Medicare in Massachusetts

As you may already know, Medicare covers all the territory of the U.S and each plan offers the same benefits in every state. However there are some exceptions and Massachusetts is one of them. If you live in Massachusetts and want to know the options you have or you are just curious about it, the following information will explain all the details about the plans available in this city.

    What are the similarities between Medicare in Massachusetts and the rest of the U.S?

     Most of the services offered by Medicare in Massachusetts are the same as the ones offered in the rest of the U.S. The following services are available for citizens of this city:

  • Original Medicare Part A (hospital insurance) and Part B (medical insurance) are available for all people eligible in Massachusetts. It works the same as in every other state. You must apply during the Initial Enrollment Period if you are turning 65 or suffer from End-Stage Renal Disease regardless of your age and you will be enrolled automatically if you suffer from amyotrophic lateral sclerosis or if you are receiving Social Security Services disability benefits.
  • Original Medicare Part C or Medicare Advantage Plans are also available. This covers the same as Original Medicare and includes more benefits. You will have to get it through a private insurance in which you will check the plans available and its prices.
  • Medicare Part D or Medicare Prescription Drug Coverage is also available and it is optional but very helpful if you want to reduce out-of-pocket costs.

      What are the differences between Medicare in Massachusetts and the rest of the U.S?

     The main difference between Medicare in Massachusetts and the rest of the U.S is Medigap. Medicare Supplemental plans offered in Massachusetts are very different and the options are more limited. Remember Medigap policies are plans made to cover the “gaps” in Original Medicare and to reduce out-of-pocket costs. Medigap policies available are Core Plan and Supplement 1.

What does Core Plan cover in Massachusetts?

     Plan Core is the most basic Medigap available in Massachusetts and its covers:

  • Medicare Part A coinsurance for inpatient hospital care plus coverage for an extra 365 days after Medicare coverage has end.
  • Medicare Part B coinsurance (generally 20% of the Medicare-approved amount).
  • The first three pints of blood in a year.
  • Medicare Part A hospice coinsurance or copayment.
  • 60 days per calendar year of inpatient days in mental health hospitals (this is in addition to Medicare’s coverage of 190 lifetime days and less any days previously covered by plan in same benefit period).

What does Supplement 1 cover?

  • Medicare Part A coinsurance for inpatient hospital care plus coverage for an extra 365 days after Medicare coverage has end.
  • Medicare Part B coinsurance (generally 20% of the Medicare-approved amount).
  • The first three pints of blood in a year.
  • Medicare Part A inpatient hospice coinsurance or copayment.
  • Medicare Part A hospital deductible.
  • Medicare Part A skilled nursing facility coinsurance.
  • Medicare Part B deductible.
  • Foreign travel emergency health coverage.
  • 120 days per year of inpatient days in a mental health hospital (this is in addition to Medicare’s coverage of 190 lifetime days and less any days previously covered by plan in same benefit period).
  • State-mandated benefits including yearly Pap tests and mammograms. Ask you insurance what other benefits does it cover.

How do I contact Medicare in Massachusetts?

      In Massachusetts there is a health insurance assistance program called Serving Health Information Needs of Elders or the SHINE program, which offers free health insurance information to residents. In case you have more questions or doubts, you can contact the SHINE program at 1-800-243-4636 Monday through Friday, from 8:45AM to 5PM.