Medicare Advantage, which is sometimes known as Medicare Part C, offers Minnesota seniors an alternative way to receive their Medicare benefits. Unlike Original Medicare, which is provided directly by the Social Security Administration, Medicare Advantage plans are provided by private insurers that bill Medicare on behalf of the beneficiary. Medicare Advantage plans are required to provide the same coverage as Medicare Parts A and B, though many offer extra services such as vision and dental coverage. Medicare Advantage premiums are mostly billed to the Medicare program, though some beneficiaries continue to pay a monthly premium that varies with the area where coverage is provided.
Medicare Advantage plans are popular in Minnesota. According to the Kaiser Family Foundation, 43% of Medicare beneficiaries in the state choose to receive their health insurance via one of 1,749 available Part C plans. This percentage ties Minnesota with Florida for having the second highest enrollment rate among the 50 states. Only Hawaii has a higher rate of Medicare Advantage enrollment, at 45%.
Seniors in Minnesota who opt into a Part C plan can choose between four basic plan types: HMO, PPO, PFFS and SNP. In this guide, we explain the differences between these plan types, as well as give overviews of eligibility, enrollment and prescription drug coverage in Minnesota. We also list several state and local resources that can help seniors in Minnesota find and sign up for a Medicare Advantage plan that’s ideal for them.
About Medicare Advantage Plans in Minnesota
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans available across the country. In Minnesota, seniors have a choice between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans and Special Needs Plans (SNPs).
Health Maintenance Organizations (HMOs)
Health Maintenance Organizations (HMOs) group all of their covered services together under one umbrella, with most clinics and care providers working for the same organization that provides insurance coverage. Members of HMOs typically enjoy relatively low monthly premiums, but care options and flexibility is limited. Specialist visits often require a primary care physician’s recommendation before they are approved, and non-emergency out-of-plan care can be expensive.
Preferred Provider Organizations (PPOs)
Preferred Provider Organizations (PPOs) offer somewhat more flexibility than HMOs, as beneficiaries can often seek care outside of a single, unified provider system. PPOs generally have negotiated contracts with a network of independent providers that have all agreed to the billing terms and payment structures. Members of PPO plans can usually expect to pay higher monthly premiums than HMO members, but a referral often isn’t needed to visit a specialist. In-network care is paid for according to the plan rates, while out-of-network care may cost more at the point of service. Plan rates may apply, and reimbursement may be issued, if non-network services are approved in advance, unavailable inside of the network or delivered on an emergency basis.
Private Fee-for-Service (PFFS)
Private Fee-for-Service (PFFS) plans are structured in a way that’s very similar to privately purchased health insurance. Members of a PFFS plan can usually shop around for a provider they feel comfortable with, and their costs are dependent on whether the provider accepts the plan’s payment terms. Non-network providers are still likely to charge private-pay rates, while plan rates are available from practitioners and clinics that accept the insurer’s terms. PFFS plans usually have higher monthly premiums than HMOs and PPOs.
Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are designed for beneficiaries who are dually eligible for Medicare and Medicaid or have chronic medical conditions that require specialized care services. Membership in a specific plan is usually limited to seniors who qualify based on their situation or need for the condition-specific care the plan covers. Common conditions covered by SNP policies include diabetes, physical disabilities and Alzheimer’s disease. Monthly premiums for SNPs can be expensive, and co-payments for general care tend to be relatively high. Despite this, an SNP can be ideal for seniors with very specific health care needs that require therapy or long-term care.
Enrollment and Eligibility for Medicare Advantage in Minnesota
Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.
Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:
- Initial Coverage Election Period: This is the 7-month period during which everyone is eligible to enroll in a Medicare Advantage plan. The period spans from 3 months before the month of one’s 65th birthday to 3 months after one’s birthday month.
- Annual Election Period (AEP): Also referred to as the Open Enrollment Period, the AEP runs from October 15-December 7 each year. During this period, anyone can enroll in Medicare Advantage for the first time or change to a new plan.
- Medicare Advantage Open Enrollment Period: From January 1-March 31 each year, anyone who is already enrolled in Medicare Advantage can switch to a different plan, or disenroll and switch back to Original Medicare. This period is not open to anyone who is not currently enrolled in Medicare Advantage.
- General Enrollment Period: In some circumstances, one can join Medicare Advantage between April 1-June 30. This enrollment period only applies to those who enrolled in Medicare Part B for the first time during Medicare’s Open Enrollment Period (January 1-March 31).
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
Prescription Drug Coverage
Seniors in Minnesota can get prescription drug coverage in several ways. Original Medicare beneficiaries can opt into Part D coverage. Many Medicare supplements, including Medical Assistance, the state Medicaid program, contain a prescription drug benefit. Beneficiaries who receive benefits through Medicare Advantage usually have the option of buying into a plan that includes some prescription coverage. For beneficiaries whose Part C plan lacks prescription medication benefits, or whose plan leaves gaps in coverage, private supplements and Medical Assistance remain an option. Minnesota’s Medicare Advantage plans are compatible with the state Medicare Part D prescription drug plan, which combines with Part C to cover prescription costs. This program does charge a monthly premium, though seniors with high prescription drug expenses may save money through lower co-payments and deductibles than many private plans charge.
Getting Help with Medicare Advantage in Minnesota
Both Original Medicare and Medicare Advantage are invaluable resources for seniors. Both programs are complex, however, and it can be difficult for many seniors to navigate their options. Below, we have listed several resources Minnesota seniors can use to find advice, application assistance and extra help with the Medicare benefits they are eligible for.
State-Wide Medicare Advantage Resources
Minnesota SHIP Program
The Minnesota Board on Aging operates the statewide MN SHIP program that provides advice, assistance and direct application support for health care resources to Minnesotans aged 60 and over. Program assistance includes discount pharmaceutical programs, Extra Help benefits for Part D premiums and other Medicare issues. MN SHIP case workers also provide preadmission screening for seniors moving into long-term care and fraud prevention and reporting hotlines. Eligible seniors must meet income and asset limits for some means-tested programs.
Minnesota Commerce Department
The Minnesota Commerce Department provides free information about health insurance, costs of care and Medicare coverage on its website. Information provided includes up-to-date changes to Medicare legislation, Medicare Advantage plan changes and available Part D benefits. Further information and advice about benefits includes the end of Minnesota Medicare Cost plans and other variations on Medicare benefits in the state. Fraud, waste and abuse reporting is also available through the department.
Minnesota Senior Health Options
The Minnesota Senior Health Options (MSHO) program focuses assistance on the 35,000 Minnesotans who are eligible for both Medicare and Medicaid. People in this category are usually seniors who have reached eligibility for Medicare, while having income and assets that fall below the state Medicaid threshold. MSHO coordinates care between these two services, helping to ensure seniors who are dual-eligible get full coverage of their health needs with minimal to nonexistent gaps in coverage. Program counselors can explain both programs to beneficiaries, assist with initial applications for coverage and help manage denials of service. Other program services include publishing educational materials for beneficiaries and their caregivers about benefits and assistance locating additional resources.
Local Medicare Advantage Resources
HealthFinders Collaborative Medication Assistance Program – Faribault
The HealthFinders Collaborative (HFC) Medication Assistance Program (MAP) -Faribault is part of a statewide medication assistance program that helps seniors find Part D benefits and co-payment assistance for prescription drugs. The program offers no-cost prescription medications to all uninsured Rice County residents. Working with Sterling Drug as a local partner, Faribault MAP provides medication assistance to patients at its own clinic and at local hospitals and emergency departments. Prescriptions may be delivered to seniors with limited ability to travel to a pharmacy. The MAP staff includes MNsure-approved navigators, who act as certified benefits counselors for seniors seeking coverage under Original Medicare and Medicare Advantage. Navigators help seniors aged 60 and over understand and apply for benefits, as well as identify other benefits they may be eligible for. Program counselors can also assist beneficiaries apply for private insurance, including Medicare supplements and Extra Help, the federal assistance program for Part D co-payments.
Land of the Dancing Sky Area Agency on Aging
Land of the Dancing Sky Area Agency on Aging is the regional branch of this Minnesota Board on Aging’s senior resource program. Through the AAA, seniors can receive no-cost counseling about their health insurance options, including Medicare, and available prescription drug programs. The AAA also provides SHIP and Senior Medicare Patrol assistance and acts as the local Aging and Disability Resource Center (ADRC).
County Human Services Offices
Every county in Minnesota has a Department of Human Services office so seniors can receive assistance and services in the area where they live. Case workers in these DHS offices can assist Minnesota seniors with signing up for benefit programs they may be eligible for, as well as provide impartial advice regarding Original Medicare, Medicare Advantage and Medicaid benefits.
