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Medicare Advantage in Minnesota

Medicare beneficiaries in Minnesota may have many Medicare Advantage plan options available, depending on where they permanently reside.

How Medicare Advantage works in Minnesota

Medicare Advantage (Part C) is another way to receive your Medicare benefits; you get the benefits through private insurance companies, but these companies must follow Medicare rules. If you have Medicare Advantage, you’re still enrolled in the Medicare program, but you’ll interact directly with your insurance company, not the federal government.

All Medicare Advantage plans are required to offer at least the same level of coverage as Original Medicare, Part A and Part B, but many offer additional benefits not included in Original Medicare. Depending on the specific plan, you may have coverage for vision, dental, health wellness programs, or prescription medications. If you need hospice care, you’ll be covered through Original Medicare, even if you’re in a Medicare Advantage plan. Although specific benefits vary by plan, Medicare Advantage generally works the same way in all states, including Minnesota.

All Medicare Advantage members must continue to pay the Part B premium, in addition to any premium the plan requires.

Eligibility rules for Medicare Advantage in Minnesota are the same as for other states. To enroll in Medicare Advantage, you must:

  • Have Original Medicare, both Part A and Part B.
  • Live in the service area of the plan you’re considering.
  • Not have end-stage renal disease (ESRD), in most cases. There are a few exceptions. If you have ESRD and you’d like to enroll in Medicare Advantage, contact Medicare and see if you qualify (contact information is at the end of this article).

You can enroll in a Medicare Advantage plan during the following periods:

  • Initial Coverage Election Period: This is the period when a beneficiary is first eligible for Medicare Advantage. It starts three months before you have both Medicare Part A and Part B and ends on whichever date falls later: the last day of the month before your Part A and Part B start date, or the last day of your Initial Enrollment Period for Part B.
  • Annual Election Period: During the Annual Election Period, you can switch from Original Medicare to Medicare Advantage, add prescription drug coverage, or disenroll from Medicare Advantage. This period occurs from October 15 to December 7.
  • Medicare Advantage Disenrollment Period: During this period, you can disenroll from Medicare Advantage and return to Original Medicare. This period occurs from January 1 to February 14 every year.
  • Special Election Period: Outside of the annual enrollment period, you can only make changes to your Medicare Advantage coverage if you qualify for a Special Election Period. Certain situations, such as moving out of a plan’s service area, may trigger a special enrollment.

Types of Medicare Advantage plans in Minnesota

Minnesota beneficiaries may have several choices when it comes to Medicare Advantage plans, depending on what’s available in their area and whether they meet certain eligibility requirements:

Some types of Medicare Advantage plans include:

  • Health Maintenance Organization (HMO): Members are usually required to use providers in the plan’s network to be covered (except in emergencies). You’ll have a primary care doctor and need a referral to see a specialist.
  • Preferred Provider Organization (PPO): Members typically have lower costs if they use providers in a preferred network, but can also go out of network. You won’t have a primary care doctor, and you generally won’t need a referral to see a specialist.
  • Health Maintenance Organization Point-of-Service (HMO-POS): This is a type of HMO plan that lets you use out-of-network providers for a higher cost. You’ll typically still have a primary care doctor, but you may not need a referral to see a specialist.
  • Private Fee-for-Service (PFFS): The insurance company, not Medicare, sets payment terms. In some PFFS plans, members can use any provider that accepts the plan’s payment terms, and providers agree to treat patients on a case-by-case basis. You’ll only be responsible for the plan’s copayment and coinsurance requirements, but providers can charge up to 15% above the Medicare-approved amount.
  • Special Needs Plan (SNP): Enrollment is limited to beneficiaries who meet certain criteria, such as living in an institution, having certain chronic illnesses, or being eligible for Medicaid. SNPs always come with prescription drug coverage.
  • Medical Savings Account (MSA): This is a high-deductible Medicare Advantage plan combined with a medical savings account. Your plan deposits money into your savings account, which can be used to pay for health expenses, tax-free. The plan doesn’t pay for Medicare-covered services until you reach the deductible.

Some Medicare Advantage (Part C) plans include prescription drug coverage. These are called Medicare Advantage Prescription Drug plans. With these plans, you get your Part C and Part D benefits under a single plan. A Medicare Advantage Prescription Drug plan can be any of the above types, except for an MSA.

If you want drug coverage with a Medicare Advantage plan, you must get it through that plan; you can’t add a stand-alone Medicare Part D prescription drug plan to Medicare Advantage in most cases. An exception is if you’re in an MSA or PFFS plan. MSA plans don’t ever come with drug coverage, and not all PFFS plans include it. If you’re in an MSA plan or a PFFS plan that doesn’t include drug benefits, you can enroll in a stand-alone Medicare prescription drug plan (Part D).

Comparing Medicare Advantage plans available in Minnesota

As a Medicare beneficiary, it’s important to carefully compare all of your options when choosing a Medicare Advantage plan. Plans may not be offered in every location, so if you’re searching for Medicare Advantage plans in Minnesota, always make sure to input your zip code to view plans that service your area.

It’s especially important to shop around and compare prices if you need prescription drug coverage. Each plan determines the prices for drugs in its formulary, so costs can be very different across insurance companies, even to cover the same drugs.

Remember that even if you’re happy with your current coverage, costs and benefits can change from year to year. This means it’s nearly always worth it to look around and make sure your coverage still meets your current needs.

When searching for a Medicare Advantage plan, pay attention to not just the premium cost, but other cost-sharing expenses, like copayments, coinsurance, and deductibles. Some plans offer premiums as low as $0, but you’ll still need to keep paying your Part B premium.