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Medigap Coverage in Massachusetts

Massachusetts is one of the three waiver states that standardized their Medigap plans before national plans were established in the other 47 states. Massachusetts has its own Medigap system with 2 comprehensive plans to choose from, either the Core Plan or the Supplement 1 Plan.

The Medigap application process works the same in Massachusetts as other states. There is an open enrollment period that starts when a resident turns 65 and is enrolled in Medicare Parts A and B. Disabled Massachusetts residents under the age of 65 are eligible for a Medigap plan, but those under 65 with ESRD are not.

The following table illustrates how the two Massachusetts plans differ:

Two Medigap Plans
Medigap Benefits Core Supplement 1
Part A inpatient hospital care co-insurance x x
Part A inpatient hospital care deductible x
Part A hospice co-insurance or co-payment x x
Part A skilled nursing facility co-insurance x
Part B co-insurance x x
Part B deductible x
Foreign travel emergency x
Inpatient stay at mental health facility 60 days
per year
120 days
per year
State-mandated benefits x x

Medigap Benefits for Both Plans

Below are the basic benefits that both plans in Massachusetts cover:

  • Inpatient hospital care
  • Part B Medical costs
  • First 3 pints of blood
  • Part A hospice care and co-insurance or co-payment
  • State-mandated benefits

Both plans cover basic health care benefits including inpatient hospital care which covers the Part A co-insurance and coverage for up to 365 days after Medicare benefits have been used in a benefit period. Secondly, the plan covers Part B medical costs. Thirdly, the plans cover the cost of the first 3 pints of blood each year. Fourthly,  hospice care and the co-payment and co-insurance for prescriptions and health care is included. Finally, both plans cover state mandated benefits such as annual mammograms and pap smears.

Core Plan

The Core Plan costs less than the Supplement 1 Plan but it provides less coverage. All five benefits mentioned above are covered completely in the Core Plan. In addition, the plan covers 60 days for an inpatient stay at mental health hospitals per year.

The Core Plan’s premium tends to be half the cost of Supplement 1 plans, according to state records. Despite the lower cost, the plan does leave out certain elements that older residents may need.

Supplement 1 Plan

The Supplement 1 Plan is the most comprehensive of the two Massachusetts plans. Beyond all of the basics provided in the Core Plan, it offers five other features:

  • Part A inpatient hospital deductible
  • Part A skilled nursing facility co-insurance
  • Part B deductible
  • Foreign travel emergency treatment
  • 120 days of inpatient mental health care per year

This plan covers the Part A deductible for inpatient hospital visits and the co-insurance for skilled nursing facilities. Furthermore, it covers the deductible for Medicare Part B. The inpatient mental health care days are extended from 60 days offered in the Core Plan to 120 days offered in the Supplement 1 Plan. Finally, the it offers coverage abroad for foreign travel.

The Supplement 1 Plan offers extensive coverage and despite the higher cost, it may be the most suitable option for a senior that frequently utilizes health care facilities.

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