Do you have a plan in place for maximizing your Medicare benefits? Though Medicare offers valuable health insurance benefits, it does have certain gaps in its coverage that can cost you a lot of money. While there are several tools available to help reduce these costs, Medicare Supplement Insurance is one worth an extra look. In this article, we will review all you need to know about Medicare Supplement Plans in Massachusetts.
It surprises many people to learn that Medicare won’t cover all of their medical costs. That is the case, though, and it’s important to keep it in mind as you approach Medicare. Medicare covers most of your medical expenses, but far from all of them.
Medicare was created with the intention that you would have to help pay for the cost. These costs take two forms:
The costs of actually using your coverage (like when you see the doctor or stay at the hospital) include:
There is no limit or cap on these charges. You face an unknown, and uncapped liability when you use Original Medicare.
Besides the costs that Medicare doesn’t cover, which are often spoken of as gaps in your coverage, there are certain areas of coverage that are missing, too. One of the biggest gaps in coverage is emergency care outside the United States. Except in very limited circumstances, Medicare doesn’t work outside of the U.S.
It is these missing areas of coverage, and the potential for unlimited medical costs, that Medicare Supplement Insurance was created to offset.
Medicare Supplement Plans (also called Medigap) are health insurance products created and administered by private insurance companies to lower your out of pocket costs under Medicare. In exchange for paying a premium, your policy will help cover some, or all, of the costs mentioned earlier: the deductibles and co-insurance you’d normally have to pay out of pocket. In addition to this, many of the Medigap plans available also cover you outside of the U.S., so you can be protected against emergency care when Medicare would normally not help.
The rules and regulations governing Medicare Supplement Insurance have been standardized throughout 47 of the U.S. states. Massachusetts is one of three states that have not adopted these standardized rules. For instance, in the 47 standardized states there are 10 standard Medigap Plans available: Plans A, B, C, D, F, G, K, L, M, and N.
As you research Medicare Supplement Plans in Massachusetts, however, you won’t find these plans. Instead, you’ll see that you have the choice between two plans:
For people eligible for Medicare before January 1, 2020, Medicare Supplement 1 Plan is also available. Anyone eligible for Medicare after 2019 must use the Core plan or Plan 1B.
The Core provides basic coverage designed to help with lengthy hospital stays and the cost for “routine” medical care under Part B. It does not provide help with:
Medicare Supplement 1 Plan is more comprehensive, and covers:
Plan 1 covers the Part B deductible; Plan 1A does not. Plans 1 and 1A also provide additional coverage for inpatient mental health hospital stays.
Regardless of which Medigap plan you choose, your experience will be similar when it comes to using your benefits. Whenever you go to the doctor or medical facility, you’ll use both Original Medicare and your Medigap plan. The provider will bill Medicare whatever amounts Medicare is required to cover. The remainder will be billed to your Medicare Supplement plan. Depending on which option you chose (Core or Plan 1), your plan may pay all of the outstanding amount. Or, you might have some responsibility, also. In this manner, you are protected from very large out of pocket costs, especially with Plan 1.
To enroll in a Medicare Supplement plan you must first have Medicare coverage. This means both Part A and Part B. You also have to continue paying your Part B premium (in addition to the premium for your Medigap plan) because if you don’t have active Medicare coverage your supplement plan won’t pay any benefits.
Most people have their first chance to enter Medicare when they turn 65. For these people, there is a seven month enrollment window known as your Initial Election Period. The window starts three months before the month you turn 65. It closes at the end of the third month after the month of your 65th birthday. You can enroll in Original Medicare at any point during these seven months. Be aware, though, that you might be automatically enrolled if you are already receiving Social Security benefits. As you enter Medicare, you can also enroll in the Medicare Supplement Plan of your choice.
The same thing holds true if you decide to delay taking Part B (because you keep working, for instance). As long as you have qualifying employer coverage in place, you can wait on Part B until your employer coverage ends. In this case you’ll also be able to enroll in a Medicare Supplement plan once your Part B becomes active.
In many states in the country it can be difficult to get Medicare Supplement coverage if you enter Medicare before turning 65 (because of disability or illness). However Medicare Supplement Plans in Massachusetts are required to offer coverage to everyone, regardless of age. In addition, plans in Massachusetts can’t charge higher premiums for people under 65.
You should try to enroll during your Medigap Open Enrollment Period, which lasts for six months and only starts when you are BOTH age 65 or older AND enrolled in Part B.
Yes. It’s easier to switch in Massachusetts than in many other states. You can change plans annually.
No. To get drug coverage, you’ll need to enroll in a standalone Part D drug plan.
No. You should consider adding separate coverage for those services.
Yes. You can do that during the Medicare Annual Election Period, which runs from October 15 to December 7.
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