Overview of Medicare Advantage Plans in Minnesota
Medicare Advantage plans in Minnesota are another way to receive health care coverage if you don’t have Original Medicare, also known as Medicare Part A and Part B. Medicare Advantage plans are often referred to as Medicare Part C.
All Medicare Advantage plans in Minnesota must offer beneficiaries the same coverage as Original Medicare. Some (MA) plans offer additional benefits, so when you compare rates, it’s essential that you make sure you’re comparing the same benefits.
Medicare Advantage Plans in Minnesota: When Can I Enroll?
There are three times when a beneficiary can enroll in a Medicare Advantage plan in Minnesota.
Initial Coverage Election Period (ICEP)
The ICEP is when you’re first qualified to sign up for a Minnesota Medicare Advantage plan. To qualify, you:
- Must be enrolled in Medicare Part A and Part B
- Must live in the service area of the plan
- With some exceptions, cannot have End Stage Renal Disease ESRD
If you delay enrolling in Part B, your ICEP is the three-month period ending on the last day of the month before your Part B coverage starts.
Annual Election Period (AEP)
The annual election period runs from Oct. 15 to Dec. 7. During this time, you can:
- Switch plans
- Add prescription drug coverage (Medicare Part D Prescription Drug Plan)
- Disenroll from a Medicare Advantage plan in Minnesota and return to Original Medicare
Special Election Periods (SEP)
Special Election Periods allow you to make changes to your Medicare Advantage plan coverage in Minnesota.
Some examples of SEPs are:
- Moving to a different address in the same area, but you have other plan options
- Losing other health coverage
- The insurance company discontinues your current Medicare Advantage plan
- You become Dual-Eligible for Medicare and Medicaid
- Institutional conditions apply such as moving into a nursing home or other residential facility
Medicare Advantage Disenrollment Period
The Medicare Advantage Disenrollment Period runs from Jan. 1 to Feb. 14 each year. During this time, you can drop your current Medicare Advantage plan, return to Original Medicare, and buy a separate Medicare Part D Prescription Drug Plan.
Popular Types of Medicare Advantage Plans in Minnesota
Beneficiaries who choose a Medicare Part C plan in Minnesota rather than Medicare Part A and Part B have several types of Medicare Advantage plans in Minnesota to choose from. The Medicare Advantage plans available may vary based on your location.
Preferred Provider Organization Medicare Advantage PPO
- PPOs typically have a preferred provider network.
- You don’t need a referral to see a specialist.
- You don’t have to have a primary care doctor (PCP).
- Medicare Advantage PPOs in Minnesota may or may not include prescription drug coverage (Medicare Part D).
Health Maintenance Organization Medicare Advantage HMO
- You must seek care from in-network providers.
- You must have a PCP.
- You must get a referral from your PCP to see a specialist.
- The HMO may or may not include Medicare Part D.
Private Fee-for-Service Medicare Advantage PFFS
Unlike Medicare Advantage HMOs and PPOs, in a PFFS plan, the insurance company decides how much it and the beneficiary will pay for a service rather than Medicare making the decision.
- These plans may or may not have a provider network.
- You don’t have to choose a PCP.
- You don’t need a referral to see a specialist.
- The PFFS plan must cover all services that Original Medicare considers medically necessary.
- Some PFFS plans include Medicare Part D.
Special Needs Medicare Advantage Plans (SNPs)
Special Needs Medicare Advantage Plans in Minnesota are for beneficiaries with unusual situations or institutional conditions.
- You must meet specific eligibility requirements such as chronic health conditions, live in an institution, or be Dual-Eligible for Medicare and Medicaid benefits.
- The formulary (drug list), benefits, and doctors are tailored to the needs of the SNP.
- All Special Needs Plans must include prescription drug coverage.
- You might or might not have to choose a PCP.
- You must have a referral to see a specialist.
Medicare Advantage Plans in Minnesota: Enrollment Statistics
Minnesota’s nearly 5.5 million residents live in 87 counties. The five largest are:
- In 2015, 905,779 residents were eligible for Medicare Part A and Part B.
- Among Minnesota Medicare beneficiaries, 53 percent had Medicare Advantage plans.
- Medicare Advantage enrollment grew by 6 percent between 2015 and 2016.
- In 2016, 23 percent were in an HMO.
Medicare Advantage Plan in Minnesota & Prescription Drugs
Most Medicare Advantage plans in Minnesota combine health care benefits and prescription drug coverage. These plans are known as Medicare Advantage Prescription Drug plans (MAPDs).
Insurance companies typically charge monthly premiums for (MAPDs). Some service areas may offer a plan that has a $0 Premium. Even if your plan has a $0 premium, you’ll be responsible for other out-of-pocket costs. You must also continue paying your Part B premiums because you’re still in the Medicare program even though you’re receiving benefits through a Medicare Advantage plan.
Medicare Advantage Prescription Drug plans (MAPDs) have a list of medications they cover called a formulary. The list can change at any time. If it does, the insurance company must notify you.
(MAPDs) in Minnesota must offer at least two medications in each drug category (for example, antibiotics or heart medicine). The medicines are divided into Prescription Drug tiers. The higher the tier, the higher the cost:
- Tiers 1 and 2: generic drugs
- Tiers 3 and 4: brand name drugs
- Tier 5: specialty drugs for complex conditions
Drug tiers, copayments, deductibles, coinsurance, and restrictions vary between plans. Also, each company’s formulary is different, so check to see which formulary best covers your needs.
Network Restrictions on A Medicare Advantage Plan in Minnesota
Network restrictions vary depending on which type of Medicare Part C plan in Minnesota you have.
- PPO: You can use an out-of-network doctor or hospital, but coinsurance and copayments will be higher. Emergency care is covered in-network or out-of-network.
- HMO: Except in medical emergencies, if you go out of the HMO network, services are not covered.
- PFFS: You can go out-of-network if the doctor or hospital accepts the plan’s terms.
- SNP: You typically have to stay in-network for care, except for emergencies or if you have End Stage Renal Disease ESRD and need dialysis outside of your living area.
Additional Benefits to A Medicare Advantage Plan in Minnesota
Some Medicare Advantage plans in Minnesota offer additional benefits to those covered by Medicare Part A and Part B. Those benefits might include:
- Wellness programs
- Routine vision and dental
- Diet and nutrition recommendations
Because policies can vary between insurance carriers, it’s crucial that you carefully compare the policy’s benefits, out-of-pocket costs, and formulary in addition to rates. A close review will help you get the best Medicare Advantage policy for your needs.
Minnesota Medicare Resources
Health Coverage Options in Minnesota
Extra Help Program