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.

If you have more than one type of coverage, including MA, employer-sponsored coverage, Veterans (VA) health benefits, military (TRICARE) benefits, or any other health coverage, one coverage may pay for costs that your other coverage doesn't pay for, meaning you have to pay less out of your own pocket. If you are in this situation, make sure you understand how Medicare interacts with other types of coverage.


Medicare beneficiaries and their caregivers in Minnesota can receive free, confidential, and unbiased one-on-one health insurance counseling through the State Health Insurance and Assistance Program (SHIP). Senior Medicare Patrol (SMP) is another program which aims to empower seniors to identify, help prevent, and report instances of Medicare waste, fraud and/or abuse.
Every Medicare beneficiary in the Twin Cities metro area who is currently enrolled in a Medicare Cost Planwill have their plan end on December 31, 2018.  You will need to take action to enroll in new Medicare coverage for 2019. The phaseout of Medicare Cost Plans has been decades in the making due to the high expense of administering the plans. The decision to end the plans was signed into law more than twenty-years ago as part of the Balanced Budget Act of 1997. Since then, there have been several extensions of Medicare Cost Plans. Most recently, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended Medicare Cost Plans through 2018 for most counties in Minnesota. 
As of 2018, there were 370,000 Medicare Cost plan enrollees in Minnesota, but most of them had to switch to new plans (either Medicare Advantage or Original Medicare) for 2019. This is described in more detail below, but Minnesota’s enrollment in private Medicare plans could end up fluctuating significantly for 2019, depending on how many of those enrollees opted to have coverage under Original Medicare versus Medicare Advantage.

According to the Star Tribune, one of the biggest changes happening in Minnesota this year for Medicare recipients may be the reduction in the number of Medicare Cost plans available in your county. Medicare Cost plans are types of Medicare Advantage plans that work like a regular HMO when patients get services inside the network; however, they revert to working like Original Medicare Part A and Part B outside of the plan’s network. This means that beneficiaries can enjoy low costs when they can use a plan doctor, but they will still have their services covered if they need to step outside of the plan’s list of providers.
Remember, Medicare Advantage plans may offer additional benefits that are not offered in Original Medicare coverage. Beneficiaries who need prescription drug coverage may prefer the convenience of having all of their Medicare coverage included under a single plan, instead of enrolling in a stand-alone Medicare Prescription Drug Plan for Medicare Part D coverage. However, every person’s situation is different, so it’s a good idea to review your specific health needs, and compare Medicare Advantage plans in your area to find a plan option that best suits your needs.
The program for Qualified Individuals (QI) also pays for Part B premiums, though the application approval and benefits are on a “first come, first served” basis. This is sometimes due to limited funding. For an individual to qualify for the QI program, their income must be less than $1,386 a month. The combined income limit for a married couple is $1,872.
The Minnesota Board on Aging (MBA) may be helpful for seniors seeking a wide range of information. The office provides education in a broad range of areas, including health-care coverage and Medicare plans. The office was first established in 1956. Since that time, seniors have been able to turn to the Minnesota Board of Aging for a variety of programs, including:
It’s been well known that most Medicare Cost plans in Minnesota would be expiring in 2019. Why are Medicare Cost Plans in Minnesota expiring? The simplest answer is, to simplify the options available to you, the consumer. Although some seniors will be able to keep their Cost Plan, Minnesotans in about 66 counties will have to choose either a Medigap Plan or a Medicare Advantage plan this year to replace their Cost Plan.
The Minnesota Department of Commerce: provides beneficiaries with information about Medicare Part D Prescription Drug Plans and other insurance options available to them. The office is a resource for information about protection from Medicare fraud and how to report fraud. Additional links are included for federal offices that deal with Medicare and brochures that explain how to enroll in Part D Prescription Drug Plans. This government office also offers downloads of premium guides for supplemental plans available to current Medicare beneficiaries in Minnesota.
The most significant change to the Medicare program, since its enactment in 1965, began on Jan. 1, 2006. Medicare now has a prescription drug benefit (Medicare Part D). In the fall of each year, all Minnesotans with Medicare receive information about the Medicare Part D program and the Annual Open Enrollment Period for Medicare Part D and Medicare Advantage plans. Agencies, organizations and people that work with Minnesotans with Medicare will want to be kept apprised of the latest Part D information and its effect on Minnesotans with Medicare.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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Minnesota also prohibits Medigap insurers from basing premiums on an enrollee’s age. Premiums for Medigap plans in Minnesota only vary based on tobacco use and where the enrollee lives. These rating rules also apply to people who are eligible for Medicare before the age of 65, which is somewhat unusual; most of the states that have guaranteed access to Medigap for under-65 enrollees do allow the insurers to charge those enrollees higher premiums.


The program for Qualified Individuals (QI) also pays for Part B premiums, though the application approval and benefits are on a “first come, first served” basis. This is sometimes due to limited funding. For an individual to qualify for the QI program, their income must be less than $1,386 a month. The combined income limit for a married couple is $1,872.
You’re eligible for Medicare if you’re age 65 or older, receiving disability benefits, or have certain conditions, like end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease). You must be either a United States citizen or a legal permanent resident of at least five years. In some instances, you may not have to take any action in order to enroll. This may happen if you’re turning 65 and already receive Social Security benefits or Railroad Retirement Board benefits.

Once you feel fully informed about how to qualify for Medicaid in MN and how to follow the application guidelines for Medicaid, all that will be left to do is apply and enroll. Missing out on the marketplace’s open enrollment period does not mean that beneficiaries will be lacking insurance for long, because if qualifying events occur, Special Enrolment Periods (SEP) may launch. Minnesota shares Medicaid benefit requirements with other states that allow enrollment during SEPs, in the sense that the triggering events for SEPs are the same.


If you are a Minnesota beneficiary and considering enrollment in a Medicare Advantage plan, it is important to compare and evaluate the Medicare plan options available to you. While similar Medicare Advantage plans may be offered throughout the state, the cost for premiums may vary depending on your county of residence. You should also take note that some Medicare Advantage plans in Minnesota may offer monthly premiums as low as $0. If your service area offers a Medicare Advantage plan with a $0 premium, keep in mind that the plan may still include other costs besides the premium, such as copayments, coinsurance, and deductibles. In addition, you must still pay your Medicare Part B premium.
One of the reasons Medicare Cost has been so popular in Minnesota is that the state has a large population of “snowbirds” — retirees who live in Minnesota during the summer, but head south to warmer climes in the winter. With Medicare Cost plans, the enrollee still has Original Medicare — including the large nationwide network of providers who work with Medicare — in addition to the Medicare Cost coverage. Medicare Advantage plans, in contrast, tend to have localized networks that might not be suitable for a senior who lives in two different states during the year. A Medigap plan plus Original Medicare will allow a person in that situation to have access to health providers in both locations, although Medigap tends to be more expensive than Medicare Advantage. There are pros and cons to both options, and no one-size-fits-all solution.

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.
The state was the first to participate in a demonstration program to pilot Medicare Cost plans in the 1970s, and the plans have remained popular over the decades. They didn’t catch on in many other states, however, and Medicare + Choice came on the national scene in the 1990s, replaced by Medicare Advantage in 2003 (there are still Medicare Cost plans in Arizona, California, Colorado, District of Columbia, Florida, Iowa, Maryland, North Dakota, Nebraska, New York, South Dakota, Texas, Virginia, and Wisconsin, but their total enrollment was only about a third of the 625,072 people who had Medicare Cost plans in 2018 — the other two-thirds were in Minnesota).
You’re eligible for Medicare if you’re age 65 or older, receiving disability benefits, or have certain conditions, like end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease). You must be either a United States citizen or a legal permanent resident of at least five years. In some instances, you may not have to take any action in order to enroll. This may happen if you’re turning 65 and already receive Social Security benefits or Railroad Retirement Board benefits.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Enrollment issues can also be classed as a qualifying event for Medicaid benefits in MN. To avoid delays and confusion regarding the requirements for Medicaid, it might be worth paying for a short-term health insurance policy until enrolment for Medicaid application guidelines opens again. So long as beneficiaries are aware of how to qualify for Medicaid in Minnesota, financial woes and health worries can become a thing of the past.
Blue Cross and Blue Shield of Minnesota has been in business since 1933. With over two million members, Blue Cross and Blue Shield of Minnesota has been meeting the health care needs of persons in Minnesota and around the country. Blue Cross and Blue Shield of Minnesota has long been recognized as one of the highest quality health plans in the Midwest for member satisfaction. As the state’s oldest, largest and most-trusted health plan, Blue Cross and Blue Shield of Minnesota welcomes the opportunity and responsibility to improve the health of Minnesotans and their communities.
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.

Now that you have an idea of the type of Medicare plan options for Minnesotans, would you like some assistance looking for a plan that fits? I’d be happy to help, and you can click on the “View profile” link below to view my profile if you’d like. How about setting up a phone call with me, or having me send you some information by email? You can click on the links below to do that. Some folks prefer to research plans on their own; you can do that easily by clicking on the Compare Plans option on the right.


Even when you enroll in Medicare, your out-of-pocket costs, including deductibles, co-insurance and co-pays can be significant. This is especially true in Minnesota where health insurance premiums vary based on location and population density. It is important to consider options that can help reduce your out-of-pocket costs. Medicare supplements (also known as Medigap), Medicare managed-care style health plans (Advantage and Cost plans) and Part D plans can provide you the coverage and protection you may need. These additional plans must be approved by the Minnesota Department of Insurance, so you can rest assured that all plans meet the established criteria.
Medicare Supplement plans, also known as Medigap plans, have higher monthly premiums but they don’t have network restrictions or many out of pocket expenses, if any. The other thing that’s nice about Medicare Supplement plans is that they are renewable every year once you are enrolled. This means that even if your health condition should change, you can’t lose coverage.
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.   
Health Maintenance Organization (HMO) plans: One of the most popular types of managed-care plans, this type of Medicare Advantage plan comes with a provider network that you must use to be covered by the plan (with the exception of medical emergencies). If you use non-network providers, you may have to pay the full cost for your care. You’re also required to have a primary care physician; if you need to see a specialist, you’ll need to a get a referral from your primary care doctor first.
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.
DFL lawmakers and Gov-elect Tim Walz are considering various possibilities for a MinnesotaCare buy-in program that would open the coverage up (for a price) to anyone buying their own coverage, or to people in areas of the state where there are limited plan options available in the individual market. The details haven’t been worked out yet, but this is something to watch in Minnesota in 2019.
In February 2013, Governor Mark Dayton signed HF9, a bill that expanded access to Medicaid Assistance (Minnesota’s Medicaid program) under the ACA. News reports in 2013 widely reported that Medicaid expansion was expected to provide health coverage for 35,000 newly-eligible Minnesota residents. But Families USA projected estimated in April 2017 that 222,900 people were enrolled in Medicaid in Minnesota due to expansion.
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.
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