The reality is that ageing brings with it multiple health conditions that are in most cases expensive to treat. It is therefore important, as you get older, to enroll in health insurance such as Medicare. Because the golden years of life are more physically challenging and less sound money-wise, good financial planning is to make sure that you have health insurance. Original Medicare and it's supplement plans provide coverage for many kinds of medical expenses incurred by senior citizens who are 65 years and above, and some disabled people. You qualify for Medicare benefits from the time you turn 65 years, if you have a certain disability lasting more than 24 months, or if you have health ailments like ALS or End-Stage Renal Disease.
Medicare in Massachusetts
Basically, the way Medicare works in other states is the same way it works in Massachusetts.
Original Medicare in Massachusetts
This is the main plan offered by Medicare and it is run by the Government. Original Medicare has 2 basic parts; Medicare Part A which provides coverage for hospital and nursing facility services, and Part B which covers medical services like doctor visits and lab tests. Original Medicare has limited prescription drug benefits. As such, if you want comprehensive prescription drug cover, you will have to sign up for a stand-alone policy known as the Medicare Prescription Drug Plan. Policyholders can also enroll for the Supplement Insurance Plan (Medigap), which also works with Original Medicare.
Medicare Advantage Plan
Medicare beneficiaries in Massachusetts can also apply for a Medicare Advantage Plan (Part C). This plan offers similar cover as Part A and Part B of Original Medicare, as well as additional benefits. These extra benefits include, routine vision or dental, prescription drugs, and hearing. The Medicare Advantage Plan does not replace Original Medicare; it is simply a different way of getting your Original Medicare cover. That means, you have to continue paying your Part B premium.
Telephone Enrollment Medigap Plans in Massachusetts
If you are a resident of Massachusetts, in addition to your Original Medicare policy, you also require a Medicare Supplement plan that fits your budget and lifestyle. The reason for this is that the Original plan does not provide complete cover; it does not cover costs like co-payments, deductibles and coinsurance. You need a Supplement Plan which basically fills the gaps in coverage. You can enroll for the Supplement Plan over the telephone or online.
If you live in Massachusetts, you have guaranteed issue rights to buy a Medigap policy, but the policies are different.
Basic benefits
- Inpatient hospital care: covers the Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends.
- Medical costs: covers the Part B coinsurance (generally 20% of the Medicare-approved amount).
- Blood: covers the first 3 pints of blood each year.
- Part A hospice coinsurance or copayment.
Medigap plans
Core Plan
Covers
- Basic benefits .
- 60 days per calendar year of inpatient days in mental health hospitals.
- State-mandated benefits (yearly Pap tests and mammograms. Check your plan for other state-mandated benefits).
Doesn't cover
- Part A: inpatient hospital deductible.
- Part A: skilled nursing facility coinsurance.
- Part B: deductible.
- Foreign travel emergency.
Supplement 1 Plan
Covers
- Basic benefits.
- Part A: inpatient hospital deductible.
- Part A: skilled nursing facility coinsurance.
- Part B: deductible.*
- Foreign travel emergency.
- 120 days per calendar year of inpatient days in mental health hospitals.
- State-mandated benefits including yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.
*Note: Supplement 1 Plan (which includes coverage of the Part B deductible) will no longer be available to people who are new to Medicare on or after January 1, 2020. These people can buy Supplement 1A Plan. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Supplement Plan 1.
Supplement 1A Plan
Covers
- Basic benefits.
- Part A: inpatient hospital deductible.
- Part A: skilled nursing facility coinsurance.
- Foreign travel emergency.
- 120 days per calendar year of inpatient days in mental health hospitals.
- State-mandated benefits including yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.
Compare these plans side-by-side
If a "yes" appears, the plan covers the described benefit 100%. If "no" appears, the policy doesn't cover that benefit.
Medigap Benefits | Medigap Plans | ||
Core Plan | Supplement 1 | Supplement 1A | |
Basic benefits | Yes | Yes | Yes |
Part A: inpatient hospital deductible | No | Yes | Yes |
Part A: skilled nursing facility coinsurance | No | Yes | Yes |
Part B: deductible* | No | Yes* | No |
Foreign travel emergency | No | Yes | Yes |
Inpatient days in mental health hospitals | 60 days per calendar year | 120 days per benefit year | 120 days per benefit year |
State-mandated benefits (yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.) | No | Yes | Yes |
*Supplement 1 Plan (which includes coverage of the Part B deductible) will no longer be available to people who are new to Medicare on or after January 1, 2020. These people can buy Supplement 1A Plan. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Supplement Plan 1.
