Massachusetts is ranked 6th among the US states with the highest median household income. However, 11.1% of the state’s residents still live under the poverty line, and they may not be able to afford the average cost of monthly premiums pegged at $554. To alleviate this burden, several programs exist to provide more affordable options, and among the most popular is Massachusetts Medicare Insurance.
Medicare is a federally-funded program designed to give more accessible health insurance coverage to people over 65, although younger applicants with certain disabilities may also be accepted into the program. The state of Massachusetts also offers certain assistance programs for Medicare beneficiaries in the state.
One way to obtain Medicare coverage is to apply for Original Medicare, which is administered directly by Medicare. This Original Medicare covers Part A (hospital services including inpatient care) and Part B (medical services including preventive services and durable medical supplies).
Medicare Part A normally does not require the payment of monthly premiums, but Medicare Part B does. Both parts have deductibles, coinsurance, and copayments.
The beneficiaries of Original Medicare may obtain Medicare Supplement insurance, which is also known as Medigap. These are available from private carriers approved by Medicare, or from employers. These supplementary plans can provide additional coverage for health care services that are not covered by Original Medicare. Other plans may also cover the out-of-pocket costs of Medicare, including deductibles and copays.
One type of supplemental plan is called Medicare Part D, which covers the costs of prescription medication. These are valuable additions to Original Medicare coverage, as it will cover the cost of outpatient prescription drugs.
Medicare Part C refers to the Medicare Advantage Plans that are also available from private companies approved by Medicare. These come with a monthly premium, but they do not cover just the services that are covered by Medicare Part A and Part B.
They may offer additional benefits that are not part of Original Medicare. Some plans may also have Medicare Part D coverage for prescription medication.
In Massachusetts, several types of Medicare Advantage Plans are available commercially. These can be Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPO), Point of Service (POS) which may use out-of-network Medicare providers, Private Fee-for-Service (PFFS), or Special Needs Plans (SNPs).
In Massachusetts, the Medicaid program is called MassHealth. However, those who are not receiving MassHealth benefits may receive help from the Medicare Savings Program to help cover the costs of premiums, as well as the deductibles and other out-of-pocket expenses for Medicare Part A and Part B. An applicant can be enrolled in any of the MSPs provided certain requirements are met, including income and asset limits.
The Qualified Medicare Beneficiary Program (QMB) pays for the premiums of Part A and Part B, along with the deductibles, coinsurance, and copays. To qualify in 2018, an individual’s monthly income must be less than $1,032 while a married couple cannot have a combined income of more than $1,392.
The Specified Low-Income Medicare Beneficiary (SLMB) program covers the cost of Medicare Part B premiums. An individual can qualify with a monthly income of less than $1,234 while the combined monthly income of a married couple cannot be more than $1,666.
There’s another MSP program for Qualified Individuals (QI) which also pays for Part B premiums. Applications are granted on a “first come, first served” basis due to funding limitations. To qualify, an individual needs to earn less than $1,386 a month while the limit for a married couple is limited to $1,872 per month.
The payment for Medicare Part A premiums is covered by the program for Qualified Disabled and Working Individuals (QWDI) program. Among the requirements is a monthly income of $4,132 for an individual. Those who are living with a spouse have a combined income limit of $5,572.
The QMB, SLMB, and QI programs have an asset limit of $7,560 for individuals and $11,430 for married couples. The QDWI program limits assets to $4,000 for individuals and $$6,000 for married couples.
Finally, there is the Extra Help Program (Low-Income Subsidy) that can provide subsidies for Medicare Part D. These also come with income and resource limits for individuals and married couples.
Details about Medicare can be confusing. Fortunately, residents in Massachusetts can get answers and counselling from the SHINE (Serving the Health Insurance Needs of Everyone) Program. This is absolutely free and completely confidential.