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Medicare Supplement Plans (Medigap) in Massachusetts

October 5, 2017

As a Medicare beneficiary in Massachusetts, your Medicare Supplement (Medigap) options and costs will depend on your particular zip code and location. Medigap plan coverage in Massachusetts works differently than in other states.

How Medigap plans work in Massachusetts

If you are enrolled in Original Medicare, Part A and Part B, a Medicare Supplement (Medigap) plan can help with your out-of-pocket Medicare costs. Medigap helps fill the gaps in Original Medicare coverage by paying for cost-sharing expenses like deductibles and copayments, as well as, in some cases, some benefits that aren’t covered, such as foreign travel coverage.

Medicare Supplement insurance isn’t a substitute for Medicare health coverage and is designed to work alongside your Original Medicare coverage. It doesn’t include prescription drug coverage, which must be purchased through a stand-alone Medicare Prescription Drug Plan. Medigap plans sold after December 31, 2005, no longer include prescription drug coverage, but if you enrolled in a plan with prescription drug benefits before then, you can generally stay on the plan.

Unlike other states, Massachusetts doesn’t have age restrictions for Medigap eligibility. If you are a Massachusetts resident with Part A and Part B, you can enroll in a Medigap plan offered in your area, regardless of age. The exception is if you are under 65 and have Medicare because of a disability or end-stage renal disease (ESRD). Insurance companies aren’t required to sell Medigap plans to Medicare beneficiaries with ESRD until they turn 65.

In Massachusetts, you can enroll in a Medicare Supplement plan during your Medigap Open Enrollment Period (OEP), the six-month period when you’re first eligible. This enrollment period begins when you turn 65 and enroll in Part B. During this period, you have guaranteed-issue rights to join any Medicare Supplement plan, regardless of disability or health issues. Insurance companies cannot reject you or charge you a higher premium due to health reasons.

Outside of your Medigap Open Enrollment Period, you may have a guaranteed right to join any Medigap plan in the following situations:

  • If you lose employer or retiree health coverage.
  • If you join a Medicare Advantage plan and decide to go back to Original Medicare within the first 12 months.
  • If your Medigap policy ends through no fault of your own.
  • If your Medigap plan misleads you or violates the rules.

There may be other situations where you can join a Medigap plan with guaranteed issue. For more information, contact Medicare at 1-800-633-4227. TTY users can dial 1-877-486-2048. Customer representatives can be reached 24 hours a day, seven days a week.

Types of Medigap plans in Massachusetts

Medicare Supplement plans in Massachusetts have different standardized benefits than plans offered in other states. There are two types of Medigap plans, the Core Plan and the Supplement 1 Plan.

Supplement Core Plan may cover:

  • Part A inpatient hospital coinsurance ($335 per day for Days 61 to 90; $670 per day for Days 91 and beyond for each lifetime reserve day after day 90 (up to 60 days over your lifetime). The Supplement Core Plan also covers the full cost of 365 days after Medicare coverage ends.
  • Part A hospice coinsurance/copayment
  • Part B coinsurance
  • First three pints of blood
  • 60 days of inpatient mental health coverage per calendar year, in addition to Medicare’s mental health coverage of 190 lifetime days

Supplement 1 Plan covers:

  • Part A inpatient hospital coinsurance ($335 per day for Days 61 to 90, $670 per day for Days 91 and beyond for each lifetime reserve day after day 90 (up to 60 days over your lifetime). The Supplement 1 Plan also covers the full cost of 365 additional days after Medicare coverage ends.
  • Part A hospice coinsurance/copayment
  • Part B coinsurance
  • First three pints of blood
  • Part A inpatient hospital deductible
  • Part A skilled nursing facility (SNF) coinsurance
  • Part B deductible
  • Limited overseas emergency coverage
  • 120 days of inpatient mental health coverage per calendar year, in addition to Medicare’s mental health coverage of 190 lifetime days

All Medicare Supplement plans in Massachusetts are required to use a community-rated method when pricing premiums. Community-rated pricing means that all plan members pay the same premium cost. This is in contrast to other premium-pricing methods, such as attained-age or issue-age rated, that charge members different premiums based on age or when they enrolled in the plan.

Choosing a suitable Medigap plan in Massachusetts

When shopping for Medicare Supplement insurance in Massachusetts, it’s important to compare plans to get the best price available. As mentioned, each insurance company is required to charge all members the same premium cost. However, this still means that premium costs may vary across different insurance companies, even for the exact same benefits. Your costs and available selection will depend on where you live and the plans offered in your county.