But once that window closes, enrollees often find themselves locked into the plan they have – regardless of how the premium changes – because in most states, switching to another plan can be impossible or prohibitively expensive due to medical underwriting. (Under federal guidelines, there are seven limited circumstances when you can get a new Medigap plan without medical underwriting.)
The legislation that introduced Medicare Advantage also created a competition clause that banned Medicare Cost plans from operating in areas where they faced substantial competition from Medicare Advantage plans, but the implementation of the competition clause was delayed for many years. In 2015, legislation (MACRA) called for the competition clause to be implemented as of 2019.
Another wrinkle is that people who want a supplement might have a better chance of getting into the coverage during the transition out of their Medicare Cost plan, when the supplement is provided on a “guaranteed issue” basis. Later, insurance companies can ask questions about a senior’s health status and deny coverage depending on the answers, said Greiner of the Minnesota Board on Aging.
Are you tired of paying for all of your healthcare costs? Even if you are under certain Medicare Advantage plans, you can still be on the hook for a lot of costs. Luckily, we can help you find the best Medicare Advantage plans in Minnesota for 2019 that will help you pay for these expenses. Then, you can enjoy retirement instead of worrying so much about money concerning your healthcare.
But as of 2013, a similar analysis determined that four states (Arizona, Florida, Georgia, and Idaho) required issue-age rating (carriers would also have the option to use community rating instead), and the remaining 38 states allowed premiums to be set on an attained-age basis, which means premiums rise as an enrollee gets older (carriers in those states can use issue-age or community rating instead, but most do not).
Besides the income limit for Medical Assistance in Minnesota, there is an asset limit. Assets are personal possessions that have value, such as cars, checking and savings accounts, real estate and investments. The asset requirements for Medicaid in MN do not apply to children who are younger than 21 years of age, adults without children, pregnant women and certain other groups. Parents and any caretaker relative who are eligible for MA with a spenddown have certain asset limits. Seniors and people who are 21 years of age and older who are disabled or blind have to adhere to an asset limit as well. Assets that do not need to be noted toward the Medicaid asset limit requirements include the applicant’s place of residence, household goods, personal items like clothing and jewelry and special items owned by an American Indian.
You may choose not to enroll in Medicare Part B when you are first eligible because you are already covered by group medical insurance through an employer or union. If you lose your group insurance, or if you decide you want to switch from your group coverage to Medicare, you can sign up at any time that you are still covered by the group plan or during a Special Enrollment Period(SEP).
HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in a health plan. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
The state of Michigan launched a new subsidy program in 2017 that will reduce the cost of Medigap premiums for its residents. It offers considerable savings — up to $125 per month — for certain Medigap beneficiaries who are under 65 and have a disability. For more information, including the online application, visit https://michiganmedigapsubsidy.com.
The donut hole is being eliminated in 2019 for brand-name drugs, one year ahead of schedule. The gap in prescription drug coverage (the donut hole) starts when someone reaches the initial coverage limit ($3,820 in 2019), and ends when they have spent $5,100 (these thresholds are each slightly higher than they were in 2018). Prior to 2011, Medicare Part D enrollees paid the full cost of their medications while in the donut hole. But the ACA has been steadily closing the donut hole, and it will be fully closed by 2020, when enrollees in standard Part D plans will pay just 25 percent of the cost of their drugs all the way up to the catastrophic coverage threshold. But the Bipartisan Budget Act of 2018 (BBA 2018) closes the donut hole one year early for brand name drugs. As a result of the BBA, enrollees will pay 25 percent of the cost of brand-name drugs (down from the 30 percent that was originally scheduled) and 37 percent of the cost of generic drugs (down from 44 percent in 2018). The cost of closing the donut hole one year early for brand-name drugs is being shifted onto drug manufactures. The Medicare Part D maximum deductible is $415 in 2018, up slightly from $405 in 2018.
Some residents are not allowed to apply for Medicaid online through ApplyMN or MNsure. Where do you sign up for Medicaid? Applicants who cannot apply online are required to submit a Minnesota Health Care Programs (MHCP) paper application through their local tribal or county office. A paper application is only allowed if everyone in the family meets one of the following:
Prior to 2014, Medical Assistance in Minnesota was available to parents with dependent children if their household income was up to 100 percent of poverty, and to adults without dependent children if their household income was up to 75 percent of poverty. Minnesota was already very progressive in providing Medicaid access for most of the state’s low-income population – in many states there was no coverage at all for childless non-disabled adults prior to 2014, and in states that haven’t expanded Medicaid under the ACA, there still isn’t.
Each year, most Medicare beneficiaries should receive their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing Medicare Advantage and Medicare Part D plan providers by Sept. 30. CMS makes information available to the public on Medicare.gov in October. The Medicare website is also a tremendous asset for individuals with questions about Medicare rules, timelines, Medicare Part D, etc.
Medicare Savings Programs help people on Medicare pay for some of their out-of pocket Medicare costs. The costs paid depend upon your income but can include Medicare Part A and B premiums, co-insurance, copayments, and deductibles. You need to have countable income that is 135% of the Federal Poverty Guidelines (FPG) or less ($1,366/month for an individual, $1,852/month for couples) to qualify for a Medicare Savings Program.
Another wrinkle is that people who want a supplement might have a better chance of getting into the coverage during the transition out of their Medicare Cost plan, when the supplement is provided on a “guaranteed issue” basis. Later, insurance companies can ask questions about a senior’s health status and deny coverage depending on the answers, said Greiner of the Minnesota Board on Aging.
Minnesota made history for kick-starting the Basic Health Program before any other state in the nation. People who are curious about “what are the Medicaid application guidelines?” will be interested to learn that prior to expansion, the process of learning how to qualify for Medicaid in MN was much more generous than it is now. The Medicaid benefits eligibility rules for adults with dependent children used to be up to 100 percent of poverty or 75 percent for adults without dependents.

But a Star Tribune review of January enrollment data shows zero-premium plans have been much less popular in Minnesota, with only about 5 percent of state residents who enrolled in a Medicare health plan opting for the coverage. Greiner said her group's analysis of federal data came to the same conclusion; the relatively low interest in zero-premium plans showed up again in recently released figures for February, she said.


You may be worried that in order to purchase a Minnesota Medicare supplemental insurance policy that you will have to have a medical exam before you purchase one. This could be a serious issue if you have any preexisting medical issues that you feel your medical supplements will not be able to cover. You could be denied coverage or have to spend more money on your coverage than you were originally planning on spending. These are both serious concerns for any person looking for medical coverage and ones that you should worry about when you are shopping for supplements.
Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had only Original Medicare.
Not surprisingly, the popularity of Medicare Advantage plans varies significantly from one state to another, with only one percent of the Medicare population enrolled in Advantage plans in Alaska (there are no individual Medicare Advantage plans available at all in Alaska; people with Advantage coverage there have employer-sponsored Medicare Advantage plans), versus 56 percent in Minnesota.
American Indians can continue to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.
The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A and Part B, you can select other coverage options like a Medigap (Medicare Supplement) plan from approved private insurers. The best time to buy a Medigap policy is the six month period that starts the first day of the month that you turn 65 or older and enrolled in Part B. After this period, your ability to buy a Medigap policy may be limited and it may be more costly. Each state handles things differently, but there are additional open enrollment periods in some cases.
And although 16 percent of Medicare beneficiaries are under 65 and eligible for Medicare due to a disability (including ALS and kidney failure), federal rules do not guarantee access to Medigap plans for enrollees who are under age 65. The majority of the states have implemented regulations to ensure access to at least some Medigap plans for people in this situation, although it varies considerably from one state to another.
Some residents are not allowed to apply for Medicaid online through ApplyMN or MNsure. Where do you sign up for Medicaid? Applicants who cannot apply online are required to submit a Minnesota Health Care Programs (MHCP) paper application through their local tribal or county office. A paper application is only allowed if everyone in the family meets one of the following:
Medicare Savings Programs help people on Medicare pay for some of their out-of pocket Medicare costs. The costs paid depend upon your income but can include Medicare Part A and B premiums, co-insurance, copayments, and deductibles. You need to have countable income that is 135% of the Federal Poverty Guidelines (FPG) or less ($1,366/month for an individual, $1,852/month for couples) to qualify for a Medicare Savings Program.
DFL lawmakers and Gov-elect Tim Walz are considering various possibilities for a MinnesotaCare buy-in program that would open the coverage up (for a price) to anyone buying their own coverage, or to people in areas of the state where there are limited plan options available in the individual market. The details haven’t been worked out yet, but this is something to watch in Minnesota in 2019.
If you did not enroll during the IEP when you were first eligible, you can enroll during the General Enrollment Period. The general enrollment period for Original Medicare is from January 1 through March 31 of each year. Keep in mind that you may have to pay a late enrollment penalty for Medicare Part A and/or Part B if you did not sign up when you were first eligible.
Among those losing Cost plans, about 142,000 people are being automatically enrolled in new MA plans from their current insurer, although they are free to make a different choice. Some of those being automatically enrolled in an MA plan are finding their doctor is not in the new health plan’s network, Greiner said, and there are cases where the new MA plan’s drug coverage brings much higher copayment requirements. 

Original Medicare, on the other hand, provides wider access to doctors and hospitals and gives people a choice of Part D coverage from a variety of companies. While Medicare itself only covers 80 percent of costs in many cases, people who use the government program in tandem with Medigap and Part D coverage can see lower copayments for doctor and hospital care than with MA plans.

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.
The annual open enrollment period for people selecting a Medicare health plan ends Friday, but that doesn’t mean the shopping season is over for more than 300,000 Minnesotans who are losing their Medicare Cost coverage next year. Beginning Saturday, people losing Cost plans will be eligible for a special enrollment period where they have until month’s end to buy replacement coverage that takes effect Jan. 1, and enrollment options that stretch into 2019. (Snowbeck, 12/6)
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