Preferred Provider Organization (PPO) plans: This type of Medicare Advantage plan offers more provider flexibility. PPOs typically have a preferred provider network, but you may also use out-of-network doctors if you choose, although your cost sharing may be higher. Unlike HMOs, you don’t need referrals for specialist care and you aren’t required to have a primary care doctor.
Final decisions haven’t been made on exactly which counties in Minnesota will lose Cost plans next year, the government said. But based on current figures, insurance companies expect that Cost plans are going away in 66 counties across the state including those in the Twin Cities metro. They are expected to continue in 21 counties, carriers said, plus North Dakota, South Dakota and Wisconsin.
The average cost of monthly premiums for insurance in Minnesota is $477, which may be too expensive for some of the residents in the state. However, the US federal government offers more affordable Minnesota Medicare insurance coverage for beneficiaries over the age of 65, and some workers with disabilities may qualify as well. The Minnesota state government also offers various assistance programs for Medicare beneficiaries.
If you don’t want Medicare Advantage, think about a Medigap policy (Medicare Supplement Insurance). If you get Original Medicare, you can pay an extra monthly premium to get a private Medigap policy that covers some of the expenses that Medicare Parts A and B won’t cover, such as co-insurance, copayments, and deductibles. Medigap policies do not cover prescription drugs (you need Part D for that). Learn more about Medigap policies or find one in your area.
On September 12, 2013, the Centers for Medicare & Medicaid Services (CMS) announced a new partnership with the State of Minnesota to test new ways of improving care for Medicare-Medicaid enrollees. Building on the state's Minnesota Senior Health Options (MSHO) program, CMS and Minnesota will work together to improve the beneficiary experience in health plans that maintain contracts with both CMS as Medicare Advantage Special Needs Plans and with the state to deliver Medicaid services.
Since 1997, Minnesota has provided Medicare coverage for approximately 35,000 Medicare-Medicaid eligible individuals over age 65 through the Minnesota Senior Health Options (MSHO) program. Today, the Minnesota demonstration recognizes this program stability and is focused on administrative flexibility rather than developing a new capitated system. The current demonstration will be evaluated for its ability to further promote integration. However, the longevity of the MSHO program provides for unique data analysis opportunities. MSHO claims data are a rich resource for researchers to analyze the impact of integrated care on health care outcomes for Medicare-Medicaid eligible. To that end, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) published Minnesota Managed Care Longitudinal Data Analysis which highlights the importance of providing integrated options for Medicare-Medicaid eligible individuals. It may be found at this link: https://aspe.hhs.gov/report/minnesota-managed-care-longitudinal-data-analysis
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Private insurance companies must have contracts with Medicare to offer Medicare Advantage plans and Medicare Prescription Drug Plans. Depending on the terms of the contract between the plan and Medicare, not every plan is available statewide or in all service areas. Each year, the plan must renew its contract with Medicare, so the availability of a plan in a specific service area is subject to change.
Private managed care programs for Medicare beneficiaries are particularly popular in Minnesota. Fifty-six percent of all Minnesota Medicare enrollees were enrolled in private Medicare plans in 2017, as opposed to a national average of 33 percent. Minnesota has by far the largest share of its Medicare population enrolled in private plans; the next closest state is Hawaii, where 45 percent of Medicare beneficiaries have private coverage.
People who qualify for both Medicare and MA coverage are called “dual eligibles.” Most dual eligibles do not have to pay Medicare premiums, because either MA pays them or because the person also qualifies for a Medicare Savings Program (MSP). MA, including Medical Assistance for Employed Persons with Disabilities (MA-EPD), may also help pay for Medicare co-insurance and deductibles, as well as some services Medicare doesn’t cover. That’s why you shouldn’t decline Medicare Parts B or D if you also qualify for MA.
Private managed care programs for Medicare beneficiaries are particularly popular in Minnesota. Fifty-six percent of all Minnesota Medicare enrollees were enrolled in private Medicare plans in 2017, as opposed to a national average of 33 percent. Minnesota has by far the largest share of its Medicare population enrolled in private plans; the next closest state is Hawaii, where 45 percent of Medicare beneficiaries have private coverage.
MA plans feature a network of doctors and hospitals that enrollees must use to get the maximum payment, whereas supplements tend to provide access to a broader set of health care providers, said Shawnee Christenson, an insurance agent with Crosstown Insurance in New Hope. While that might sound good to beneficiaries, supplements can come with significantly higher premiums, Christenson said.
In all but three states, Medigap plans are standardized under federal rules. But Minnesota is one of three states that have federal waivers that allow the state to do its own Medigap standardization. So instead of the ten Medigap plans (A through N) that are marketed in most states, Minnesota Medigap plans include Basic, Basic with riders, Extended Basic, and Medigap plans F, K, L, M, and N. There are also Medicare Select Medigap plans in Minnesota, just as there are in other states.
In all but three states, Medigap plans are standardized under federal rules. But Minnesota is one of three states that have federal waivers that allow the state to do its own Medigap standardization. So instead of the ten Medigap plans (A through N) that are marketed in most states, Minnesota Medigap plans include Basic, Basic with riders, Extended Basic, and Medigap plans F, K, L, M, and N. There are also Medicare Select Medigap plans in Minnesota, just as there are in other states.
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Most Americans become eligible for Medicare when they turn 65. But younger Americans gain Medicare eligibility after they have been receiving disability benefits for 24 months, or have ALS or end-stage renal disease. Thirteen percent of Minnesota’s Medicare beneficiaries were under age 65 as of 2017, versus 16 percent nationwide. On the high and low ends of the spectrum, 23 percent of Medicare beneficiaries in Alabama, Kentucky, and Mississippi are under 65, while just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.
Before enrolling in a Medicare Advantage Prescription Drug plan, it’s a good idea to check that the formulary includes your prescription medications; the formulary is a list of prescription medications covered by the plan. Formularies vary by plan, and not every medication is covered by every Medicare plan, so it’s important to double check. Keep in mind that formularies are subject to change. The formulary may change at any time. You will receive notice from your plan when necessary.
Since 1997, Minnesota has provided Medicare coverage for approximately 35,000 Medicare-Medicaid eligible individuals over age 65 through the Minnesota Senior Health Options (MSHO) program. Today, the Minnesota demonstration recognizes this program stability and is focused on administrative flexibility rather than developing a new capitated system. The current demonstration will be evaluated for its ability to further promote integration. However, the longevity of the MSHO program provides for unique data analysis opportunities. MSHO claims data are a rich resource for researchers to analyze the impact of integrated care on health care outcomes for Medicare-Medicaid eligible. To that end, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) published Minnesota Managed Care Longitudinal Data Analysis which highlights the importance of providing integrated options for Medicare-Medicaid eligible individuals. It may be found at this link: https://aspe.hhs.gov/report/minnesota-managed-care-longitudinal-data-analysis
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Other types of Medicare Supplement plans in Minnesota have different sets of basic benefits. Some have deductibles of their own, while some may pay at least part of the Medicare Part B deductible. Every Medicare Supplement plans in Minnesota either covers at least part of the Part A deductible, or lets you add a “rider” on the policy for this purpose at an additional cost.
HealthPartners is committed to helping you be your best, every day. That’s why we work with partners to help you get the care and coverage you need. We have a partnership in Iowa and Illinois with UnityPoint Health. We also have a partnership in North Dakota and South Dakota with Sanford Health. And we have a collaboration in Wisconsin with Bellin Health, ThedaCare and others through Robin with HealthPartners.
A federal law passed in 2003 created a “competition” requirement for Medicare Cost plans, which stipulated the plans could not be offered in service areas where there was significant competition from Medicare Advantage plans. Congress delayed implementation of the requirement several times until a law passed in 2015 that called for the rule to take effect in 2019.
As a result, an estimated 320,000 Medicare Cost enrollees in Minnesota needed new coverage for 2019. There are 21 counties where Medicare Cost plans continue to be available, but Medicare Cost enrollees in the rest of the state were not able to keep their Cost plans. Instead, they had the option to enroll in a Medicare Advantage plan (some were automatically enrolled in a comparable Medicare Advantage plan, although they had an option to pick something else instead), or select a Medigap plan to supplement their Original Medicare. Enrollees whose Medicare Cost plans ended have guaranteed issue rights to a Medigap plan, so they can purchase one even if they had pre-existing medical conditions. But that guaranteed-issue right only lasts for 63 days, which means Monday, March 4, 2019 is the last day these individuals can purchase a Medigap plan without having to go through medical underwriting.
As is the case nationwide, enrollment in private Medicare plans grew in Minnesota in 2018. As of December 2018, there were 581,822 Minnesota Medicare beneficiaries with private Medicare coverage, which amounts to nearly 58 percent of the state’s Medicare population. Nationwide, most people with private Medicare plans are enrolled in Medicare Advantage plans, but Medicare Cost plans are another type of private Medicare coverage, and as of 2018, Minnesota residents accounted for two-thirds of the national total enrollment in Medicare Cost plans.
A pay-per-visit health coverage plan that allows individuals to go to any doctor, hospital, or other health care supplier who accepts Medicare and who is accepting new Medicare patients. The individual is responsible for paying a deductible and copayment. Under Original Medicare, Medicare pays a portion of the Medicare-approved amount, while the individual pays for his/her share (coinsurance).
Preferred Provider Organization (PPO) plans: This type of Medicare Advantage plan offers more provider flexibility. PPOs typically have a preferred provider network, but you may also use out-of-network doctors if you choose, although your cost sharing may be higher. Unlike HMOs, you don’t need referrals for specialist care and you aren’t required to have a primary care doctor.
