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.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.

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.
Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries nationwide have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage. Some Medigap plans that were sold prior to 2006 included coverage for prescription drugs, but sales of those plans ceased as of 2006, when Medicare Part D became available. Part D was created under the Medicare Modernization Act of 2003, which was signed into law by President George W. Bush.

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.
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.
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.

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.
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.
The Medicare-Choices email list is designed to help health insurance counselors, volunteers, attorneys, providers, consumers or other interested parties find resources, receive up-to-date information about Medicare, Medicare Advantage, Medicare Part D, Medicare Advantage, Medical Assistance, Minnesota Long-term Care Partnership or other related public or private benefits.

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 legislation that introduced Medicare Advantage also created a competition clause that banned Medicare Cost plans from operating in areas where they faced substantial competition from Medicare Advantage plans, but the implementation of the competition clause was delayed for many years. In 2015, legislation (MACRA) called for the competition clause to be implemented as of 2019.

The Medicare-Choices email list is designed to help health insurance counselors, volunteers, attorneys, providers, consumers or other interested parties find resources, receive up-to-date information about Medicare, Medicare Advantage, Medicare Part D, Medicare Advantage, Medical Assistance, Minnesota Long-term Care Partnership or other related public or private benefits.


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.

We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
What happens when your Medicare pays for most of your costs, but not all of your costs? Don’t worry- Medicare Supplement Insurance (Medigap) will pay for the extra costs such as copayments, coinsurance, and deductibles that Medicare may not completely cover. It’s a policy that helps pay for some things that Medicare may not completely pay for.  Medigap plans are sold by private insurance companies licensed to offer these plans in your state. Medigap plans are different than Medicare Advantage Plans (like an HMO and PPO).  Medigap policies do NOT cover most Part D prescription medications. If you want drug coverage, you can add standalone Part D plans available in your service area.

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.
People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and 13 percent of Minnesota Medicare beneficiaries are under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65, but the majority of the states — including Minnesota — have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans. Minnesota law grants a six-month open enrollment period to anyone who enrolls in Medicare Part B, regardless of age (federal rules only grant this window to people who enroll in Part B and are also at least 65 years old).
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.
The Medicare-Choices email list is designed to help health insurance counselors, volunteers, attorneys, providers, consumers or other interested parties find resources, receive up-to-date information about Medicare, Medicare Advantage, Medicare Part D, Medicare Advantage, Medical Assistance, Minnesota Long-term Care Partnership or other related public or private benefits.

The Minnesota Medicaid program is for people with low income and is known as Medical Assistance (MA). Low income residents of Minnesota that qualify for Medicaid get health care through various health plan providers serving different counties. Minnesota residents that do not get health care through a health plan receive care on a fee-to-service basis. With this option, the health plan providers bill the state directly for the services they offer… Read More


If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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