What Medigap Supplement 1A Covers in Massachusetts

All Medigap Supplement 1A plans offer the same standardized coverage, regardless of the insurance provider. Massachusetts simplifies Medigap plans, meaning every insurer selling a Supplement 1A plan provides the exact same benefits. Here’s what you get with a Medigap Supplement 1A plan in Massachusetts:

• Medicare Part A Coinsurance and Hospital Costs: Covers hospital costs for an extra 365 days after your Medicare benefits are exhausted.
• Medicare Part B Coinsurance or Copayments: Covers the 20% coinsurance under Part B that Medicare doesn’t pay.
• First 3 Pints of Blood: Covers the first three pints of blood used each year.
• Skilled Nursing Facility Coinsurance: Covers coinsurance for skilled nursing care.
• Foreign Travel Emergency: Provides 80% coverage for emergency medical services while traveling abroad (up to plan limits).
• Medicare Part A Deductible: Fully covers the Part A hospital deductible.
• Medicare Part B Excess Charges: Covers additional charges if your provider bills more than Medicare’s approved amount.

The main difference between Supplement 1A and the original Supplement 1 plan is that Supplement 1A does not cover the Part B deductible. This change aligns with federal Medicare rules that prevent new enrollees (eligible after January 1, 2020) from enrolling in a Medigap plan that covers the Part B deductible.

Because these benefits are standardized, the only difference between insurers is usually the premium cost.

How Massachusetts Medigap Plans Work

Medigap plans (also called Medicare Supplement Insurance) work differently in Massachusetts than in other states. While most states offer 10 standardized Medigap plans (A, B, C, etc.), Massachusetts offers its own versions. Here’s a breakdown:

1. Standardized Plans in Massachusetts

Massachusetts offers two primary Medigap options:

• Core Plan: Covers Medicare Part A hospital coinsurance, Part B coinsurance/copayments, three pints of blood, and 60 days of inpatient mental health care.
• Supplement 1 Plan: Includes all the benefits of the Core Plan plus Part A and Part B deductibles, skilled nursing facility coinsurance, foreign travel emergency care, and Part B excess charges.

2. Supplement 1A Plan

In response to Medicare changes in 2020, Massachusetts introduced the Supplement 1A Plan, identical to the Supplement 1 plan but without coverage for the Part B deductible.

3. Unique Features of Massachusetts Medigap Plans

• Community Rating: Premiums are community-rated, meaning they don’t increase as you age. This makes costs more predictable over time.
• Guaranteed Issue: If you’re eligible, insurers can’t deny coverage or charge you more based on health conditions. Learn more from your SHIP representative.

4. Enrollment Periods

Your Medigap open enrollment period begins when you first enroll in Medicare Part B and are at least 65. During this time, insurers cannot deny coverage or charge higher premiums based on pre-existing conditions.

Need Help Choosing the Right Plan?

If you’re not sure whether a Medigap Supplement 1A plan is right for you, compare it with other options like MedicareAdvantage plans. You can also explore Medigap Core plans if you’re looking for a lower-cost option with basic coverage.

Helpful Links for More Information:

• Compare Medigap Plans: Learn more about the differences between Medigap and Medicare Advantage.
• Medicare.gov - Medigap: Find official information on Medigap policies from Medicare.
• Understanding Open Enrollment: Know when and how to enroll in a Medigap plan.
• SHIP Program Assistance: Get free help from your state’s Health Insurance Assistance Program.

Bottom Line: Standardized Coverage, Flexible Costs

With Medigap plans in Massachusetts, every insurer offers the same benefits, but the premium costs may vary. Be sure to compare plans carefully to find the right one for your healthcare needs and budget. Remember, community-rated premiums mean your costs stay predictable, and guaranteed issue rules protect you from being denied coverage due to health conditions.

If you need help enrolling or understanding your options, visit our Medicare Enrollment Guide or contact us today at A Joy to Enroll.

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