Minnesota residents, like citizens of all other 49 states, can enroll in the government’s Medicare program during the year in which they reach 65 years of age. The base plan, which is sometimes known as “Original” or “Traditional” Medicare, is actually separated into two parts: Part A, which covers hospital care, and Part B, which takes care of non-hospital treatment (such as primary doctor visits and outpatient treatment). Despite the fact that Traditional Medicare aims to be comprehensive, there are “gaps” in coverage which, if you aren’t careful, could leave you with some fairly serious medical bills.
Coverage and Benefits
There are some basic expenses associated with Traditional Medicare. Part B automatically comes with a monthly premium, and you can find out exactly how much it will cost you by clicking here. If you are fortunate enough to have a lengthy employment history (ten years/40 quarters or more), then you will be given access to Part A benefits for free. Otherwise, there are additional premiums.
Minnesota senior citizens that decide to opt for Medicare coverage have a few different options to work with. The moment they enroll into standard Medicare they’ll receive Medicare Part A coverage which covers things like hospital visits, hospital stays and some outpatient care. Patients can opt for Medicare Part B as well, which is additional optional coverage for more outpatient services and enhanced medical equipment at a higher cost.
Minnesota patients looking for even more coverage options can also add Medicare Part C as long as they already have Medicare Parts A and B. Part C is known as Medicare Advantage and is coverage through a private insurance company for additional benefits and services. Medicare Part D is the final coverage option available to residents and it’s the drug coverage policy.
For more info on Original Medicare and more, take a look at the table below.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
The Breakdown: Medigap, Medicare Advantage, and other Medicare Plans in Minnesota
Minnesota has a sizeable population of seniors enrolled in Medicare: 819,803 to be exact. Of those, more than half (51%) chose a Medicare Advantage policy instead of accepting their Original Medicare benefits from the government. Another 20% of Medicare beneficiaries prefer to protect their savings with a Medigap supplement insurance policy. And the remaining 29% are either relying on employer-bestowed supplemental coverage, or they are taking their chances with Traditional Medicare all by itself.
Warning: before you obtain a Medicare supplement policy, you must make sure you are already enrolled in Medicare. By clicking that link, you can connect with government representatives who will help you enroll.
Should Everyone Purchase Supplemental Medicare Coverage?
Purchasing supplemental Medicare coverage is an affordable way to protect yourself from the gaps in Traditional Medicare coverage, but it is not required by any state or federal law. Neither is it a prerequisite for receiving Original Medicare benefits. Without it, however, you might be susceptible to the following costs:
|Medicare Part A Costs||Medicare Part B Costs|
Every year the cost of quality health care continues to rise, making it more and more difficult for Minnesota residents to get good care. That’s why it’s so important for residents to look into additional coverage options. With larger deductibles and higher costs overall, more patients are being stuck with expensive bills after being treated for medical issues.
Supplemental health insurance, such as Medigap or Medicare Advantage can help cover the costs that traditional Medicare just won’t cover. These plans cost a bit more up front, but they are an investment into not getting stuck with large bills.
By investing in a quality supplemental insurance policy, you can avoid getting stuck with Medicare coverage gaps. The Part A deductible alone is over $1,100 per year for residents of Minnesota, and that doesn’t even take into account the cost of uncovered prescription plans or long-term hospital stays. Long-term hospital stays past the first 60 days will cost patients $296 per day on average, and those are costs that a supplemental plan could help cover.
If you’re considering obtaining a supplemental Medicare insurance plan, there are two different options available to you, Medigap (Medicare Supplement) or Medicare Advantage. Both plans offer benefits but they are very different from one another. While Medigap just helps to cover things like deductibles and the percentage of coverage Medicare doesn’t offer on a particular service, Medicare Advantage puts health insurance completely into the hands of a private company. Both options give you more coverage than Medicare, but it’s important to understand the differences to understand what you are getting.
Medicare Supplement Insurance in Minnesota
If you have Medicare, but don’t use your benefits all that often, you might think that supplemental coverage is a needless expense right now. But even the healthiest individual could come down with a serious health emergency at any time. Without a proper supplement, you could have to pay thousands of dollars in out-of-pocket expenses that your budget isn’t prepared to handle.
Medicare Supplement Insurance, more commonly known as a Medigap policy, is a great way to cover the “gaps” in your Traditional Medicare coverage. Medigap policies are small, affordable health insurance supplements which provide you with coverage and benefits where Traditional Medicare falls short. Additionally, private insurance companies work together with the federal government in order to more efficiently cover Medicare’s benefit gaps. Plans A-D, F, G, and K-N are available for purchase. Each plan offers identical coverage across all 50 states, so if you live in Minnesota and want to supplement your Traditional Medicare with Supplement Plan K, all you have to worry about is choosing an affordable policy from a reputable insurance agency.
This useful chart explains what each Medigap policy can offer you:
Medicare Advantage Plans in Minnesota
Medicare Advantage, while it is often sold as a form of supplemental coverage, acts more like a replacement of Traditional Medicare in practice. For many seniors, it is an easy way to coalesce all of their Medicare benefits under one single insurance policy at a relatively affordable cost. Many even have the opportunity to add additional benefits and coverage, such as prescription drugs, for a modest additional expense each month.
However, switching to a Medicare Advantage plan comes with risks of its own as well. In order to keep their policies competitively priced, many private insurance companies who underwrite Medicare Advantage policies keep their networks small and restricted. This means that switching to Medicare Part C might also require you to switch doctors. Additionally, you will also be losing the security of having your benefits guaranteed by the federal government. By law, the private company issuing your policy must give you equal or greater benefits than you were receiving under Original Medicare, but what if the company goes bankrupt and you lose your coverage? Getting it back could be quite a challenge.
Medicare Advantage plans use HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) networks in order to provide you with care. Going to a hospital or doctor outside of your chosen network could cost you a lot of money if your claim is denied.
Comparing Medigap Policies and Medicare Advantage in Minnesota
There are many differences between the two policies, but the first, and arguably the most important difference is how the claims are handled. When you use Medigap, the added insurance company pays nothing at all until after Medicare does. Once Medicare is done, the Medigap policy comes in and covers a portion of what is left over.
Both of the two policy types are handled by a private insurance company, but Medigap is a more standardized type of policy than Medicare Advantage. You know what benefits you’re getting and the overall coverage you can expect, because the benefits are in-line with what you’re getting from Medicare. No matter what area of the country you live in, you’re going to get the same benefits and coverage from your Medigap policy. The only variable you have to think about is your monthly premium, and that will be different depending on your income, where you live and the insurance you choose.
Medicare Advantage on the other hand isn’t so simple. These plans are all handled by private insurance companies and benefits can vary wildly from one policy to the next. When you have Medicare Advantage, also known as Medicare Part C, your policy replaces Medicare Parts A and B entirely. And instead of dealing with Medicare, you just deal with the insurance company. On top of the standard coverage you would get with Medicare, you can add on extras like dental, vision and prescription coverage. You get a more custom insurance policy which is more complicated but gives you greater control as well.
As with most other aspects of Medigap, the pricing of these policies is simpler and more straightforward than it is with Medicare Advantage. You get a set monthly premium and that’s what you’re expected to pay every month. With Medicare Advantage you get a more variable payment policy and the private insurance company that’s managing it can adjust your rates more frequently than what you’ll experience with Medigap. The government will cover many of your Medicare Advantage costs for you, but whatever is left over on premiums, co-payments, deductibles and everything else will all go straight to you.
We’ve only skimmed the surface of the major differences between the two policies. That’s why we put together a complete list of important questions and answers about both policies down below. Read through the table to learn more, or if you would like to speak with professionals about the policies, you can talk with one of our knowledgeable representatives and get help finding the right policy for you today.
|Questions||Medicare Advantage||Medicare Supplement|
|How does each of the plans handle medical expenses?||Your private insurance estimates the costs of Minnesota healthcare costs and creates a set of premiums and co-payments based on that information. Medicare pays a portion of those premiums and you pay what’s left.||You cover the premium for your supplemental policy each month and you pay for any remaining costs that are left over after Medicare and Medigap pick up their portions.|
|Do I have to pay for Part B still?||Yes||Yes|
|What can I expect to pay with this policy?||Medicare Advantage plans are huge and complicated. This makes it difficult to estimate what your expected costs will be, and they can change over time for things like premiums, co-payments, regular care and emergency care.||Just budget for your fixed premium amount and you’ll enjoy coverage for most of your medical costs. With some policies you will still have to pick up the remaining costs after receiving care, but they should be minimal.|
|What coverage does the plan offer me?||Advantage plans are customizable. They offer Medicare Parts A and B coverage and additional coverage that you add on.||Medigap covers just the services approved under Medicare. It helps pick up the remaining tab after Medicare pays its portion.|
|Will this policy make it easy to budget my healthcare costs?||Advantage plans are more difficult to budget for generally. If you receive infrequent care you should be able to budget for your plan effectively. If you start needing more frequent care, it will be difficult for you to budget.||When you use a comprehensive plan, such as Medicare Plan F, you’ll enjoy complete coverage and you just pay your premium each month. With lower plans you will have to budget for co-payments and remaining medical costs that aren’t covered.|
|Is this plan guaranteed or can it be cancelled?||You aren’t guaranteed coverage with an Advantage policy. Your company has a chance to drop you each year, leaving you searching for coverage.||As long as you can make the premiums and your company stays in business, you are guaranteed coverage from one year to the next with Medigap.|
|Am I required to go through a pre-certification or pre-approval process to obtain this policy?||Yes, as with many private insurance policies, you can be expected to go through a pre-certification process before you can be covered by the policy.||No. If you qualify for Medicare you can a Medigap policy.|
|Are their restrictions on the doctors and facilities I can make use of with this plan?||Yes, with an Advantage policy you are usually restricted to a specific network of doctors and hospitals.||No, you are free to go to any doctors or hospitals that accept Medicare coverage.|
|Which plan is right for me?||Advantage plans are best for patients that need infrequent care, and those that live in urban areas with plenty of doctors and hospitals to work with.||Medigap is best for patients that need frequent care, or patients that don’t have a large network of care providers to choose from in the area.|
Helpful Medicare Resources
We have included a searchable directory for your convenience. With it, you can look up valuable contact information for local and federal Medicare resources designed to handle your Medicare questions and concerns. Feel free to reach out to as many experts as necessary; after all, choosing the right health care coverage is one of the most important decisions you can make.
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.