Massachusetts Medicare Supplement Insurance
This chapter covers the Massachusetts rules for Medicare supplement insurance. Massachusetts writes its own rules for these policies, and it uses its own standardized plans rather than the national lettered plans. The next chapter covers MassHealth and long-term care insurance.
Medicare supplement policies (Mass. Gen. Laws ch. 176K; 211 CMR 71.00)
Open enrollment (Mass. Gen. Laws ch. 176K, § 3; 211 CMR 71.10)
Massachusetts Medicare supplement coverage is guaranteed issue. No carrier may at any time deny or condition the issuance of a Medicare supplement policy, or charge more, to an eligible person because of age, health status, claims experience, receipt of health care or medical condition (Mass. Gen. Laws ch. 176K, § 3(a)). Nor may it require genetic tests or genetic information (211 CMR 71.10(1)).
An eligible person under chapter 176K is a person who lives in Massachusetts at least six consecutive months of each year, is eligible for or enrolled in Medicare hospital and physician coverage because of age or disability, and is not eligible for employer-sponsored coverage. A person eligible solely because of end-stage renal disease is excluded (ch. 176K, § 1).
Open enrollment controls when a carrier must sell to an eligible person:
| Enrollment period | When |
|---|---|
| Annual open enrollment | February 1 through March 31, for coverage effective June 1 (or when Medicare first takes effect, if earlier). Every carrier must make all its policies available (ch. 176K, § 3(d); 211 CMR 71.10(5)) |
| Initial eligibility | The six months after a person becomes initially eligible for coverage: on first enrolling in Medicare Part B, on losing employer coverage through termination of employment or employer bankruptcy, on moving out of an HMO’s service area, or on becoming a Massachusetts resident (ch. 176K, §§ 1, 3(c)) |
| Part B enrollment at 65 | The six-month period beginning with the first month a person is both 65 or older and enrolled in Medicare Part B (211 CMR 71.10(3)) |
| Other times | A carrier may also sell at other times of the year; an optional open enrollment period must last at least 60 consecutive days (ch. 176K, § 3(e); 211 CMR 71.10(8)). It may instead keep continuous open enrollment, filed with the Commissioner 30 days before it begins and ended only on 60 days’ notice to the Commissioner, selling every policy to every eligible person who applies (211 CMR 71.10(9)) |
Carriers must send insureds written notice of the annual open enrollment no later than January 1 (211 CMR 71.10(5)(b)).
Standardized Medicare supplement plans (211 CMR 71.08)
The only Medicare supplement options that may be issued in Massachusetts are the Medicare Supplement Core, Medicare Supplement 1 and (since January 1, 2020) Medicare Supplement 1A plans, and Medicare Select versions of them. No other options may be issued on or after January 1, 2006 (211 CMR 71.08(2); 71.21(9)). The national lettered plans are not among them. Federal law allows this: the Secretary may waive the lettered-plan standardization for states that had their own alternative simplification program in place on November 5, 1990 (42 U.S.C. § 1395ss(p)(6)).
- Every issuer must offer the Core plan to each prospective policyholder, and may also offer the other plans the person is eligible for (211 CMR 71.08(7)).
- Supplement 1 may not be offered to anyone who becomes Medicare-eligible on or after January 1, 2020. It is available only to a person who turned 65, or first became eligible because of age, disability or end-stage renal disease, before that date (211 CMR 71.08(2)(b); 71.10(3)). A company that offers Supplement 1A to people eligible before 2020 must also offer them Supplement 1 (71.08(2)(b)).
- A person who newly enrolls in Supplement 1 may not switch to the same company’s Supplement 1A until covered under Supplement 1 for at least 12 months (211 CMR 71.08(8)).
The Division of Insurance’s plan comparison shows what each plan covers (Division of Insurance, Medicare Supplement Plans Offered in Massachusetts 2026):
| Benefit | Core | Supplement 1 | Supplement 1A |
|---|---|---|---|
| Basic benefits: Part A hospital copayments for days 61–90 and 91–150; 365 additional lifetime hospital days paid in full; Part B coinsurance (in most cases 20% of the approved amount); first 3 pints of blood | Yes | Yes | Yes |
| Part A deductible | Yes | Yes | |
| Skilled nursing facility coinsurance, days 21–100 | Yes | Yes | |
| Foreign travel | Yes | Yes | |
| Part B deductible | Yes | ||
| Days in mental health hospitals beyond Medicare’s 190 lifetime days | 60 per calendar year | 120 per benefit period | 120 per benefit period |
Benefit standards, pre-existing conditions and renewability (211 CMR 71.06–71.08; Mass. Gen. Laws ch. 176K, § 3(b))
Benefit standards (211 CMR 71.08). A Medicare supplement policy may not pay sickness losses on a different basis than accident losses. It must change benefits automatically to match changes in Medicare’s deductibles and copayments, and may not duplicate Medicare benefits. It may not end a spouse’s coverage solely because of an event that ends the insured’s, other than nonpayment (211 CMR 71.08(1)). On the policyholder’s death, the issuer must refund the unearned premium paid quarterly, semiannually or annually (71.08(1)(h)). No policy sold after December 31, 2005 may pay for drugs covered by Medicare Part D (211 CMR 71.06(4)).
Pre-existing conditions (Mass. Gen. Laws ch. 176K, § 3(b)). A Massachusetts Medicare supplement policy may contain no waiting period and no pre-existing condition limitation or exclusion at all (ch. 176K, § 3(b); 211 CMR 71.06(1)).
Renewability (211 CMR 71.07). Every policy must be at least guaranteed renewable: the issuer may not cancel or nonrenew it for any reason other than nonpayment of premium or material misrepresentation, and never solely because of health status, though a hospital or medical service corporation need not keep covering a policyholder who moves out of state (211 CMR 71.07(1), (3)). Guaranteed renewable lets the issuer change premiums, but no other provision. The renewability provision appears on the first page and states any right to change premiums (71.03; 71.07(2)). Termination of a policy is without prejudice to a continuous loss that began while it was in force (71.07(3)(f)).
At the policyholder’s request, benefits and premiums are suspended for up to 24 months (longer if the issuer allows) while the person is entitled to Medicaid, if the issuer is notified within 90 days of becoming entitled. The policy is reinstated if the person asks within 90 days of losing Medicaid (211 CMR 71.07(3)(g)).
Massachusetts regulations and required provisions (211 CMR 71.13–71.19; 211 CMR 40.15)
Advertising (211 CMR 71.17). Every Medicare supplement issuer must file each advertisement intended for use in Massachusetts (written, radio or television) with the Commissioner no later than 15 days before it is used.
Standards for marketing (211 CMR 71.16). Every issuer or other entity marketing Medicare supplement insurance must set up marketing procedures to make sure comparisons are fair and accurate, excessive insurance is not sold, the applicant’s existing accident and sickness coverage is identified, and buyers understand the policy and Medicare’s benefits (71.16(1)). The first page of the policy must say: “Notice to Buyer: This Policy may not cover all of your medical expenses.” (71.16(1)(c)). Cold lead advertising (marketing that hides that its purpose is to solicit insurance and that a producer or issuer will make contact), twisting and high-pressure tactics (force, fright, threat or undue pressure) are prohibited, and the procedures for checking compliance must be auditable (71.16(2), (3); 71.03). The terms “Medicare Supplement” and “Medigap” may be used only for a policy that complies with 211 CMR 71.00 (71.16(4)).
Permitted compensation (211 CMR 71.18). A producer may be paid for selling a Medicare supplement policy only if the first-year commission is no more than 200% of the second-year commission. Renewal commissions must equal the second-year amount and be paid for at least five renewal years. When an existing policy is replaced, the producer may receive no more than the renewal compensation the replacing issuer pays (71.18).
For example, if the second-year commission on a policy is $100, the first-year commission may be no more than $200.
Appropriateness of recommended purchase and excessive insurance (211 CMR 71.15). A producer or issuer recommending a purchase or replacement must make reasonable efforts to determine whether it is appropriate. A sale that would give a person more than one Medicare supplement policy is prohibited. A policy may not be issued to a person enrolled in Medicare Part C unless it takes effect after the Part C coverage ends.
Required disclosure provisions (211 CMR 71.13, 71.14; 40.15). The application must ask whether the applicant has another Medicare supplement, Medicare Advantage, Medicaid or other health coverage, or intends to replace a policy. It must tell the applicant: “You do not need more than one Medicare Supplement Insurance Policy.” The agent must list other health policies the agent sold the applicant that are in force, or that were sold in the past five years and are no longer in force (211 CMR 71.14(1), (2)). Any other accident and sickness or long-term care policy issued to a Medicare-eligible person, except disability income and the other policies 211 CMR 71.02(2) lists, must carry the notice “THIS [POLICY OR CERTIFICATE] IS NOT A MEDICARE SUPPLEMENT [POLICY OR CONTRACT].” (211 CMR 40.15(2)).
Reporting of multiple policies (211 CMR 71.19). By March 1 each year, an issuer must report to the Division (the State Rating Bureau) every Massachusetts resident for whom it has more than one Medicare supplement policy in force, with each policy or certificate number and date of issue.
Buyer’s guide (211 CMR 40.15(1); 71.13(2)(d)4.). The buyer’s guide is the Guide to Health Insurance for People with Medicare (developed by the NAIC and CMS) with a Massachusetts attachment. Every insurer selling hospital or medical expense coverage to a Medicare-eligible person must deliver it at the time of application and get an acknowledgment of receipt. A direct response insurer delivers it on request, and no later than delivery of the policy.
Outline of coverage (211 CMR 71.13). Every policy has an outline of coverage, which is not part of the policy. The issuer must give it to every applicant when the application is presented and, except for direct response, get an acknowledgment of receipt (71.13(1)(a), (b)). The outline has three parts: a cover page; the text, including premium information, disclosures and a Massachusetts Summary; and charts comparing Medicare Parts A and B with the three Massachusetts plans (71.13(2)(b), (c)). It states that neither the company nor its agents are connected with Medicare, and the Massachusetts Summary explains the ban on balance billing: a physician who agrees to treat a Medicare beneficiary may not charge or collect more than the reasonable charge the U.S. Secretary of Health and Human Services sets. The physician may collect the copayment or coinsurance, but not an amount that, with it, is more than the Medicare-approved amount (71.13(2)(c)2.). If the policy issued differs from the one applied for, a revised outline must be attached saying the coverage originally applied for has not been issued (71.13(1)(c)).
Right to return (211 CMR 71.13(1)(e)). Every policy must state that the policyholder may return it within 30 days of delivery and have the premium refunded if not satisfied for any reason. The policy is then treated as if it had never been issued (71.13(2)(c)2.).
Replacement (211 CMR 71.14). When a sale will replace Medicare supplement coverage, the issuer or agent must give the applicant, before the policy is issued or delivered, the Notice to Applicant Regarding Replacement. One copy signed by the applicant and agent goes to the applicant, and the issuer keeps another; a direct response issuer delivers the notice with the policy (71.14(4), (5)). The notice tells the applicant that the replacement policy may not contain pre-existing conditions, waiting periods, elimination periods or probationary periods, and not to cancel the present policy until the new one has arrived and the applicant is sure of keeping it (71.14(5)).
Lesson summary
- A Massachusetts Medicare supplement may never be denied or priced on age or health, and has no waiting period or pre-existing condition exclusion. Carriers must sell during annual open enrollment, February 1–March 31 for June 1 coverage, and in the six months after initial eligibility; they may sell at other times, including through continuous open enrollment (ch. 176K, § 3; 211 CMR 71.10).
- Only Core, Supplement 1 and Supplement 1A, and Medicare Select versions of them, may be sold, not the lettered plans. Every issuer must offer Core; Supplement 1 is limited to people eligible for Medicare before January 1, 2020 (211 CMR 71.08).
- Medigap rules: advertising filed 15 days before use (71.17); first-year commission at most 200% of the second year’s, renewals for five years (71.18); no sale of a second Medigap policy (71.15); multiple policies reported by March 1 (71.19); 30-day right to return (71.13); a signed replacement notice before issue (71.14); guaranteed renewable (71.07).
- The outline of coverage and the Guide to Health Insurance for People with Medicare are delivered at application, with an acknowledgment of receipt; a policy may be suspended for up to 24 months while the policyholder is on Medicaid (211 CMR 71.13, 71.07; 40.15).