What You Need to Know
Medicare Advantage plans have to offer the same basic protections as Original Medicare.
Most Medicare Advantage plans in Minnesota provide prescription drug coverage.
You can join a Medicare Advantage plan during one of the enrollment periods each year.
If you qualify for Original Medicare, or Medicare Part A (hospital care) and Medicare Part B (outpatient care), you may be wondering if the federal program offers enough coverage. Original Medicare won’t cover all of your medical expenses or prescription drugs. It also doesn’t limit your out-of-pocket costs.
One alternative could be a Medicare Advantage (MA) plan, or Medicare Part C. These plans are offered by private insurers that Medicare pays to provide at least the same coverage as Original Medicare except hospice care, which stays covered under Medicare Part A. Most MA plans include Medicare prescription drug coverage and a limit on your out-of-pocket expenses.
What Types of Medicare Advantage Plans Are Available in Minnesota?
Many of Minnesota’s Medicare Advantage plans work with networks of doctors and healthcare facilities to keep the costs of services more affordable. If you use non-network providers, costs will often be higher. The different types of plans in Minnesota are:
- Health Maintenance Organization Point-of-Sale (HMO POS): With most HMO plans, you must use in-network doctors for your care. If you use out-of-network doctors, you’ll face higher out-of-pocket costs except in emergencies. You’ll have to pick a primary care physician (PCP) and get referrals to see specialists.1
- Preferred Provider Organization (PPO): With a PPO plan, you won’t have to choose a PCP, get referrals for specialists or be limited to in-network doctors. However, you’ll likely pay more if you go to an out-of-network doctor.2
- Special Needs Plans (SNP): SNPs are for people with specialized health needs. Like other Medicare Advantage plans, SNPs are available through Medicare-approved private insurance companies and vary by county.3 Minnesota does not offer a chronic condition SNP (C-SNP). The two types of SNPs in Minnesota are:4
- Dual Eligible SNP (D-SNP): These plans are available if you’re eligible for Medicare and Medical Assistance (Minnesota Medicaid services) and are either over age 65 or age 18 through 64 with a disability.
- Institutional SNP (I-SNP): You qualify if you live in a skilled nursing facility or other institution or if you need in-home nursing care.
- Private Fee-for-Service (PFFS): You won’t need a PCP, and you can visit any Medicare-approved healthcare provider that accepts your plan. Your plan determines how much it will pay for medical services and how much you’ll pay for care.5
- Medicare Cost Plans: In-network providers bill the plan for services with no excess charges. You don’t need a PCP or referrals for specialists, but the plan has to refer you to any out-of-network providers, in which case Medicare pays. After changes to federal guidelines, Medicare Cost plans are only available in 21 Minnesota counties in 2021.6
- Medical Savings Account (MSA): Some MSA plans are available in Minnesota. They combine a high-deductible insurance plan with a medical savings account that you use to cover your healthcare costs. They cover the same services as MA plans, but not prescription drugs.7
You’ll save money with most MA plans by using in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
To get prescription drug coverage in Minnesota with Original Medicare, you’ll have to buy a separate Medicare Part D plan. Most Medicare Advantage plans (except for some Medicare Cost, MSA and PFFS plans) include prescription drug coverage.
When selecting a Medicare Advantage plan, be sure your prescriptions are included on the plan’s list of covered drugs, known as the drug formulary. If your Medicare Advantage plan covers prescription drugs, you can lose that plan by buying a Part D plan.
How Do You Choose Medicare Advantage Plans in Minnesota?
First, check if your doctors and hospitals are listed on the plans you’re considering and whether they’re in-network or out-of-network. Then compare the costs and benefits of different Medicare Advantage plans in Minnesota, including:
- Premiums: Your monthly cost for health insurance in addition to the Medicare Part B premium ($148.50 for most people in 2021). Zero-premium plans might be an option, but other costs under those plans (like deductibles and coinsurance) could cost more.
- Other Costs:
- Deductible: Your out-of-pocket costs for healthcare services before your plan starts paying each year.
- Coinsurance: This set percentage of the total cost is your share of the cost of a service.
- Copayment: The fixed price you pay for a specific service.
- Out-of-pocket maximum: The total amount of out-of-pocket expenses you pay each year, except for premiums.
- Plan Benefits:
- Vision: Covers frames and routine vision exams.
- Dental: Covers teeth cleaning and checkups.
- Telehealth: Covers remote or virtual visits.
- Additional Perks: Many Minnesota Medicare Advantage plans cover part or all of your gym memberships or fitness classes.
Vision and Dental
Most Medicare Advantage plans also offer vision and dental coverage.
When and How Do You Enroll in a Medicare Advantage Plan in Minnesota?
- Initial Enrollment Period (IEP): You can sign up for a Medicare Advantage plan when you enroll in Original Medicare during the seven months around your 65th birthday.
- Annual Open Enrollment Period (or Annual Election Period): You can join, switch or disenroll from a Medicare Advantage plan from October 15 to December 7 each year. New coverage is effective January 1 of the following year.
- General Enrollment Period: If you enroll in Medicare during this period (January 1 – March 31), you can sign up for a Medicare Advantage plan between April 1 and June 30. Coverage begins July 1. Premium penalties may apply.
- Medicare Advantage Open Enrollment Period (OEP): From January 1 to March 31 each year, if you’re enrolled in an MA plan, you can switch to a different MA plan or return to Original Medicare. Also, if you enroll in a Medicare Advantage plan during your IEP, you can change that plan or switch back to Original Medicare one time only during the first three months of enrolling in Medicare Part A and B.9
- Special Enrollment Period (SEP): Under certain circumstances, you can disenroll, join or switch to a different plan outside of regular enrollment periods.10 Reasons include:
- You moved from the plan’s service area.
- You get your healthcare coverage from an employer or union health plan.
- You are losing your coverage, whether from a job or Medicaid.
- Your plan is being discontinued or is leaving the Medicare program.
- You need an SNP after being diagnosed with a health condition.
After signing up, you can replace Original Medicare with a Medicare Advantage plan. To qualify, you have to live within the plan’s service area. Starting in 2021, you can join an MA plan with end-stage renal disease.
Who Has Signed Up for Medicare Advantage in Minnesota?
Around 580,000 of Minnesota’s 1,200,000 Medicare-eligible seniors have signed up for Medicare Advantage plans. That is a penetration rate of about 50%, much higher than the national average of 39%11 and among the highest MA penetration rates in the country.
How Much Do Medicare Advantage Plans Cost in Minnesota?
How much Medicare Advantage coverage will cost depends on your plan type and where you live. For example, one ZIP code in Minneapolis offers 41 plans with monthly premiums ranging from $0 to $199.13 A ZIP code in Rochester has 17 available plans with premiums between $0 and $217.14 Be sure to consider costs like deductibles and copays as well when comparing different plans.
What If You Want to Change Your Medicare Advantage Plan?
You can change your Medicare Advantage plan in Minnesota during any open enrollment period each year. Just sign up for a new plan. When your new plan starts, your old plan will be canceled automatically.
What Are the Alternatives to Medicare Advantage?
The most common alternative to Medicare Advantage in Minnesota is to stay with Original Medicare.
If you’re worried about out-of-pocket costs, there’s an additional option to consider. You can cover expenses not paid by Original Medicare by buying a Medicare Supplement insurance plan, or Medigap policy, from a private insurer. You’ll still need a stand-alone prescription drug plan (Medicare Part D).
PACE (Program of All-Inclusive Care for the Elderly) isn’t available in Minnesota at this time.
What Medicare Resources Are Available in Minnesota?
The Senior LinkAge Line at (800) 333-2433 is Minnesota’s State Health Insurance Assistance Program (SHIP). It provides no-cost, objective, comprehensive help with Medicare through the Minnesota Board on Aging.
The federal government oversees Medicare Advantage and Part D plans.15 The Minnesota Department of Commerce and the federal government both regulate Medicare Cost plans. Call (800) 657-3602 or email for consumer protection issues.
If you have Medicare, you might qualify for the Medicare Savings Programs. These programs help people living on limited income pay premiums, deductibles, coinsurance and copayments. Download an application or call the Senior LinkAge Line at (800) 333-2433.
If a Medicare Advantage plan in Minnesota is the best Medicare option for you, compare the coverage and costs of the plans in your area. Be sure you know which plan you want once you’re eligible to sign up.