Massachusetts Medicare Plans

As one of the first thirteen colonies, Massachusetts is full of historical and patriotic landmarks. From the Freedom Trail to the beaches of Cape Cod, you’re bound to find a lot to do in your glorious state of residence. Head to Fenway Park for a ballgame, as it brings a touch of nostalgia.

Massachusetts is not only unique in it’s history, it is also unique in it’s Medicare coverage. Although you can still enroll in a Medicare Supplement or Medicare Advantage plan in Massachusetts, the MediGap plans are different in MA than they are in every other state in the country. It is important to work with a licensed agent who is familiar with the different MediGap plans and enrollment guidelines for Massachusetts to make sure you fully understand your insurance coverage!

What are Medicare Options in Massachusetts?

Unlike other states, when it comes to Medigap plans, Massachusetts does not offer the traditionally lettered A-N plans. Rather, Massachusetts has limited the amount of Medicare Supplement plans to 2 options (3 if you turned 65 prior to January 1, 2020). 

In Massachusetts, you will see the Core Plan, Supplement 1A Plan, and Supplement 1 Plan.  

Core Plan in Massachusetts

The Core Plan is Massachusetts is the MediGap plan that covers what are known as Basic Benefits. This plan is very similar to Plan A in most other states. The coverage for this plan includes your Medicare Part A co-payments when hospitalized past day 60, your coinsurance for Medicare Part B (typically 20%) and your first 3 pints of blood. This plan, however, also carriers some out-of-pocket, including both the Medicare Part A and Part B deductibles, as well as any coinsurance from a skilled nursing facility. The Core Plan typically has a lower monthly premium than the Supplement 1 or Supplement 1A plan, but also carriers higher out-of-pocket amount that you need to be aware of when choosing this plan. 

Supplement 1 in Massachusetts

Supplement 1 in Massachusetts is the highest coverage Medicare Supplement plan offered. This plan is very similar to MediGap Plan F in most other states, both in coverage and in enrollment guidelines. If you turned 65 after January 1, 2020, you are not eligible to enroll in the Supplement 1 plan. If you did turn 65 prior to 2020, however, you are eligible for this full coverage plan. Supplement 1 has been a popular choice due to the full coverage and low out-of-pocket costs. The Supplement 1 covers things such as both the Medicare Part A and Part B deductibles, the coinsurances of both Medicare Part A and B, as well as 120 days per year in a mental hospital. Although this coverage level is very desirable, often times the premiums can be high, and it is a great idea to look into the alternative of Supplement Plan 1A.

Supplement 1A in Massachusetts

Supplement 1A in Massachusetts is a very desirable Medicare Supplement plan to ensure full coverage with very low out-of-pocket. Similar to Medicare Supplement Plan G in other states, the Supplement 1A plan covers the majority of gaps left by Original Medicare, including your Medicare Part A deductible, Medicare Part A and B coinsurances, and costs related to skilled nursing care. The out-of-pocket cost you will see on the Supplement 1A plan is going to be your Medicare Part B annual deductible. This Part B deductible is typically very low, and will save you a lot of money throughout the year in premiums when compared to Supplement 1.

When is the Open Enrollment Period in Massachusetts?

As a Medicare beneficiary, you can enroll in any Medicare Supplement within your first six months of your Part B effective date. This is considered your open enrollment period. medicare-open-enrollmentDuring this time, insurance carriers are required to approve your MediGap application and can not impose any pre-existing conditions limitations.

Massachusetts, unlike most states, has what as known as year-long guaranteed issue. This means that insurance carriers are not allowed to required applicants to undergo medical underwriting, and cannot deny coverage to someone based on pre-existing conditions. Essentially, you can change or enroll into a Medicare Supplement plan at any point with guaranteed acceptance. There is one catch, however. Although plans must accept your application, insurance carriers are permitted to impose a 3-6 pre-existing conditions limitation if you are not coming from another form of creditable coverage (another MediGap plan, a Medicare Advantage plan, or employer coverage). This means that although the plan must accept you as a member, the insurance carrier can deny charges during the first 3-6 months of enrollment if you had a pre-existing condition with no insurance coverage. For this reason it is extremely important to not delay your coverage until the last minute. 

Can I Change Medicare Supplement Plans in Massachusetts?

You can apply to change your Medicare Supplement during any month of the year in Massachusetts, with the year-long guaranteed issue rule. There is no medical underwriting to apply for a MediGap plan in Massachusetts, however, you want to make sure you have another form of creditable coverage before applying to avoid the pre-existing conditions limitation.

Excess Charges in Massachusetts

Massachusetts is one of eight states that does not allow what is known as a Medicare Part B excess charge. Excess charges can be seen when doctors or healthcare providers do not accept Medicare Assignment, meaning they do not accept Medicare’s payment as payment in full, and you are responsible for additional costs up to 15%. Luckily, in Massachusetts, excess charges are prohibited and not allowable by providers.

What is the Cost of a Medicare Supplement Plan in Massachusetts?

Monthly premiums for Medicare Supplement plans are based on three main factors- age, gender, and location. There are other things that may impact your premium such as tobacco use. The premium amounts will vary based on these factors, so it is important to receive a quote based on your specific demographic information.

Medicare Plans in Massachusetts for Those Under 65

When it comes to Medicare in Massachusetts, there is no offered open enrollment for MediGap plans required by the state for those under 65. You’ll be required to go through and pass any medical underwriting that is necessary for acceptance. If you’re under 65 and disabled but still qualify for Medicare, you may not pass this underwriting. If you fit within this category, there are Medicare Advantage Policies that you can look into.

Once you reach 65, more Medicare supplement plans will open up for enrollment in Massachusetts without any health questions. This period guarantees acceptance.

Medicare Advantage in Massachusetts

Massachusetts also offers options for Medicare Advantage plans. In these plans you must live in your plan’s service area and enroll during an appropriate election period.  Medicare Advantage plans do not required medical underwriting if enrolling during an election period, but are also significantly different plans than Medicare Supplement plans.

Medicare and Medicaid in Massachusetts

It is possible to qualify for both Medicare and Medicaid in the state of Massachusetts. These two programs, however, are separate and have different qualifications you must meet in order to receive benefits. To qualify for Medicaid, you must meet Alabama’s state income requirements. To qualify for Medicare, you must be either over the age of 65, or under 65 but receiving Social Security Disability Insurance for a minimum of 24 months before applying for Medicare. 

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