October 6, 2016
As a Medicare beneficiary in Minnesota, you have multiple options when it comes to how you receive your coverage. Your choices begin with whether you wish to receive your coverage through Original Medicare Part A and Part B or through Medicare Advantage (Part C). If you decide to enroll in a Medicare Advantage plan offered by a Medicare-approved private insurance company, your options will depend on which plans are available in your area.
Original Medicare is a federal program that provides health coverage for individuals 65 years old and older and some individuals with qualifying disabilities under the age of 65. In terms of costs and benefits, Original Medicare coverage in Minnesota works the same way as it does in other states. Under Original Medicare, you’re not limited to using providers in a certain network and can use any provider that accepts Medicare patients. To obtain the full value of your benefits and potentially lower your out-of-pocket expenses for covered services, you’ll want to check and make sure your provider also accepts Medicare assignment—that is, the amount Medicare will pay for a particular service, less any deductible and/or coinsurance you may owe.
Original Medicare comes in two parts, Part A and Part B.
Part A covers hospital services, including:
Part B covers medical services, including:
To be eligible for the Medicare program, you must be 65 or older and either a U.S. citizen or a legal permanent resident for at least five consecutive years. As long as you’ve worked at least 10 years, and paid Medicare taxes, you usually don’t pay a premium for Medicare Part A. However, most people pay a monthly premium for Part B. There are other cost-sharing requirements in Original Medicare, including deductibles, copayments, and coinsurance.
Original Medicare doesn’t cover everything. Prescription drugs, routine vision and dental care, hearing aids, and dentures aren’t covered. You may be able to obtain coverage for some of these services if you choose to enroll in a Medicare Advantage plan.
Most people enroll in Medicare when they’re first eligible at age 65. You can sign up during your Initial Enrollment Period, which begins three months before you turn 65, includes the month you turn 65, and ends three months later. You may qualify before age 65 if you receive disability benefits or have certain conditions, such as Lou Gehrig’s disease or end-stage renal disease.
If you’re still working and/or have coverage through an employer’s or union’s group health plan, you may choose to delay Part B enrollment to avoid paying a premium for benefits you don’t need. You can sign up for Part B later when your coverage ends or you stop working, using a Special Enrollment Period (SEP). You won’t have to pay a Part B penalty if you had health coverage based on current employment (either your own or through your spouse’s employer).
If you miss your IEP or don’t qualify for an SEP, you can still enroll in Medicare Part A and/or Part B during the General Enrollment Period (GEP). This enrollment period runs from January 1 to March 31 every year. You may have to pay a higher premium for Part A and/or Part B if you didn’t sign up when you were first eligible.
Like other states, Minnesota residents can sign up for Medicare in the following ways:
Beneficiaries in Minnesota can also choose to get Medicare coverage through private insurance companies. The specific plans and benefits available to you will depend on where you live, since not all plans are offered in every location. If you are looking online for private Medicare plans in Minnesota, always make sure to provide your zip code when comparing plans.
Medicare Part C, more commonly known as Medicare Advantage, provides another way to receive your Original Medicare benefits. Medicare Advantage plans are offered by private insurance companies that contract with Medicare. They are required to cover at least the same benefits as Original Medicare (with the exception of hospice care, which is covered by Part A); they may have other benefits as well. If you enroll in a Medicare Advantage plan, you’re still in the Medicare program; however, you will receive and use a separate membership card, pay a plan premium (if applicable), and claims will be submitted directly to the private insurance company. You’d still pay a monthly premium for Part B.
To be eligible to enroll in a Medicare Advantage plan, you must have Medicare Part A and Part B and live in the service area of the plan in which you want to enroll. Usually you are not eligible to enroll in a Medicare Advantage plan if you have end-stage renal disease (ESRD).
Medicare Advantage plans may come with prescription drug coverage (also known as Medicare Advantage Prescription Drug plan or MA-PD). People who sign up for Medicare Advantage plans that include prescription drug coverage receive their health and prescription drug benefits under one plan.
Medicare Part D is optional prescription drug coverage. This coverage is only available through Medicare-approved private insurers and doesn’t automatically come with Original Medicare. If you have Original Medicare, you can add on this coverage by signing up with a stand-alone Medicare Part D Prescription Drug Plan. You’ll probably pay a separate plan premium for a Medicare Part D Prescription Drug Plan, as well as additional costs like copayments and deductibles. You can’t enroll in a stand-alone Medicare Prescription Drug Plan if you have a Medicare Advantage Prescription Drug plan, or you’ll be automatically disenrolled from Medicare Advantage and returned to Original Medicare.
To enroll in a stand-alone Medicare Part D Prescription Drug Plan, you must have Part A and/or Part B and live in the service area of a plan that provides drug coverage. It’s important to sign up for Medicare Part D prescription drug coverage as soon as you’re eligible. Unless you have creditable prescription drug coverage (that is, prescription drug coverage that is at least as good as Medicare Part D), you may have to pay a Part D late enrollment penalty if you sign up later with a Medicare plan that offers prescription drug coverage.
Original Medicare may require many out-of-pocket costs. If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Some plans also cover benefits not included in Original Medicare, such as certain overseas emergency medical care coverage (up to plan limits).
Keep in mind that Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans.
Learn more about how Medicare plans work in Minnesota, including:
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