from expensive medical bills.

Call us today and get the coverage you need! As always, our services are always 100% free so don’t hesitate to call the number above or fill out an online rate form!