Medigap in Massachusetts
You have guaranteed issue rights to buy Medicare supplemental coverage in Massachusetts, but the policies available there are different from the standardized Medigap plans available in most states. There are three different Medicare Supplement plans in Massachusetts, and they all offer the same basic benefits.
Medigap Plans Available in Massachusetts
Massachusetts is one of three states that do not offer the same standardized Medigap plans common across the rest of the United States. The other two states are Minnesota and Wisconsin.
There are three types of Medigap plans standardized throughout Massachusetts.
- Core Plan
- Supplement 1 Plan
- Supplement 1A Plan
The plans provide certain basic benefits that are common across all three types of Medigap plans.
- Inpatient hospital care covering Medicare Part A coinsurance and coverage for 365 additional hospital days after Medicare coverage ends.
- Medicare Part B coinsurance (usually 20 percent of the bill) for medical costs such as doctor visits.
- Medicare Part A hospice copay or coinsurance.
- Costs of first three pints of blood each year.
Medigap — sometimes called Medicare Supplement — helps you pay out-of-pocket expenses that Medicare Part A and Part B do not cover. These include copayments, deductibles and coinsurance.
You cannot use Medigap to cover your Original Medicare premiums.
Massachusetts Medigap Core Plan
The Massachusetts Medigap Core Plan provides the least amount of benefits.
In addition to the basic benefits offered by all three plans, it covers 60 days every calendar year in mental health hospitals.
The Core Plan also covers health benefits that the state requires insurers to cover. These include such things as annual mammograms and pap smears.
- Medicare Part A inpatient hospital deductible
- Medicare Part A skilled nursing facility coinsurance
- Medicare Part B deductible
- Foreign travel emergency medical and hospital costs
Massachusetts Supplement 1 and 1A Plans
The biggest difference between the Massachusetts Supplement 1 and 1A Plans is that the Supplement 1 Plan covers the Medicare Part B medical insurance deductible. The Supplement 1A does not cover it.
Massachusetts is phasing out the Supplement 1 plan. If you became eligible for Medicare on or after Jan. 1, 2020, you can no longer buy the Supplement 1 Plan. But you are still eligible for the Supplement 1A plan.
|Benefits||Core Plan||Supplement 1 Plan||Supplement 1A Plan|
|Medicare Part A hospitalization copayments||Yes||Yes||Yes|
|Medicare Part B coinsurance||Yes||Yes||Yes|
|Medicare Part A and Part B blood (first 3 pints per year)||Yes||Yes||Yes|
|Part A deductible for hospital days 1 through 60||No||Yes||Yes|
|Skilled nursing facility coinsurance days 21 through 100||No||Yes||Yes|
|Medicare Part B annual deductible||No||Yes||No|
|Medicare-covered services needed while traveling in a foreign country||No||Yes||Yes|
|Mental health hospitalization coverage beyond Medicare’s 190 lifetime days (minus any days previously covered by your plan in the same benefit period)||60 days per calendar year||120 days per benefit period||120 days per benefit period|
You can also compare Medigap plans in Massachusetts by using the Medicare comparison tool at the Medicare website.
In addition to the Medigap plans offered in Massachusetts, residents who are eligible for Medicare may consider Medicare Advantage plans or Medicare Part D prescription drug plans.
Be aware that you cannot purchase both a Medigap policy and a Medicare Advantage plan. You will have to choose one or the other.
3 Cited Research Articles
- Commonwealth of Massachusetts. (2020, March 10). Medicare Supplement Plans Offered in Massachusetts 2020. Retrieved from https://www.mass.gov/doc/medigaphmo-guide-effective-010120/download
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medigap in Massachusetts. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-massachusetts
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How to Compare Medigap Policies. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies