In the 1980s, in an effort to control costs, Minnesota began implementing PMAP, or pre-paid medical assistance programs. PMAPs provide blocks of Medicaid funding to non-profit HMOs and a variety of rural health programs across the state. The program was instituted as a demonstration project in 1983, but has continued to be the mechanism by which Medicaid funds are dispersed to providers in Minnesota for three decades.
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.
Medicare Advantage (also called "Part C") and Medicare Cost plans are ways to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower. With Medicare Cost plans, you have more flexibility, because you can still use Original Medicare to pay for out-of-network providers.
For some services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage or Medicare Cost plans, you may have to pay a monthly premium, unless you qualify to get help paying for your Medicare premiums, copayments, and deductibles through MA, a Medicare Savings Program (MSP), or the Low Income Subsidy (LIS).
In addition, both Minnesota Medigap plans and Medicare plans usually come with a package of membership benefits. These extra benefits may help members save money on such non-Medicare expenses as memberships to fitness clubs, dental care, glasses, and even over-the-counter vitamins and medicine. These membership benefits aren’t insurance, but they may offer the same sort of discounts that people enjoy when they have to pay for in-network services with insurance.
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.
What are the income requirements for Medicaid? In the event that an adult’s income exceeds the 135 percent Federal Poverty Level, he or she may sign up for a different kind of care in Minnesota, called MNCare. State tax from Minnesota hospitals and health care providers fund this program, which includes basic health services for people who do not exceed the income requirement for Medicaid in Minnesota.
Without the flexibility of Medicare Cost plans, state residents might turn to an Basic or an Extended Basic Supplement plan in Minnesota. Insurers may charge more for a Minnesota Medigap plan, but, many times they have more thorough coverage. Minnesota Medigap plans will pay for almost all covered services, so some recipients may end up saving money anyway.
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.
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).
A Medicare Part D Prescription Drug Plan (PDP) can help pay your prescription drug costs. Designed to work alongside Original Medicare coverage, Medicare Prescription Drug Plans are available from private insurance companies approved by Medicare and doing business in Minnesota. You can also enroll in a Medicare Prescription Drug Plan if you enroll in a Medicare Advantage plan that does not include Part D prescription drug coverage in its benefits.
Minnesota made history for kick-starting the Basic Health Program before any other state in the nation. People who are curious about “what are the Medicaid application guidelines?” will be interested to learn that prior to expansion, the process of learning how to qualify for Medicaid in MN was much more generous than it is now. The Medicaid benefits eligibility rules for adults with dependent children used to be up to 100 percent of poverty or 75 percent for adults without dependents.
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.
A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.
You should always compare your Medicare insurance options before the Annual Election Period because plans change. It’s critically important to anticipate likely changes to Minnesota Medicare Advantage plans in 2019 for one important reason. While nothing has been finalized as of this article, it’s likely that the government will reduce or eliminate Medicare Cost Plans within many counties of this state.
Medicare2019.com is a privately owned website and is not associated, endorsed or authorized by the Center for Medicare and Medicaid Services or any other government entity. This site contains basic information about Medicare, services related to Medicare, private medicare, Medigap and services for people with Medicare. If you would like to find more information about the Government Medicare program please visit the Official US Government Site: at www.medicare.gov
From Oct. 1 through March 31, we take calls from 8 a.m. to 8 p.m. CT, seven days a week. You’ll speak with a representative. From April 1 to Sept. 30, call us 8 a.m. to 8 p.m. CT, Monday through Friday to speak with a representative. On Saturdays, Sundays and federal holidays, you can leave a message and we’ll get back to you within one business day.
See whether you would prefer a Medicare Advantage plan. Medicare Advantage plans have to offer at least the basic benefits that Original Medicare offers, but some Medicare Advantage plans might also offer coverage for things that Original Medicare doesn’t cover. Use the Medicare Plan Finder to see if there’s a Medicare Advantage plan that meets your needs.
Medicaid coverage may be different from one state to another. Though they must comply with federal regulations, every state runs its own program; the federal government does not control it. Some information about Medicaid is true in every state. For instance, in Minnesota Medicaid covers some services that are not covered other states. Other states may cover services Minnesota does not. In addition, the costs may be different; not every beneficiary of Health Link in Minnesota will pay the same monthly premium. Certain low-income Medicaid insurance beneficiaries could pay no premiums at all if they qualify for no-cost coverage.