Major Pitfalls To Avoid With Massachusetts Medicare

Major Pitfalls To Avoid With Massachusetts Medicare

Last updated on: October 28, 2022

Many Massachusetts residents worry a lot about health insurance, often wondering how they're going to afford monthly premiums and how they're going to afford the care they need that isn't covered. Fortunately, Medicare offers an affordable option for aging Americans and those in MA under the age of 65 with certain qualifying disabilities. Unfortunately, many people don't have all of the information they need and end up making costly and unfortunate mistakes. For this reason, we've put together a short but essential list of major pitfalls to avoid with Massachusetts Medicare.

Delaying Medicare Enrollment When Your Massachusetts Job Insurance is A Secondary Payer

If you have health insurance through your employer, it's crucial to determine if your insurance is considered primary or secondary. If it's deemed to be primary, you likely have no reason to sign up for Medicare. However, if you're eligible for Medicare and the insurance plan you receive through your employment is considered secondary, your plan won't pay for any medical claims until Medicare has paid its share.

Additionally, if you have retiree coverage or COBRA, those are also secondary payers, so it's probably a good idea to enroll in Medicare as soon as you are eligible.

Failing To Review Your Massachusetts Part D Plan Each Year

Medicare Part D, the Medicare prescription drug plan, has open enrollment each year in Massachusetts between October 15th and December 7th. If you're enrolled in a Part D plan, it's a good idea to review your plan each year around the Massachusetts enrollment period. Part D costs and coverage can change a lot from year to year. For example, some plans raise premiums, increase your share of costs for prescription drugs, or require you to go to specific pharmacies to get the best prices. Additionally, if you've been prescribed new medications, you always want to check and see if they're covered under your plan and what they will cost. Because Part D plans can change from year to year, you're also permitted to switch your Part D plan each year during open enrollment. For this reason, you always want to look into your coverage and make sure you're still signed up for the best plan at the best price.

Choosing A Prescription Drug Plan in Massachusetts That Doesn't Fully & Affordably Cover Your Prescriptions

Before deciding which Massachusetts Part D plan to enroll in, it's a good idea to make a list of all the medications you're currently taking, as well as any medications you think you might need to take in the future, if you know. You can then choose your Part D plan based on which plans offer the most coverage for the drugs you need. While Part D plans are regulated and are required to cover certain medications, they can also provide additional coverage for other medications, which varies from company to company. You want to make sure the plan you choose offers the most comprehensive coverage for your specific needs.

Additionally, you want to check and see if the plan you've chosen or plan to choose places any restrictions on coverage. For example, some plans require you to get prior approval before they will pay for a particular drug, or they might require you to try other, less expensive medications before they'll pay for the drug you'd like to take. These are all factors you should consider when deciding which company to purchase your Part D plan through.

Missing The MA Deadline To Sign Up After You Leave Your Job

Many people have health insurance coverage through work, in which case they aren't required to sign up for Medicare in Massachusetts at age 65. Therefore, you will miss your enrollment window, but you are permitted to delay until you no longer have creditable coverage through work. In this case, you won't have to pay the late enrollment penalty. However, once you finish working or you lose creditable health coverage, don't forget to sign up for Medicare! If you miss the deadline, you could end up having to pay the late fee forever. Once you leave your job or lose your health insurance, you have 8 months to enroll in Medicare Part B before facing the late fee. In addition to the lifetime late penalty, you could also end up without health insurance for many months. If you don't enroll within 8 months, you won't be able to enroll until January 1-March 31st, and you will have to wait until July 1st for your coverage to begin.

Choosing The Wrong Massachusetts Medigap Policy

When you first become eligible for a Medicare Supplement Plan in Massachusetts, you can enroll in whichever one you wish. You don't have to go through medical underwriting, meaning the insurance companies cannot deny you overage or increase your rates due to pre-existing or current health conditions. This is why it's so important to do your research and figure out which plan you want before you become eligible. If you choose a supplement plan that isn't the best fit for you and then want to switch later down the road, you might not be able to. Some supplement plans pay for all of the twenty percent coinsurance remaining from the Original Medicare coverage, while others only pay for fifty or seventy-five percent of that. Some supplement plans are quite comprehensive with their coverage, and others are far more basic. Failing to choose the right supplement plan during Massachusetts's enrollment window could end up being a costly mistake.

Failing To Sign Up For Medigap On Time in Massachusetts

Failing to sign up for a Medicare supplement plan at the right time is one of the most significant mistakes a person can make. As you probably already know, Original Medicare only pays for 80 percent of covered services in most cases. Additionally, there's no out-of-pocket maximum. This means if you have a $200,000 surgery, you would be responsible for 20 percent of that! That's where the Medicare supplements come in. Many of them cover the entire 20 percent that Medicare leaves you responsible for. However, if you don't sign up on time, you run the risk of not being able to sign up ever. During the Medicare Supplement Open Enrollment period, insurance companies are not permitted to deny you coverage based on pre-existing or current health conditions. However, if you fail to sign up on time, you will have to go through medical underwriting, where they will be permitted to make a decision based on your health status. They can also charge you a higher monthly premium. Therefore, if you're lucky enough to be able to purchase the plan you wish, you could have to pay a significantly increased price because of this mistake.

Not Understanding Your Out-Of-Pocket Costs

In the state of Massachusetts, Original Medicare pays for a large portion of your covered medical costs. However, there's still a portion that you will be responsible for. If you're not aware of this, it could come as quite a surprise to you when you receive your bill after receiving medical services. In order to be prepared for all of your out-of-pocket costs, it's essential to understand what you're facing.

Massachusetts Medicare Premium: The premium is the monthly fee you're responsible for in order to keep your plan active. Most people are able to enroll in Medicare Part A without having to pay a premium, but some people are required to pay a monthly fee. There's also the Medicare Part B premium ($148.50 per month as of 2021 for most people, depending on income), the Part D monthly premium ($33.06 for most people in 2021, depending on income), and your Medicare Supplement premium. If you're enrolled in a Medicare Advantage Plan, you may or may not have a monthly premium.

  • Massachusetts Medicare Deductible: The deductible is the amount of money you have to pay before Medicare starts helping you pay for your healthcare costs. 
  • Massachusetts Medicare Copayment: The copayment is a fixed amount of money that you have to pay when you receive certain services. For example, every time you see a doctor or a specialist, you may have to pay a copayment unless Medicare fully covers the services, or you have a Medicare Supplement plan that covers this cost.
  • Massachusetts Medicare Coinsurance: This is the amount of money you have to pay after Medicare pays their portion. For most covered services, this is 20 percent. You can offset this by enrolling in a Medicare Supplement plan.

Lastly, you want to make sure you're familiar with assignments. When a medical professional accepts Medicare assignment, this means they are willing to accept the amount of payment on Medicare's fee schedule for whichever service they are performing. If the provider doesn't accept assignments, they can charge you up to 15 percent extra, referred to as an excess charge. 

Assuming You Live in Massachusetts and Can't Afford Medicare

Many people wrongly assume that they can't afford Medicare, so they don't bother looking into it or researching it. This is definitely a mistake. If you need health insurance, but you have a limited income, there are steps you can take that can make it more affordable for you.

Massachusetts Medicare Savings Programs: These savings programs can help you pay the Part B monthly premium and may help you cover some other costs as well. (link to Medicare Medicaid Plans Overview Article)

Massachusetts Extra Help: Extra help is a federal program that can help pay for some of your prescription drug costs

Massachusetts Medicaid: If you are struggling to afford Medicare, and you also meet the income requirements for Medicaid, you might be dual-eligible. In this case, Medicare will be your primary payer, and Medicaid will pick up some or all of the remaining costs.

Failing To Sign Up For Original Medicare On Time in Massachusetts (For Any Reason)

Timing is everything, and that's no different when we're talking about Medicare. When you become eligible for Medicare, you must enroll on time in order to avoid any late penalties unless you qualify to delay enrollment without penalty. Your Initial Enrollment Period for Original Medicare is a 7 month period. If you fail to enroll during this time, you could end up paying a late fee – forever. In addition to the late penalty, you could also end up without health coverage for several months, which is a dangerous position to be in.

Enroll Medicare Can Help With All Of Your Massachusetts Medicare Needs

If you live in Massachusetts, whether you're already enrolled in Medicare, or you're about to become eligible, and you want to make sure you don't miss your chance, Enroll Medicare is here to help. We can assist you in choosing the right plan at the best price. Our goal is to make it as simple as possible for you to take control of your health. We have expert support staff who are always available to help you with all of your Medicare needs. Don't hesitate to contact us today!


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