The federal Medicare program (Parts A through D and the 2026 figures), Medicaid, and long-term care basics are covered in the national Senior and Special Needs guide. Massachusetts is one of the states that doesn't use the federal lettered Medigap plans. Its Medicare supplement law (M.G.L. c.176K; 211 CMR 71) has its own plans, community rating and an annual open enrollment period. Long-term care is governed by c.176U.

Medicare supplement

Plans (211 CMR 71.08 to 71.09):

• Massachusetts offers Core, Supplement 1 and Supplement 1A instead of the lettered plans.
• Supplement 1 may not be sold to people who first became eligible for Medicare on or after January 1, 2020. They get Supplement 1A instead.

Eligible person (c.176K s.1). Someone eligible for Medicare who lives in Massachusetts at least six consecutive months of each calendar year.

Pricing:

• Community rating (s.7). Everyone covered under a policy pays the same premium, regardless of age, sex, health status or occupation.
• Late enrollees. A late-enrollee or upgrade surcharge may be no more than 15% a year, for no more than three years.
• Rate increases. A requested increase of more than 10% is communicated to insureds at least 90 days before it takes effect.

Enrollment:

• No waiting periods or preexisting condition exclusions are allowed (s.3(b)).
• Initial eligibility. A carrier can't deny or price-discriminate against an eligible person who applies within six months of first becoming eligible (s.3(c)).
• Annual open enrollment runs February 1 through March 31, with coverage effective June 1 (s.3(d); 211 CMR 71.10(5)).

Replacement (211 CMR 71.14). The replacement notice tells the applicant they have 30 days to decide, at no cost, whether to keep the new policy.

Long-term care (M.G.L. c.176U)

Renewal and termination. A policy can't be cancelled or nonrenewed because of the insured's age or deteriorating mental or physical health (s.3(a)).

Benefit conditions:

• A preexisting condition is one treated or recommended within six months before coverage. It may be excluded only for losses beginning within six months after coverage starts (s.3(b)).
• Benefits can't be conditioned on a prior hospitalization (s.3(c)).

Sales and delivery:

• Outline of coverage. A producer delivers it before presenting the application (s.3(f)).
• Free look. The policy may be returned within 30 days of delivery, and the refund is due within 30 days (s.3(e)).

Contestability (s.4):

Other rules:

• Nonforfeiture (s.5). The buyer must be offered a nonforfeiture benefit. If they decline, a contingent benefit upon lapse applies after substantial rate increases.
• Claim denials (s.3(k)). After a written request following a denial, the insurer explains the denial within 60 days.
• Producer training (s.6(b)). Producers complete 8 hours before selling LTC, then 4 hours every 24 months. The hours count toward CE.

Common exam traps

• Massachusetts uses Core, Supplement 1 and Supplement 1A, not lettered plans. Supplement 1 is closed to people newly eligible since 2020.
• Medigap is community rated, with no preexisting condition exclusions.
• Annual Medigap open enrollment is February 1 to March 31, with coverage effective June 1.
• A late-enrollee surcharge is 15% a year for up to three years.
• The LTC free look is 30 days. After two years, an LTC policy is contestable only for knowing, intentional misrepresentation.
• LTC training is 8 hours, then 4 hours every 24 months.