How Do Medigap Plans Work in Massachusetts?

Massachusetts handles healthcare differently than the rest of America, and Medicare insurance is no exception. Medigap plans here are not the same “alphabet soup” of standardized A-N Medigap plans available in most of the United States. The Bay State’s Medigap plans are more straightforward and easy to understand than the traditional Medigap policies. Plus, if you scroll down, you can learn how to apply for Medigap without answering any health questions. Additionally, MA doesn’t allow Medicare excess charges.

What is Medigap?

Medigap fills in the gaps that Original Medicare leaves behind. It can cover copays, coinsurance, and deductibles. However, it does not cover prescription drug coverage. It is recommended that Medigap enrollees enroll in a Part D plan.

Who can enroll in a Massachusetts Medigap plan?

Any Massachusetts resident who is eligible for Medicare can enroll in a Medigap plan, with one exception, Medicare beneficiaries under 65 with End Stage Renal Disease (ESRD) cannot enroll in a Medigap plan.

How do Medigap plans work in Massachusetts?

As we said, plans are laid out differently than the majority of Medigap plans in other states. In Massachusetts, there are only 3* standardized Medigap plans to choose from. This narrowing of key plans makes it easier to select Medigap coverage. In other states, it can be confusing to choose between the multiple plan options.

Comparing Massachusetts Medigap plans

Here is a breakdown of the 3 plans available in MA:

*Medicare Supplement 1 is ONLY available to those who qualified for Medicare prior to January 1, 2020. If you were eligible but did not enroll, you may still be able to enroll in Massachusetts Medigap Supplement Plan 1.

Massachusetts community-rated Medigap plans explained

In Massachusetts, Medigap plans use community rating. This means your monthly premium doesn’t vary by gender or age. With this approach, insurance companies set a single premium for everyone. Your plan can only increase due to external factors, like yearly inflation. This method keeps prices stable and prevents older individuals from facing higher premiums just because of their age. Note: Some plans offer a Medigap initial enrollment discount. This is the only time in which you may pay less than other enrollees in the same plan.

How much are Medigap plans in Massachusetts?

Since Massachusetts has different plans than all other states AND have unique community rated discounts when you first sign up, we have to give you pricing over the phone. Give us a call at 800-930-7956 and we will get you Medigap pricing and discount info.

Massachusetts Medigap With No Health Questions!

In addition to the 3 special Medigap plans offered, Massachusetts also offers a separate special guaranteed issuance window for enrolling in Medigap. This means that a Massachusetts Medigap insurance provider cannot deny residents coverage or charge more for a preexisting condition unless you’re under 65 and have ESRD. See complete details below.

Mass Medigap Guaranteed Issuance rules: Switching Plans

While all Massachusetts Medigap plans offer guaranteed issuance, there are only certain times of the year when you can be approved with no medical underwriting. Do not wait until you’re in the hospital to enroll or switch your Medicare Supplement plan. If you miss your enrollment window, you may not be able to enroll until the following year. Here are the enrollment windows and rules for enrolling in Medigap

Initial Mass Medigap Open Enrollment Period: (6-months)

The best time to buy a Medigap policy in Massachusetts is during your Medigap Open Enrollment Period. This is the 6-month period that starts as soon as you are enrolled in Part B. Below are events that will trigger your initial 6-month Medigap Open Enrollment. (Source)

• You enroll in Medicare Part B for the first time
• You move to Massachusetts from another state
• You lose or about to lose employer coverage
• You move out of the service area of your Medicare Advantage HMO plan
• You turn 65, even though you qualified for Medicare before age 65 due to End Stage Renal Disease

Medigap Special Enrollment period: (63 days)

There are several events that trigger a Medigap Special Enrollment Period that runs for 63 days after your event occurs:

• New to Medicare beneficiaries enrolled in a Medicare Advantage who disenroll in the first 12 months
• Medigap or Medicare Advantage insurers violated or misrepresented their policy
• Retiree health insurance is terminated
• Employer health insurance coverage that pays second to Medicare, was stopped or is about to be stopped
• Medigap insurance ends because the provider is unable to make its debts

You can usually apply for a new Medigap plan up to 60 days before the special enrollment event date to avoid a gap in coverage.

Make sure you apply no more than 63 days after your coverage ends.  Keep copies of letters, notices, emails, or claim denials as proof of your coverage being terminated. You may need to include these with your Medigap application to prove you have a guaranteed right.

Massachusetts Annual Medigap Open Enrollment (Feb-March)

Massachusetts is one of the few states that offer an annual time to enroll or switch Medigap plans.

• Every February 1 – March 31
• Anyone on Medicare can switch or join a new Medigap plan during this time (except Under 65 with ESRD)
• New coverage begins the following June 1.

HMO/PACE Ending Medigap guaranteed enrollment period (5 months)

If your Massachusetts Medicare HMO or PACE plan no longer is available as of December 31, you will have from October 2 -March 4 to enroll in a Massachusetts Medigap plan without medical underwriting.

Massachusetts Medigap Initial Open Enrollment vs. Annual Open Enrollment Periods

While both Massachusetts’s Medigap Initial Open Enrollment and Annual Open Enrollment offer guaranteed issuance insurance, there are a few differences.

The Mass Medigap Initial Open Enrollment gives you six months from when you first become Medicare eligible to join any plan, regardless of medical history. Coverage usually begins the first of the month following your application.

The Mass Medigap Annual Open Enrollment period is a 2-month period from Feb 1 -March 31 which allows you to switch or join a Medigap plan without reviewing your health records. New coverage usually begins on June 1st.

Medigap for Under 65 in Massachusetts

Unlike other states, Most Massachusetts residents under 65 who qualify for Medicare can enroll in Medigap as long as they are first enrolled in Medicare Part A and Part B. Medigap insurers in Massachusetts cannot refuse to sell a policy, exclude or limit coverage, or require a waiting period before coverage starts due to existing health problems.

There is one big exception: those under 65 who are eligible for Medicare solely due to End-Stage Renal Disease (ESRD) are not eligible for Medigap. Learn more about Medgap under 65 here

What happens if I move out of Massachusetts?

If you move out of Massachusetts, you can keep your Mass Medigap policy (source)

Get a Medigap Quote Enroll in Medigap

Are there any Massachusetts Medigap Discounts?

There sure are! Enrolling when you’re first eligible is important because you may be eligible to receive a discount for the first 3 years.

• 1st eligible for Medicare discount: you may receive up to 15% a month
• Autopay discount: you may receive a discount of $2 a month
• Massachusetts Medigap Household discount: you may receive a discount of 5% a month
• Massachusetts Medigap Roommate Discount: people who qualify for this discount will receive anywhere from 5% to 12% off each.

No Medicare Excess Charges in Massachusetts

In certain states, physicians have the option to add an additional fee of up to 15%, known as Excess Charges. At the end of 2020, both Congress and the Massachusetts legislature passed laws regarding surprise billing. Known as the federal “No Surprises Act,” it prohibits surprise billing and establishes a legal framework (Source). That means you won’t have to pay excess charges. Learn more in our article “How to avoid Medicare Excess Charges.”

Additional Help with Medigap in Massachusetts

If you have a question, want a quote, or are ready to enroll in a Massachusetts Medigap plan, give us a call at 800-930-7956.

Remember, Senior65.com NEVER charges you a fee to help you get a quote or enroll.