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Medicare Supplement Plans in Massachusetts

Medicare Supplement plans in Massachusetts follow a different structure than you will see in most states. Rather than offering ten plans with letter designations, there are just two Medicare Supplement plans in Massachusetts.  They are known as the “Core” plan and Supplement 1.

Note that there was once a Supplement 2 that included prescription medication coverage, but Medicare Supplement plans are no longer allowed to include coverage for medication. Supplement 2 is no longer available to new applicants, but you can apply for prescription coverage through Medicare Part D.

Since there are fewer choices for Medicare Supplement plans in Massachusetts, you may find the system a little easier to understand. The federal government developed this system to help fill some of the “gaps” created by Original Medicare.  It includes Medicare Parts A and Part B. This is why Medicare Supplement plans are often referred to as Medigap plans.

The gaps are simply holes in coverage that leaves seniors with out-of-pocket expenses. This may include:

  • Copayments
  • Coinsurance
  • Deductibles
  • Excess charges

Excess charges are the difference between the maximum amount that Medicare will pay for a service and the actual price charged by a medical provider. Due to the “Ban on Balance Billing” law that prevents doctors from charging more than what Medicare is willing to pay for services, excess charges have been eliminated in this state.

Medicare Supplement Plans in Massachusetts: Statistics

There were more than 1 million Massachusetts Medicare beneficiaries in 2014, and that number went up to nearly 1.3 million in 2017. Let’s take a look at approximately how many of those beneficiaries were represented by each of the state’s five largest counties:

  • Middlesex – 227,000
  • Worcester – 131,000
  • Essex – 133,000
  • Suffolk – 91,000
  • Norfolk – 106,000

The average age of retirement in Massachusetts is 65, and the average Medicare beneficiary age is 71.

When Should I Apply For a Medicare Supplement Plan in Massachusetts?

Massachusetts is different than most states when it comes to enrolling in a Medicare Supplement plan. While other states give insurance companies the right to deny coverage based on medical history during certain periods, the State of Massachusetts operates under the policy of continuous open enrollment for all Medigap plans. This means that you can apply for a Medicare Supplement plan in Massachusetts any time after signing up for Medicare Part B without worry that the insurance company will deny you coverage due to your medical history or a pre-existing condition.

How Are Rates Calculated for Medicare Supplement Plans in Massachusetts?

There are three methods that insurance companies may use to calculate rates for Medicare Supplement plans, but this states limits carriers to only one of these methods. Let’s take a quick look at all three options first:

  • Issue-Age

    The rate is always based on your current age. As you get older, your rate will get higher.

  • Attained-Age

    Your premium is always based on your age at the time of enrollment. While your policy may reflect annual changes due to inflation and other factors, your premium will never increase due to your age.

  • Community

    Everyone is charged the same rate regardless of age. All annual changes in rates are based on inflation or other factors, and those changes impact everyone enrolled in the plan equally.

While most states have no Medicare Supplement plan premiums calculated with the community method, the State of Massachusetts requires that all insurance companies use this method. This means that your medical history and pre-existing conditions will never impact your Medicare Supplement plan in Massachusetts.

Which Medicare Supplement Plans in Massachusetts Should I Compare?

This is another area where Massachusetts differs from most other states. There are 10 Medicare Supplement plans available in most other states. The most popular options in those states are Plan F, Plan G, and Plan N. This state doesn’t subscribe to the lettered plan system. There are only two Massachusetts Medigap plans that you can compare.  They are known as the Core and Supplement 1.

  • Core Plan

    The most basic and affordable Medicare Supplement plan. This plan covers up to 60 days of treatment in a mental health hospital per year, the first three pints of blood received each year and state-mandated preventative treatments like mammograms and pelvic exams.

  • Supplement 1 Plan

    This Medigap plan maximizes coverage by including your Part A and B deductibles, skilled nursing facility coinsurance, medical services received while in a foreign country and up to 120 days of care in a mental health hospital each year.

Can I Use My Massachusetts Medicare Supplement Plan In Other States?

The ability to use your health insurance in any state is one of the main benefits of Medicare Supplement plans. You are never restricted to a network, so you can see any medical provider accepting Medicare as payment. Your Original Medicare will pay their portion of the bill first. Your Medicare Supplement plan in Massachusetts is designed to pick up the remaining out-of-pocket expenses.

You typically don’t have to change Medicare Supplement plans when moving to a new state.  Massachusetts is a bit different. Because Massachusetts has a unique plan design, you’ll need to switch to a new plan based on the state you move to. You may find that your new state offers a plan with an outline of coverage that is similar to your Medicare Supplement plan in Massachusetts.

How Do I Apply For a Medicare Supplement Plan in Massachusetts?

If you’re still confused about the Medicare Supplement plans in Massachusetts, you’re not alone. You can call our Medicare Specialists at any time for customized help. We can even help you apply for your coverage over the phone.  These Medicare Supplement plans are designed to save you money and ensure that you receive high-quality healthcare. Don’t delay starting your coverage.

Massachusetts Medicare Resources

While you’re reading reviews and preparing to select your Medigap plan, you may want to check out these resources. They may help you save a little money.

  • Massachusetts SHINE – free counseling and helpful resources for anyone trying to understand the Medicare system in MA
  • Mass Legal Help – learn about programs that can make healthcare more affordable for seniors and disabled Massachusetts residents
  • Extra Help – a nationwide program that serves as a low-income subsidy for prescription medication coverage