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Medicare Plans in Minnesota – Coverage and Benefits

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.

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. For more info on Original Medicare and more, take a look at the table below.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

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
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

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:

[chart category=”supplement” name=”planTypes” state=”MN” zipcode=”55106″]

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.

[chart category=”advantage” name=”topHMOPlans” zipcode=”55106″ state=”MN”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”55106″ state=”MN”]

Comparing Medigap Policies and Medicare Advantage in Minnesota

In some areas, Medicare Advantage could be the more cost-effective solution to your supplemental coverage needs. In others, a Medigap policy might be the low-cost option you need to protect your savings and give you peace of mind. Below, this informative table will help illustrate the major differences between the two so that you can make an informed decision:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

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.

[chart category=”general” name=”usefulContacts”]

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.

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