Original Medicare is fairly comprehensive health insurance, and it allows you to visit any doctor in the country who accepts Medicare. But it’s not perfect. For example, Medicare Part B requires you to pay a 20% coinsurance, which can be costly when added to other out-of-pocket expenses. To help with this, some beneficiaries choose to purchase Massachusetts Medicare Supplement Plans to fill the gaps in Original Medicare. So, if you could use some extra help with your out-of-pocket medical expenses, you should look into one of these plans.
Private insurance companies offer Medicare Supplement Plans. Which help pay for your Original Medicare out-of-pocket costs, such as the Part A deductible and the 20% coinsurance for Part B. And while these plans are sold by private insurers, Medicare Supplement Plans are standardized by the Centers for Medicare & Medicaid Services (CMS). Which mandates that all plans with the same letter name provide the same benefit package throughout the country. That means you can be sure you know what you’re getting with each plan.
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With that being said, though, private insurance companies set the premiums for these plans. So, it’s vital to shop around for the best deal by comparing both Medicare Supplement Plans and insurance carriers. EZ can help you compare both. But first, have a look at our explanation of how Medicare Supplement Plans operate in the state of Massachusetts.
Massachusetts Medicare Supplement Plans
The federal government standardized Medicare Supplement Plans across the country, with the exception of three states. Massachusetts is one of only three states that have been granted a waiver that lets them develop their own unique Medicare Supplement Plans. In every other state, there are ten different Medicare Supplement Plans (A, B, C, D, F, G, K, L, M, and N). But residents of Massachusetts are only able to choose between the Medicare Core Plan and Medicare Supplements 1 and 1A.
But just as in every other state, in Massachusetts you will pay monthly premiums for one of these Medicare Supplement Plans. In return, you will have most of your out-of-pocket healthcare expenses covered. These monthly premiums can cost anywhere from $114 to $269 in Massachusetts, depending on your plan choice and where you live.
The plans available in Massachusetts are similar to some of the lettered plans available in other states. To help you choose between them, below we’ve highlighted each of the three plan types available in Massachusetts.
Medicare Core Plan
Core Plan is Massachusetts’ version of the Plan A available in other states. It offers the most basic coverage of any plan. However, it still covers what many feel is the most important gap left by Original Medicare: the 20% of outpatient services that you pay for Medicare Part B. It also covers:
- Part A coinsurance – Part A only covers your initial 60 days of inpatient hospital stays during a benefit period; after that, you will be responsible for paying coinsurance for each day after your initial 60 days. Coinsurance for days 61 through 90 is set at $400 per day. For days 91 to 150, you will have to pay $800 per day, and you will use some of the days from your Lifetime Reserve. Medicare Core Plan takes care of all of these expenses in full.
- Skilled Nursing Facilities – If you are an inpatient at a skilled nursing facility for more than 20 days, Medicare Part A will require you to pay a coinsurance payment. In 2023, the Part A coinsurance for skilled nursing facility care will be $200 per day. Medicare Core Plan will pay this coinsurance in full.
- First 3 pints of blood – Original Medicare only pays for the fourth and subsequent pints of blood if you need blood during treatment. Plan B will pay for the first three pints.
Core Plan does not cover the Part A hospital deductible, Part A’s skilled nursing facility coinsurance, emergency medical care while traveling outside the country, or the Part B deductible.
Medicare Core Plan can cost between $114 and $162 a month.
Medicare Supplement 1
This plan is equivalent to the Medicare Supplement Plan F that is available in other states, so it covers pretty much every single gap left in Original Medicare’s coverage. This means besides the premium for Medicare Supplement 1, you’d have no out-of-pocket expenses. This plan covers:
- Part A hospital deductible and coinsurance
- Hospital costs up to an additional 365 days after Medicare benefits are exhausted
- Part A hospice care coinsurance or copayment – Hospice care is for patients who are nearing the end of their lives. These services are covered by Medicare, but copayments are required. These copayments include $5 for each symptom and pain relief medication prescription. As well as 5% of the Medicare-approved amount for inpatient assisted living. Medicare Supplement 1 covers these expenses in full.
- Blood (the first 3 pints)
- Other Medicare-approved expenses associated with Part A hospitalization
- Medicare Part B coinsurance and copayments – Visiting the doctor and receiving other types of outpatient care will typically require you to pay Medicare Part B coinsurance. This means that Medicare Part B will pay 80% of the Medicare-approved amount for covered services, and you will pay the remaining 20%. Medicare Supplement 1 will cover this 20%.
- Part B deductible – The Part B deductible is $226 in 2023. Medicare Supplement 1 pays this annual deductible, which most plans in other states do not.
- Medicare Part B excess charges – If your doctor doesn’t accept Medicare assignment, they can charge you more than Medicare will pay for the service, and you will be responsible for paying the difference, known as Part B excess charges. Medicare Supplement 1 will pay these excess charges for you if you see a doctor who doesn’t accept Medicare assignment.
Unfortunately, anyone who became eligible for Medicare after January 1, 2020 will not be able to purchase Medicare Supplement 1. You are eligible to purchase one of these plans if you became Medicare-eligible prior to the year 2020. Additionally, if you have already purchased Supplement 1 and are grandfathered in, you can keep it.
Medicare Supplement 1 premiums can cost between $217 and $269 a month.
Medicare Supplement 1A
If you like the benefits of Medicare Supplement 1 but aren’t eligible to enroll in this plan, Medicare Supplement 1a is your next best choice. The benefits are almost identical except that this plan doesn’t cover the Part B deductible. That means Medicare Supplement 1A covers:
- Part A hospital deductible and coinsurance
- Hospital costs up to an additional 365 days after Medicare benefits are exhausted
- Part A hospice care coinsurance or copayment
- Blood (the first 3 pints)
- Other Medicare-approved expenses associated with Part A hospitalization
- Medicare Part B 20% coinsurance and copayments
- Medicare-approved doctor’s office fees
- Medicare Part B excess charges
Premiums for this plan range from $166 to $260.
When To Enroll
Other states only allow Medicare beneficiaries a Medicare Supplement Plan Open Enrollment Period when they enroll in Medicare. However, Massachusetts has an annual Medicare Supplement Open Enrollment Period. This Open Enrollment Period runs from February 1 to March 31 each year. During this period, you will be able to enroll in one of Massachusetts’s Medicare Supplement Plans with guaranteed-issue rights. Meaning insurers won’t be able to deny you or charge you more for coverage.
As pointed out above, this Open Enrollment Period is unusual in our country. It also gives you as a Massachusetts resident a good opportunity to enroll in a Medicare Supplement Plan if you have missed your initial six-month enrollment window, or to switch from one plan to another. In most states, Medicare beneficiaries who miss their initial six-month enrollment period or wish to switch plans later will not have another guaranteed-issue opportunity to enroll. That is unless they qualify for one of the federal government’s very limited guaranteed-issue rights for Medicare Supplement Plans.
Massachusetts has some of the strongest consumer safeguards in the country when it comes to Medicare Supplement Plans, in addition to having its own unique standardization rules. Insurance companies in this state must use community rating to price their policies. Which means they cannot charge different rates based on their customers’ ages.
Additionally, Medicare Supplement Plan waiting periods for pre-existing conditions are not permitted. In most states, insurers offering Medicare Supplement Plans are allowed to impose delays of up to six months if you did not have continuous coverage prior to enrolling in a plan.
What if I’m under 65?
If you are under the age of 65, are disabled, and have been receiving disability benefits for at least two years, or if you have ALS or end-stage renal disease, you can enroll in Medicare under federal Medicare rules. But federal regulations do not guarantee access to Medicare Supplement Plans if you are under the age of 65.
Fortunately, though, Massachusetts is among the states that have put in place regulations to guarantee that disabled Medicare beneficiaries have some access to Medicare Supplement Plans. Massachusetts requires Medicare Supplement insurers to provide coverage to disabled Medicare beneficiaries under the age of 65. They also prohibit insurers from charging higher premiums to those enrollees. In fact, if you are under 65 and on Medicare, you will still be able to get a Medicare Supplement Plan that is priced based on community rating.
How To Choose
When it comes to Medicare coverage, don’t be afraid to ask questions. Speak to an EZ agent who can explain everything to you and give you all the guidance you need as you are signing up. EZ can assist you in enrolling in Medicare, comparing Medicare Supplement Plans, or simply weighing your options. Additionally, our agents work with the best insurance companies in the country. They can provide you with a free comparison of all available plans in your area. We will go over your medical and financial needs with you and help you find a plan that works for you. To get started, simply enter your zip code in the bar below. Or give one of our licensed agents a call at 877-670-3602.
