If you are soon approaching the age of 65, you will be eligible to enroll yourself into parts A and B of the Federal Medicare Program. This program, offered by the federal government, provides Massachusetts citizens various forms of health care coverage. Part A of Traditional Medicare primarily covers hospital visits and associated treatment. Part B, on the other hand, will help cover costs from your primary care physician, outpatient procedures, and similar treatments. Unfortunately, however, there are some health care services, both in and out of the hospital, which are not covered at all by Traditional Medicare. We will discuss these coverage gaps on this page.

Medicare Plans in Massachusetts

Medicare Parts A and B aren’t free, but they are offered at a much lower cost than traditional health insurance policies for those 65 and older. The initial costs and fees come in the form of a monthly premium for Part B. For most seniors, Part A is free if you have a significant work history. And a “significant” work history is defined as ten years (40 quarters) of employment or more.

After applying for and being approved for Medicare, the first thing you get are Part A hospital benefits. This means that the vast majority of your expenses while receiving medical care in a hospital (or hospice care) will be taken care of. However, there are exceptions. Part B benefits help pay for outpatient facilities, regular check-ups, medical supplies, and preventive care. But you do not have to accept Part B benefits under certain circumstances.

Going down the list alphabetically, next is Medicare Part C. Medicare Part C is actually a private insurance plan which is not provided by the government (but the government will help pay for it). Its benefits start out identical to Medicare Parts A & B, and you have the option to purchase more coverage if you would like. Medicare Part D is a government-provided prescription drug coverage insurance plan. It can help reduce the costs if you accept Medicare Parts A & B and need help paying for your medications. Purchasing Part D, however, requires you to purchase Medicare Part B and pay for your premiums.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Common Medicare Plans in Massachusetts

There are more than one million seniors (1,104,483) with a Traditional Medicare policy living in the state of Massachusetts. Of those, one-fifth of the population (220,897) has their benefits covered by a Medicare Advantage policy instead of Traditional Medicare. An additional 210,571 citizens (19% of all Massachusetts seniors) have a Medigap supplement insurance policy covering the gaps in their Traditional Medicare benefits. The remaining 61% of seniors either rely on some sort of employer sponsored benefits, or are hoping that Parts A and B of Medicare will cover all of their medical needs.

Why Isn’t Traditional Medicare Enough? Why Purchase Additional Coverage?

Well, the answer to this question is dependent upon your specific circumstances. If you are still closer to 65, in relatively good health, and don’t require frequent medical treatment for any chronic conditions, you might not be vulnerable to the gaps in Traditional Medicare coverage. However, the older you get, and the more demanding your medical care becomes, the more likely you will be to incur any of the following out-of-pocket expenses:

Medicare Part A Costs in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • Medicare pays 80%, you pay 20% out-of-pocket

Medicare is good for helping Massachusetts residents pay for their medical care after retirement. These days, it’s especially important in the face of rising healthcare costs. But the unfortunate truth is that eventually, rising medical costs will outpace Medicare’s affordability. If you want to avoid these expenses and protect your savings for as long as you can, you’re going to need to purchase some type of Medicare supplement coverage.

Seniors 65 and older can easily qualify for Medicare supplements in most cases. Some supplements only require that you pay a relatively affordable monthly premium in order to financially protect yourself. Most of these supplements are small, simple, and specifically designed to give you the most beneficial coverage for a reasonable price. Other plans are more complex and offer additional coverages – but sometimes at a higher price.

Why an insurance supplement? Because in addition to rising medical costs, seniors have to worry about the gaps in Medicare coverage. Believe it or not, there are still some out-of-pocket costs associated with Medicare. Extended hospital stays are a good example and can range up into the tens of thousands of dollars if you stay for longer than 2 weeks. But that’s just the tip of the iceberg. If you’re unsure that your savings can handle such a financial burden, then you should definitely look into a supplement plan.

These days, the vast majority of seniors will choose between either Medicare Advantage or a Medicare Supplement (Medigap) insurance plan. Both of these options are sold by private companies like MetLife or Humana. They should function very similar to how private health insurance does. But the benefits they provide and the guarantees they offer are radically different. You need to know those differences before you sign on the dotted line.

To protect yourself and your finances, supplementing your Traditional Medicare with additional coverage is a cost-effective solution. You could go with either a Medicare Advantage policy, or a Medigap insurance supplement plan. We’ll cover each option in detail below.

Eliminating Coverage Gaps with Medigap Supplemental Insurance

There are ten Medigap plans in total: A, B, C, D, F, G, K, L, M, and N. There used to be more, but recent legislation has eliminated plans E, H, I, and J to eliminate redundancies in the system. Each plan is designed to cover common, problematic gaps in Traditional Medicare coverage. Additionally, each plan is exactly the same from state to state. For example, Plan F in Texas comes with the exact same benefits that it does in Massachusetts. The only thing that varies is cost, of course, as well as the companies available to underwrite the policy.

This useful chart details what each Medigap plan covers:

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.
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