Medicare Options in Massachusetts
People spend their lives working hard and saving a little bit on the side for a comfortable retirement. There is nothing quite like finally having the time to kick back, relax, and enjoy your time without worrying about going to work anymore. But even a single unpredicted excessive medical bill can become an inevitable setback that leads to a huge financial strain that is hard to overcome.
Many reports reveal that numerous people in the US aged 65 and above face bankruptcy and medical debt right after going through a health issue situation in their household. On the other hand, youth with disabilities are more than likely to be drowning in medical debt due to exorbitant medical expenses and equipment that they cannot pay for themselves.
This is where the Medicare health insurance program comes in, providing ample health coverage for people on the brink of bankruptcy due to outstanding medical expenses.
Medicare is a federal government-backed health insurance program for the senior citizens of the US that provides sufficient coverage for an extensive range of medical expenses. In 2020, there were approximately 1,354,179 people in Massachusetts enrolled in Medicare. This healthcare program is overseen by the US Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS).
You become automatically enrolled in Medicare coverage once you reach the age of 65 or have received 24 disability benefit payments from the Railroad Retirement Board, had renal failure, or had ALS. Finding a healthcare coverage plan that isn’t excessively expensive and meets every need specific to your situation can be very difficult. This is why our Medicare insurance agents are here to help.
The Medicare insurance agents at Integrity Now Insurance Brokers are annually accredited by America’s Health Insurance Plan (AHIP). With our extensive knowledge of the industry’s dynamics and complexities, we make sure you have a robust healthcare plan that will help you stay debt-free and stress-free. We will help you devise the best healthcare plan which is comprehensive and provides ample health coverage without costing you an arm and a leg. Find out more about the different types of Medicare plans available in Massachusetts and how our insurance agents can help.
Medicare Plan Choices
Everyone considering enrolling themselves in Medicare can choose between one of the following options.
The Original Medicare, also known as the traditional Medicare, includes Medicare Part A and Part B.
Part A covers hospital services, lab tests, in-patient treatments, hospice care, specialized nursing facilities, and other home healthcare options.
Part B includes coverage for tests and treatments, exams, outpatient doctor appointments, mental health, hospitalization, and certain medical equipment.
The Original Medicare healthcare plan pays for 80% of the overall medical expenses. For the rest of the 20% coinsurance, you can purchase a secondary Medigap policy that private insurers provide. With Part B, you will also be charged a monthly premium unless your income is insufficient.
The Medicare Advantage healthcare plan includes Part C, which is paid for by private insurers who are under a contract with Medicare.
This health coverage plan is popular among the people of Massachusetts since it is an all-in-one solution containing both Part A and Part B Medicare benefits. Medicare Advantage pays private companies who offer Medicare a fixed amount every month to cover your medical bills.
These plans also include prescription drug coverage, known as Part D, which has added benefits like dental, hearing vision, and other health and wellness programs.
Health Maintenance Organization (HMO)
The Health Maintenance Organization or the HMO is another popular healthcare option that provides comprehensive coverage through a network of physicians for a monthly or annual fee.
This collective of medical insurance providers pays for medical treatments provided by healthcare workers who are under a contract with them. For eligibility, you require:
- A primary care provider (PCP)
- A specialist’s referral
- Approval for certain treatments and prescribed drugs
Preferred Provider Organization (PPO)
The Medicare PPO plans have a recommended network of healthcare providers, but you can also choose an out-of-network doctor or physician for a higher price.
- No PCP or a specialist’s referral is required
- Most plans offer coverage for prescription drugs
- You cannot purchase drug coverage separately
- Higher charges and premiums for out-of-network healthcare facilities
Private Fee-For-service (PFFS)
This Medicare Advantage health plan is provided by State-licensed organizations under a contract with the Center for Medicare & Medicaid Services.
The PFFS plan:
- Has no requirement of PCP or a specialty referral
- Includes drug coverage and enables enrollees to purchase other drug plans separately
- Has a higher premium cost for choosing an out-of-network provider
Special Needs Plan (SNP)
This Medicare Advantage plan is only available for people who have been diagnosed with specific chronic diseases and conditions. This healthcare plan features special treatments specifically to meet the needs of people with special needs.
- PCP and a specialist’s referral are required
- Includes prescription drug coverage
- You can join this plan at any moment if you meet the requirements
Massachusetts Medicare Part D
Medicare Part A and Part B do not offer coverage for outpatient prescription drugs. This is why enrollees should consider purchasing the Medicare Part D healthcare plan, which specifically has prescription coverage.
This creditable optional Medicare coverage plan is the best solution to prevent out-of-pocket expenses spent on prescription medication. This plan includes chemotherapy drugs, intravenous medications, and other over-the-counter drugs.
Medicare Supplement (Medigap) Plans in Massachusetts
Since the Original Medicare Part A and Part B pay 80% of the total medical expenses, many enrollees search for other options where they don’t have to pay for the rest of the 20% of their hospital expenses.
This is why the people of Massachusetts opt for a supplemental healthcare plan called Medigap.
Medigap is a secondary health insurance policy where Medicare beneficiaries are offered coverage for everything that isn’t covered in the Original Medicare plan. This set of secondary coverage policies is labeled A through N.
Private insurance companies that provide these Medicare policies must agree to the terms and conditions of Medicare and adhere to federal regulations. These plans are governed by every state’s insurance commissioners and laws.
Before signing up for Medigap, you must be enrolled in the Original Medicare Part A and Part B. You can sign up for Medigap plans in the first month after applying for Medicare Part B.
Medigap insurers in Massachusetts set their premiums in three ways:
This premium is not affected by age. Only eight states mandate this method of rating and insurance companies are likely to avoid this approach unless it is mandated.
Premiums calculated depend on the enrollees’ age at the time they purchase them. The cost increases as the enrollee advances in age.
Issue-age or Entry-age Rating
These premiums depend on the person’s age. Premiums cost less for people who are under 65 and more for people over 80. The overall cost may increase due to inflation and other reasons but not because of the person’s age.
There are ten basic Medigap plans people of Massachusetts can choose from, but the Plans F, N, and G are some of the more popular options.
Medigap Plan F
The Plan F Medigap coverage plan covers almost all the traditional Medicare Part A and B gaps.
This coverage plan will cover the Part B annual deductible ($233 in 2022), the Medicare Part A coinsurance, and any other hospital expenses for up to a year after using Medicare benefits. Your international trips, skilled nursing facilities, and hospice care will also be paid for.
Medigap Plan N
This comprehensive coverage plan is less costly than other Medigap plans and includes Plan G benefits.
Once enrolled in this plan, you will be expected to pay copayments for hospital stays and doctor appointments, the annual Part B deductible, $50 for emergency room visits, and $20 for in-office visits.
Medigap Plan G
Plan G includes all the benefits of Plan F and coverage for the Part B premiums.
You do not have to pay for Part A premiums, hospital costs, coinsurance, hospice copay, and skilled nursing facilities with this plan. There is also an added bonus of 80% coverage for foreign travel emergencies.
Which Medicare Plan to Opt for Massachusetts
After all of your life’s hard work, you deserve to receive maximum protection and a convenient and comfortable retirement.
To prevent any unforeseen excessive healthcare expenses, signing up for an insurance plan best suited to your needs and budget is crucial. Here are some factors you should consider when selecting a healthcare plan.
Opting for an out-of-network healthcare provider can be expensive. You can reduce the costs of the premium by choosing any hospital, doctor, or pharmacy that is all in the same network.
The monthly premium can have a significant impact on your budget in addition to the Part B deductible. Make sure you sign up for a plan that meets all of your requirements and also covers prescription drugs.
Whenever your doctor prescribes you a drug, make sure that medication is enlisted in your plan’s formulary. If not, you can always consult with your healthcare providers about any generic or alternate versions of that medication mentioned in the formulary.
There is no set limit on the out-of-pocket costs in the Original Medicare plan. But the MedicareSupplement insurance policies like Medigap can help lower any out-of-pocket expenses, and these charges are based on the private insurers that provide you the plan.
You can use our plan finder tool to compare the pricing on different plans in Massachusetts.
Deductibles, Coinsurance & Copays
You will be expected to make these payments every time you use your Medicare benefits.
Freedom to Travel
Medicare insurance also enables beneficiaries to travel domestically and internationally and use their Medicare benefits.
Your treatments and check-ups will be covered with Medicare insurance coverage whenever you travel. With Medicare Advantage plans, there is also a network of healthcare providers that offers coverage for emergency treatments all across the country.
Added benefits like vision, dental, and other targeted treatments appropriate to your situation should also be kept in mind when choosing a health insurance plan.
Medicare Enrolment in Massachusetts
Medicare will automatically register you once you turn 65 or have received at least four Social Security payments. But if not, you can get in touch with your local Social Security Office and apply online.
You can apply for enrolment in Medicare in the following time frames.
This enrolment period starts three months before and ends three months after your 65th birthday. You can initiate your application process during this time, or if you are already enrolled in a healthcare plan, you can use this time to switch or upgrade your plan.
If you missed the initial enrolment period, you can always apply during the general enrolment period that begins January 1st and ends March 31st. You can sign up for Part A, Part B, Medicare Advantage (Part C), Medigap, and Part D during this time frame.
The Medicare Advantage open enrolment period begins around October 15th and ends December 7th. You can enroll, switch, cancel, or upgrade your current coverage plan during this time frame. You can also change your Part D coverage during this time.
If you lose eligibility for your Medicare plans due to unforeseen events, you can enroll yourself in a healthcare plan during the special enrolment period.
Why Choose Medicare Hope Insurance Agents?
Our certified team of Medicare insurance agents at Integrity Now Insurance Brokers is well-versed with the industry’s working, and with our extensive experience, you are in safe hands. We make sure to go the extra mile for our clients and help them find an affordable healthcare plan that meets all of their requirements.
We have assisted countless of our clients in Massachusetts land comprehensive health insurance plans by premium Medicare insurance providers across the nation. Your health and comfort are our priority. With our AHIP-certified insurance agents, you never have to worry about going through the intimidating process of choosing a healthcare plan again.
For more information about your Medicare options, go through our blog and find out all the tips and tricks about applying to Medicare.
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