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. Don’t worry, the Bay State’s Medigap plans are even 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.

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 50 or older and eligible for Medicare can enroll in a Medigap plan, with one exception, Medicare beneficiaries under 65 with End Stage Renal Disease cannot enroll in a Medigap plan.

How do Massachusetts’s Medigap plans work?

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 actually 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.

How much are Massachusetts Medigap plans?

Massachusetts is a Medigap community-rated state. This means everyone pays the same rate**, regardless of age, for their Medigap policy. With that said, Medigap insurance companies’ monthly premiums can vary greatly from one to another. So, Company A’s Medigap 1 must be the same rate for all enrollees, but they can charge more than the identical plan from Company B.

**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.

We know this is not only unique but can be confusing. For any questions, call 800-930-7956.

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 End Stage Renal Disease). Hang on! Read below to learn the rules and certain times when you can receive guaranteed enrollment.

What is Massachusetts’s Medigap’s Guaranteed Issuance rule?

While all Mass. Medigap plans offer guaranteed issuance, do not wait until you’re in the hospital to enroll or switch your Medicare Supplement plan. If you were to wait, you may not be able to enroll until the following year. Here are the rules:

6-month initial Mass Medigap enrollment period:

• When you enroll in Medicare Part B for the 1st time
• Move to Massachusetts
• Employer health insurance ends
• Moves out of their Medicare Advantage (HMO) plan
• Turn 65, even though you qualified for Medicare before age 65 due to End Stage Renal Disease (cannot enroll in Medigap with ESRD and under 65)

Massachusetts Medigap Open Enrollment:

• February 1 – March 31
• Anyone can switch or join a new Medigap plan
• If you like your plan, you can keep it, and you do not need to do anything

Are there other guaranteed issuance enrollment periods?

Yes. There are two other Massachusetts guaranteed issuance enrollment periods:

5-month Medigap guaranteed enrollment period: If your 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 (medical history).

63-day Medigap guaranteed enrollment period: There are several events that trigger this enrollment period that runs for 63 days when 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 ends
• Employer-based health insurance ends
• Medigap insurance ends due to the provider unable to make its debts

Massachusetts’s Medigap Initial vs. Open Enrollment Periods

While both Massachusetts’s Medigap Initial Enrollment and Open Enrollment offer guaranteed issuance insurance, there is one key way in which the differ. Your Medigap initial enrollment gives you six months from when you first become Medicare eligible to join any plan, regardless of medical history. Your Medigap 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.

What happens if I move out of Massachusetts?

If you move out of Massachusetts, you cannot keep your Mass Medigap policy. You will need to disenroll from your Mass Medigap plan and enroll in a new plan in your new state. Don’t worry, this move will trigger a Medigap guaranteed issuance period in your new state. Your new plan will have to accept you without any medical questions asked.

This disenrollment if you move, is unique to Massachusetts and two other states. The majority of states allow you to move with Medigap plan to another state -just make sure you inform them of your move.

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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
• Household discount: you may receive a discount of 5% a month

Further help with Medigap in Massachusetts

If you’re have a question, want a quote or are all set to enroll in a Massachusetts Medigap plan, give one of our licensed agents a call at 800-930-7956.

Remember, our agents can NEVER charge you a fee to help you get a quote or enroll.