Supplemental Medicare Health Insurance in Massachusetts

Medicare is offered by the federal government in the United States mainly to those aged 65 years or older. Medicare is a social health insurance program with two main parts, called A and B. Part A and Part B are often called original Medicare and feature mainly hospital and preventive benefits. There are many medical benefits that original Medicare does not offer, so many Medicare beneficiaries turn to supplemental health plans in order to fill in the holes. As of 2010, there are ten standard Medicare supplemental plans. Massachusetts, however, structures its Medicare supplements differently than most states.

While the standard supplemental Medicare plans are referred to as plans A through N, Massachusett’s Medigap policies are all named Medex. There are only two kinds of Medex plans: Medex Core and Medex Bronze. Neither are PPO or HMO plans, which require you to join a network or choose a primary care physician and obtain all referrals from her. The benefits-to-premium ratio for both kinds of Medex plans in Massachusetts is 93.7 percent, which means that for every $100 the insurance company collects in premium costs, it expects to pay out $93.70 in benefits. You must have both Medicare Part A and Part B before enrolling in either Medex policy. You must also be a resident of Massachusetts.

Both Medex Core and Medex Bronze have the same basic benefits. Medex Core stops with these basic benefits, while Bronze offers additional ones. The core benefits include the cost of the first 3 pints of blood per year, Part A and Part B Medicare coinsurance costs and an additional 365 days of hospitalization coverage after traditional Medicare benefits have been depleted. Stays in a licensed mental hospital for treatment of mental disorders is also a core Medex benefit.

Medex Bronze offers more benefits than Medex Core. The Bronze Medex plan has benefits for full coverage for foreign travel emergency medical treatment and 100 percent coverage of the Medicare Part A and Part B deductibles and coinsurance. It also has benefits for skilled nursing facility care. You also get an additional 60 days of hospitalization benefits for mental illnesses.

Neither Medex Medigap plan offers prescription drug benefits. However, you can add a prescription drub plan to your original Medicare and Medigap insurance through private insurance companies, many of which already offer Medex plans.