Medicare in Minnesota

Medicare is a type of government-backed health insurance available to seniors over the age of 65 and adults with certain disabilities. In 2020, there were more than one million Minnesota residents enrolled in Medicare, up from 778,000 in 2010. Original Medicare is slightly more popular than Medicare Advantage plans, but enrollment is nearly split, with 543,000 residents selecting Original Medicare and 496,000 choosing Advantage plans. 

The government administers Original Medicare, which has two parts: Part A and Part B. Part A is free as long as residents have contributed to Medicare taxes for a set period. It covers inpatient care in hospitals , skilled nursing care, nursing home care, hospice care and some home health care. Part B covers outpatient services, doctor visits, diagnostic testing, medical transportation, medical supplies and prescribed medical devices. The standard monthly premium for Part B, as of 2022, is $170.10. 

The Medicare Advantage program is also known as Medicare Part C and allows residents to choose a private insurance plan at a discount. Insurance companies must offer plans that cover the same benefits provided through Medicare Parts A and B, except for hospice care which remains covered under Medicare Part A. Some people may choose an Advantage plan because it allows them to add additional coverage for vision or dental care, prescription drug coverage and savings programs that give discounts on wellness services. Medicare Part D offers prescription drug coverage, and enrollees may add it to Original Medicare. Most Advantage Plans include Part D. Premiums vary based on coverage level. Residents may also add a Medicare Supplement plan to cover out-of-pocket expenses such as deductibles and coinsurance.

This guide provides a comprehensive review of Medicare in Minnesota, including how seniors can customize their coverage. It also offers resources to help residents learn more about their benefits and complete their enrollment. 

Options for Medicare Coverage in Minnesota

While Original Medicare offers basic coverage many Minnesota residents can depend on, some people need additional coverage not provided through the traditional program. Seniors have additional options if they’d like to create a policy that meets special needs. They can explore Advantage plans and other insurance policies offered by private insurance companies and apply for financial aid if they qualify. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS)and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage is an alternative to traditional Medicare coverage. Private insurance companies administer Advantage plans instead of the government but include the same benefits seniors have through Medicare Parts A and B, aside from hospice care. The primary advantage of these plans is enrollees can add additional benefits such as prescription drugs, vision or dental coverage. They can also enroll in savings programs that offer discounts on gym memberships and other wellness products and services. Advantage plans also have out-of-pocket maximums, which can help seniors who have a set budget for medical treatment each year. 

There are four types of Advantage plans: Health Maintenance Organization (HMO), Preferred Provider Organization, Private Fee For Service (PFFS) and Special Needs Plans (SNPs). Advantage plans have different rules for eligibility, coinsurance, deductibles, premiums and network providers from one plan to the next. 

Who Should Consider Medicare Advantage

Medicare Advantage is an ideal choice for people who:

• Are generally healthy , so may benefit from lower premiums
• Would like to add vision or dental coverage to their Medicare benefits
• Want more control over their out-of-pocket expenses

Top 10 Medicare Advantage Plans in Minnesota

Minnesota residents have plenty of Medicare Advantage plans to choose from. The following table can help seniors narrow their choices by offering the best plans based on enrollment numbers, ratings and level of coverage. It also reviews costs as of April 2022. More information on Medicare C plans is provided on the Medicare Advantage plans in Minnesota page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Minnesota

Enrolling in Medicare can be difficult to navigate, especially when considering private coverage options. Minnesota residents have access to several agencies that offer counseling and support services to help them determine which coverage options are right for them, learn more about their benefits and complete their applications. Anyone with questions regarding Medicare enrollment, prescription drug coverage or researching Medicare Supplement plans in the state can contact one of these agencies.