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Medicare Plans in Massachusetts in 2022

Understanding Medicare in Massachusetts isn’t quite as simple as it is for residents of other states. That’s because Massachusetts is one of three states that doesn’t follow federal Medigap plan standardization

In fact, Massachusetts offers just three different Medicare Supplement plans, only two of which are available to newly eligible Medicare beneficiaries. However, residents of the states can also choose to enroll in a Medicare Advantage plan or Part D drug coverage just like in any other state. 

Being aware of your state-specific Medicare policies is one of the best ways to ensure that you choose the right Medicare plan for you. Read on to learn all about your Medicare options in Massachusetts.

How To Apply for Medicare in Massachusetts

Massachusetts residents who is only interested in enrolling in Original Medicare, you can do so through your local Social Security office. You can sign up in-person, online, or over the phone as early as three months before your 65th birthday. 

But enrolling in Medicare Advantage, a Medigap plan, or Part D drug coverage is best done with the help of a licensed insurance agent who can walk you through the process and help you find the best plan for you. That’s where we come in. 

If you are new to Medicare, reach out to an experienced insurance agent here at Medicare Plans Direct today. We can answer all of your Medicare-related questions and help you explore your coverage options at no cost to you.

Medicare Supplement Plans in Massachusetts

In 2019, 345,121 Massachusetts residents were enrolled in Medicare Supplement Insurance, which represented over a quarter (26%) of all Medicare enrollees in the state that year. 

Medigap plans in Massachusetts are different from every other state, as Medicare Supplement Insurance is regulated by the state and doesn’t follow federal standardization guidelines. 

In Massachusetts, there are only three Medigap plans: the Core Plan, Supplement 1 Plan, and Supplement 1A Plan. However, only two of these plans are available to new Medicare enrollees, as Supplement 1 Plan has been discontinued for people who became eligible for Medicare on or after January 1, 2020. 

The most basic of these plans is the Core Plan. This plan helps pay for the following Medicare costs:

  • Basic Benefits: Each plan includes the Basic Benefits that are also included in all other standardized Medicare Supplement plans
  • Inpatient hospital care: Medicare Part A coinsurance (plus coverage for 365 additional days after Medicare coverage ends)
  • Medical costs: Medicare Part B coinsurance (generally 20% of the Medicare-approved amount)
  • Blood: your first 3 pints of blood for a medical procedure each year
  • Medicare Part A hospice coinsurance or copayments 
  • Inpatient mental health hospital stays (60 days per calendar year) 
  • State-mandated benefits (such as yearly Pap tests and mammograms)

A more comprehensive plan available to Medicare beneficiaries in Massachusetts is Supplement 1A Plan. You can enroll in this plan regardless of when you became eligible for Medicare. Supplement 1A Plan covers:

  • Basic benefits (as listed above)
  • Medicare Part A deductible
  • Medicare Part A Skilled Nursing Facility (SNF) coinsurance
  • Foreign travel emergency costs
  • Inpatient mental health hospital stays (120 days per calendar year) 
  • State-mandated benefits (such as yearly Pap tests and mammograms)

Finally, if you became eligible for Medicare before January 1, 2020, you may have the option to enroll in the Medicare Supplement 1 Plan. This plan offers the same benefits as Supplement 1A Plan in addition to coverage for your Part B deductible.

Medigap Premiums in Massachusetts

In Massachusetts, Medigap insurance companies can only set premiums using community rating. The state is only one of eight that solely uses the community rating system for beneficiaries aged 65 and older

With community rating, insurers cannot charge premiums based on a beneficiary’s age. In many states, older plan enrollees may have to pay higher premiums than younger ones. But in Massachusetts, you will pay the same premium regardless of whether you are 65 or 100 years old

This also means that insurance companies cannot charge beneficiaries a higher monthly premium for enrolling before the age of 65. This applies to Medicare enrollees who qualify for coverage because of a disability and is not the case in most other states. 

However, a number of factors still influence Medigap premium prices in the state, and your monthly premium will depend on variables such as smoking status, gender, and residential area.

Massachusetts offers Medicare enrollees quite a few protections when it comes to Medigap premiums. Nevertheless, we always recommend consulting with a knowledgeable insurance agent before deciding on a Medicare Supplement to ensure that you find the best policy for you.   

Medigap Enrollment in Massachusetts

Your first opportunity to enroll in Medicare Supplement Insurance in Massachusetts is during your Medigap Open Enrollment Period (OEP).

Your OEP begins when you first become eligible for Medicare and enroll in Part B, and it lasts for 6 months. During this time, you can enroll in any Medigap plan offered in your area regardless of your health history

Beneficiaries under the age of 65 who qualify for Medicare because of a disability can also enroll in Medigap during their 6 month Medigap OEP. These individuals will have another OEP during the 6 months following their 65th birthday. 

However, in Massachusetts this does not apply to beneficiaries who qualify because they suffer from End-Stage Renal Disease (ESRD). Insurance companies are not required to provide coverage to these individuals in the state

There are some more protections offered to Medicare beneficiaries who would like to enroll in Medigap coverage in Massachusetts outside of their OEP. First off, insurance companies can’t impose pre-existing condition waiting periods or exclusions. This is another protection that you won’t find in many other states. 

Also, Massachusetts is one of just four states that offer either continuous or annual guaranteed issue rights. Massachusetts holds a Medigap open enrollment period from February 1 to March 31 each year. 

During this time, Medicare beneficiaries can enroll in any Medigap plan in their area without having to undergo medical underwriting, even if they missed their Medigap Open Enrollment Period. People who are already enrolled in a Medigap plan also have the option to switch to a different one during this time. 

Medicare Advantage Plans in Massachusetts

If you’re looking for additional benefits on top of what you get from Original Medicare, Medicare Advantage may be a good option for you. Also known as Medicare Part C, these plans can offer drug coverage, hearing coverage, vision coverage, dental coverage, and more

A little less than a quarter (26.5%) of Massachusetts beneficiaries were enrolled in a Medicare Advantage plan in 2021.

There are 113 Medicare Advantage plans available in Massachusetts in 2022. 100% of Medicare beneficiaries in the state have access to at least one Medicare Advantage plan in 2022. 

However, you should know that Medicare Advantage plan availability depends on where exactly you reside, as the number of plans offered differs from county to county.

For example, if you live in Worcester County, you have 60 plans to choose between. However, residents of Dukes County and Nantucket County only have 3 Medicare Advantage plans available to them. 

You should also be aware that what you pay for your Medicare Advantage plan depends on where you live, the plan that you choose, and more. In 2022, the average Part C monthly premium for Massachusetts enrollees is $50.48. Plus, all Medicare beneficiaries in the state have access to at least one plan with a $0 monthly premium. 

If you are considering enrolling in Medicare Advantage, we recommend that you consult with an experienced insurance agent. Here at Medicare Plans Direct we help you make the best Medicare choices possible at no extra cost to you. Reach out to us today to receive free Medicare advice.

Medicare Part D in Massachusetts

Another thing for Massachusetts Medicare beneficiaries to keep in mind is their Part D prescription drug plan options. In 2022, there are 21 stand-alone drug plans available to Massachusetts Medicare enrollees

Your Part D premium depends on a number of factors, such as where you live and which insurance company you purchase your plan through. In 2022, the average Part D premium in Massachusetts costs $49.63

Plans with $0 deductibles do exist, though you will usually have to pay a higher monthly premium should you choose to enroll in one. In 2022, there are four plans with a $0 deductible available to Massachusetts beneficiaries. The lowest cost stand-alone drug plan with a $0 deductible has a monthly premium of $69.00.

It is usually a good idea to enroll in prescription drug coverage when you first become eligible for Medicare. Even if you aren’t taking prescription medications when you turn 65, you will likely need drug coverage in the future. If you don’t sign up for Medicare Part D when you are first eligible and don’t have some other form of creditable drug coverage, you could face late enrollment penalty fees down the line

Some Medicare Advantage plans offer prescription drug coverage, but if you are enrolled in Original Medicare and/or a Medigap plan, you will need a stand-alone drug plan to cover the costs of your prescription medications. 

As you can see, where you live has a significant impact on your Medicare health insurance options. Understanding the plans that are available to you isn’t easy, but that’s what we’re here for. Our expertise can help you to make the best Medicare decisions possible, so reach out today to compare plans in your area.

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