Medigap Plans in Massachusetts
Article published in Northampton Living
(March 2024)
EXPERT CONTRIBUTOR
ERICA BEAUDRY
Medicare Advisor
EA Financial Solutions
413 626 9906
info@eafinancialsolutions.com
www.eafinancialsolutions.com
Understanding Medicare options can be challenging. In Massachusetts, seniors have access to 3 Medigap plans designed to fill the gaps in original Medicare coverage.
Before we explore the Medigap plans, let’s define Medicare. Medicare is a federal health insurance program for individuals aged 65 and older, as well as certain younger individuals with disabilities. While it covers many healthcare services, it doesn’t cover everything. That’s where Medigap plans come in. Medicare typically covers 80% of a medical bill while the patient or Medicare member is left with 20% of the bill after any relevant deductibles have been met. The Medigap plan is a private insurance company contracted directly with the consumer that agrees to pay the remaining 20% in exchange for a monthly premium.
There are 3 standardized Medicare Medigap (Supplement) plan choices: Core, Supplement 1 and Supplement 1A. It’s also important to note that Massachusetts is considered a “guaranteed issue” state, which we’ll explain below.
Core Plan
The Core plan is the most basic Medigap option in Massachusetts. It covers essential benefits after the Part A and Part B deductibles have been met, such as Medicare Part A coinsurance, hospital costs, Part B coinsurance or copayments, and the first three pints of blood received as an outpatient or as part of a Medicare Part B covered service
Supplement 1 Plan
Supplement 1 provides more comprehensive coverage compared to the Core plan. It includes additional benefits, such as coverage for the Medicare Parts A and B deductibles and skilled nursing facility coinsurance. This option is only available to folks who have turned 65 prior to January 2020.
Supplement 1A Plan
This plan offers coverage for the Part A hospital deductible and leaves the responsibility of the Part B medical deductible up to the member. After these deductibles are met, members do not typically have co-payments or co-insurances.
Guaranteed Issue Rights
In Massachusetts, residents have certain rights when it comes to obtaining Medigap coverage without being denied coverage or charged higher premiums based on pre-existing health conditions or advanced age. Guaranteed issue rights provide peace of mind for individuals with pre-existing conditions, as they can secure Medigap coverage without fear of denial or exorbitant premiums.
Understanding the three Medigap plan choices in Massachusetts and the guaranteed issue rights ensures that beneficiaries can make informed decisions to enhance their Medicare coverage while enjoying the protection provided by the state’s Medigap plans. Whether you are new to Medicare or already enrolled, working with an independent advisor can help you understand all of the benefits you are entitled to receive and select the right plan for your individual situation. Independent Medicare specialists do not work for insurance carriers. Instead, we provide an independent, unbiased view of all insurance options available to seniors and Medicare recipients at no cost to the people we serve.
Disclaimer: I do not work for and I am not affiliated with Medicare.
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