Medigap is a catch-all term for supplemental health care plans sold and serviced by private insurance companies under the watchful eye of the United States federal government. The feds have standardized Medigap in massachusetts into 10 unique flavors. Each of these is aimed at filling a particular gap in Medicare’s original Part A and Part B coverage, and each offering a particular set of services at varying prices. Some states, however, have their own plans on top of that.

If you are a Massachusetts resident and you are interested in purchasing Medigap in Massachusetts, there are some things you should know. This article will help familiarize you with the ways that Massachusetts’ plans may differ from those sold in other states. Since the federal government takes a hands-off approach to Medigap other than setting the 10 plan standards, it is up to individual states to regulate Medigap providers. States like Massachusetts do differ a bit from their contemporaries.

Differences in basic benefits

Like the residents of 49 other states, Massachusetts residents are guaranteed the right to buy a Medigap policy. But the basic benefits may differ. In Massachusetts, basic benefits include inpatient hospital care. This covers Medicare Part A co-insurance plus coverage for 365 additional days after Medicare coverage runs out. Basic benefits also include Part B medical co-insurance costs, which are usually 20% of the Medicare-approved amount for general medical services. Basic benefits also feature the first three pints of blood on an annual basis, as well as Part A hospice co-payments and co-insurance.

The Massachusetts core Medigap plans include the basic benefits mentioned above as well as 60 days per year for inpatient mental health hospital costs and various state-mandated benefits. The state-mandated benefits include yearly Pap tests and mammograms. The core Medigap plans do not cover the Part A inpatient hospital deductible, the Part A skilled nursing facility co-insurance costs, the Part B deductible, or foreign travel emergency cost assistance.

Supplement 1

Massachusetts Supplement 1 Medigap plans cover the basic benefits outlined above plus the Part A inpatient hospital deductible, the Part A skilled nursing facility co-insurance, the Part B deductible, foreign travel emergency assistance, and 120 days per year of inpatient mental health hospital costs. It also includes state-mandated benefits like yearly Pap tests and mammograms.

How much will each plan cost? Since each of the standardized plans may be sold by dozens of different insurance companies, the prices fluctuate quite a bit. The factors affecting prices include your age, health status, location, etc. It is in your best interest to shop around when considering a Medigap plan. We can connect you with a specialist to help you navigate these plans and find one to best meet your needs.