Minnesota Medicare Advantage Plans | Coverage in the North Star State

What Are Medicare Advantage Plans in Minnesota?

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans provide extra benefits such as dental, vision, hearing, telehealth, and fitness memberships.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65. Others qualify earlier due to disability or conditions such as ALS or ESRD. Make sure to review key enrollment periods to avoid penalties or gaps in coverage.

What Types of Medicare Advantage Plans Are Available in Minnesota?

Minnesota offers a variety of Medicare Advantage plan types:

• Health Maintenance Organization – Point-of-Sale (HMO-POS): Requires in-network care and referrals for specialists. You must choose a primary care physician.
• Preferred Provider Organization (PPO): Offers more flexibility. You can use out-of-network providers, though at a higher cost. No referrals required.
• Private Fee-for-Service (PFFS): Allows you to see any Medicare-approved provider who accepts the plan’s terms. No referrals needed.
• Special Needs Plans (SNPs):
  • I-SNPs: For individuals in institutional care or needing nursing services.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid. These plans often include enhanced care coordination, drug coverage, and extra benefits at low or no cost.
  • Note: Minnesota currently does not offer Chronic Condition SNPs (C-SNPs).
• Medical Savings Accounts (MSAs): Pair a high-deductible plan with a medical savings account funded by your insurer. MSAs typically do not include prescription drug coverage.
• Medicare Cost Plans: Available in limited counties, these plans offer flexibility to see out-of-network providers with coordination through Medicare.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, MSAs, some PFFS plans, and Medicare Cost Plans may not.

If your plan doesn’t offer drug coverage, you may:

• Enroll in a separate Part D plan (if your MA plan type allows it).
• Face a penalty if you delay enrollment and lack other creditable prescription drug coverage.

Always check that your prescriptions are on the plan’s drug formulary.

How Do You Choose a Medicare Advantage Plan?

Before choosing a plan, understand all Medicare Advantage costs:

• Premiums: Many plans offer $0 premiums, but you’ll still pay the Part B premium.
• Deductibles, Coinsurance & Copays: These vary by plan and service.
• Out-of-Pocket Maximums: All MA plans include a cap on your yearly medical expenses.
• Extra Benefits: Look for plans with vision, dental, hearing, telehealth, fitness memberships, and over-the-counter allowances.

Check whether your doctors and preferred hospitals are in-network before enrolling.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: Begins 3 months before your 65th birthday month and ends 3 months after.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop an MA plan.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Part B during this period.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Change MA plans or switch back to Original Medicare.
• Special Enrollment Periods: For situations such as:
  • Moving out of your plan’s service area
  • Losing employer or union coverage
  • Plan discontinuation
  • Newly diagnosed health conditions

What If You Want to Change Your Medicare Advantage Plan?

You may switch plans during:

• Annual Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Your new plan will automatically replace your existing one once it takes effect.

What Are Medicare Resources in Minnesota?

Minnesota provides several local resources for Medicare beneficiaries:

• Senior LinkAge Line (Minnesota SHIP Program): Offers free Medicare counseling. Call (800) 333-2433 for assistance.
• Minnesota SMP Program: Educates beneficiaries on identifying and preventing Medicare fraud.
• Minnesota Department of Commerce: Handles Medicare-related complaints.
• For low-income residents, Medical Assistance (Minnesota Medicaid) may help with medical costs. Visit Minnesota DHS or call (800) 657-3739 for details. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

• These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans (Medigap) help pay for out-of-pocket costs not covered by Original Medicare, including copays, coinsurance, and deductibles.

• You must have Medicare Parts A and B to purchase a plan.
• The best time to enroll is during the six-month Medigap Open Enrollment Period (when you enroll in Part B).
• Medigap does not cover prescription drugs—consider a standalone Part D plan.
• There are 10 standardized plans; the most popular are Plans F, G, and N.
• Medicare Supplement Plan G had the highest enrollment in 2023 and is among the fastest growing.
• Plan F is no longer available to those newly eligible for Medicare as of 2020.

Learn more about Medicare Supplement in Minnesota.

Next Steps

If a Medicare Advantage plan in Minnesota aligns with your healthcare needs and budget, compare available plans in your ZIP code. Review costs, provider networks, and added benefits—then get ready to enroll during the appropriate time frame.