“Medigap” is a kind of Medicare supplement insurance policy built to fill the coverage gaps related to Original Medicare Parts A & B. Though Medicare attempts to be comprehensive, there are many healthcare necessities which it does not cover. And if you don’t have any Medigap insurance to pay for these basics, you could find yourself having to pay thousands in out-of-pocket healthcare costs. In order to get Medigap insurance, you have to first be enrolled in Original Medicare.

Federal Regulations for Medicare Supplements

The Centers for Medicare and Medicaid Services (CMS) are tasked with governing the Medigap plans that insurance agencies offer. Right this moment, you can choose from one of ten different plans. CMS legislation assures that regardless of your chosen plan, you will be given the exact same coverage as would be offered in any other state.

Medigap Enrollment In Massachusetts

For most states, there are 10 Medigap plans available to each Medicare enrollee, and they are labeled A-N (excluding E, H, I, and and J). However, in Massachusetts, seniors are limited to one of two available plans: the Supplement Core Plan, and the Supplement 1 Plan. The Core Plan offers fewer benefits, but at the same time is likely to be less costly than the Supplement 1 Plan.

Medigap Benefits Core Plan Supplement 1
Basic benefits Yes Yes
Part A: inpatient hospital deductible No Yes
Part A: skilled nursing facility coinsurance No Yes
Part B: deductible No Yes
Foreign travel emergency No Yes
Inpatient days in mental health hospitals 60 days per calendar year 120 days per benefit year
State-mandated benefits (yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.) No Yes

Plan Coverage & Cost

Health insurance – and the cost for it – are tailored to you, the individual. Your weight, tobacco habits, age, gender, and distinct location will all affect the monthly costs you pay for a Medicare supplemental insurance policy.

Like any insurance product, the cost of your Medicare Supplement (also known as Medigap) plan is determined by several underwriting concerns. Your overall health, medical history, use of tobacco products, gender, and age are all considered when calculating your monthly premium. Perhaps surprisingly, where you live in Massachusetts, as particular as the zip code you live in is also taken into consideration. This is because of the widely varying costs of healthcare providers from one part of the state to another.

Most Popular Medicare Supplement Plans in Massachusetts

Because of the unique situation in Massachusetts, it can be difficult to gauge which Medigap plan will suit your needs best. In other states, Plan F is the most popular because it is comprehensive (it covers every single gap in Medicare) and simple (one low monthly payment gets you automatic coverage). You should check with your local insurance office to find out how to get an equivalent form of coverage in your area.

How do Medicare Plan Ratings Work?

In an effort to give seniors in Massachusetts a tool to use for evaluating and comparing the many Medicare products available, Medicare issues an Overall Star Rating report that assigns each of the companies in the state with a star rating. The report is based on data gathered by Medicare and includes an evaluation on how well the company practices preventive measures such as testing and screening, if chronic disease like diabetes is managed effectively, what the experience of its members is with the company, complaints, and the quality of customer service provided. The more stars a company is assigned, the better the company is (in the eyes of Medicare) in providing quality services.

Helpful Medigap Tips & Tricks

Doctor/Provider Network Restrictions

Do you prefer to vacation? Do you migrate yearly as the seasons change? Are you living out in the country, or is there an overall lack of variety in terms of health care providers in the area? Then you could be better off with a Medicare supplemental insurance policy. Sure, there are additional methods to supplement your Medicare coverage gaps, but very few of them offer the freedom that Medicare supplement does. With Medicare supplement insurance, you are free to obtain care from virtually any facility and any health care provider which will take Medicare.

Doctors List

If you have a primary physician or you regularly visit a specialist, you will be able to continue that relationship with a Medigap (Medicare Supplement) plan, providing they accept Medicare. Medigap insurance does not limit people in their choice of healthcare providers. If they accept Medicare, Medigap is happy to work with them. Other plans often work only with healthcare providers that belong to a specific network or a PPO list. This practice could preclude you from using your doctor if he or she is not a member of the network. In addition, because Medigap accepts any healthcare provider that accepts Medicare, you can travel anywhere in the country and not have to worry about losing coverage on a trip or visit. Other plans may limit travel claims to emergencies only.

Drug, Vision and Dental Coverage

For most states, Medicare Part D is the main entity responsible for helping seniors acquire their necessary prescription drugs at an affordable price. Additionally, neither Medicare nor Medigap policies provide any coverage for vision or dental needs. In most states, vision in dental must be covered out of pocket, or by a private insurance company.

Enrollment Options & Best Time To Enroll

When you register for a Medigap policy, you should first be participating in Medicare Parts A & B. Then you can start the Medigap enrollment process. The sooner you enroll, the less complicated the process will be. But in the event you hold out, you might need to answer personal questions about your health in order to be deemed qualified to receive coverage.

  • Initial Enrollment Period: Signing up for a Medigap policy during your IEP (within 6 months of signing up for Medicare) assures your acceptance and coverage without the need of health surveys or medical exams.
  • Guaranteed Issue: Common among senior citizens who are losing an employer or group health plan. The organization you apply to must accept and cover you, regardless of your present health status.
  • Annual Enrollment Period (AEP): Medigap insurance coverage is one of the few types of insurance which isn’t impacted by the AEP. You can register for or change Medigap plans at any time all through the year.
  • Underwritten: An elaborate process where you have to answer questions about your health and possibly undergo a physical exam before your preferred insurance company will offer to provide you a policy.

Free Look Period

By federal law, you’ve got 30 days to examine your Medicare supplemental insurance policy after your coverage begins. If, for whatever reason, you are unsatisfied with your coverage, you may get rid of your policy for a complete refund inside your first 30 days.

What Medigap Plan Is Best For Me?

The perfect Medicare Supplement plan is one that meets all of your projected healthcare needs, is one you fully understand, is provided by a reputable company, and is affordable for your budget. That plan is out there. The challenge is finding it among all your options. At Medigap.com, we’ve given you a head start in that search by compiling a comprehensive list of Medicare Supplement (Medigap) providers licensed in Massachusetts. We’ve provided you with helpful information including answering the most commonly asked questions so you will be prepared to make an educated decision about a Medicare Supplement plan that is a perfect fit for you!

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.