There are several different Medicaid long-term care programs for which Minnesota seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Minnesota offers multiple pathways towards Medicaid eligibility.
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.
Between January 1 and March 31 each year, if you are enrolled in a Medicare Advantage plan, you can leave your plan and return to Original Medicare, and buy a Part D prescription drug plan to supplement your Original Medicare. Starting in 2019, you also have the option to switch to a different Medicare Advantage plan during this time. From 2011 through 2018, there wasn’t an option to switch to a different Medicare Advantage plan outside of the fall open enrollment period unless you had a circumstance that allowed you a Special Enrollment Period. But the 21st Century Cures Act (Section 17005) expanded the timeframe of the window (from one and a half months to three months) starting in 2019, and allows people to switch from one Medicare Advantage plan to another.

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.
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MA plans feature a network of doctors and hospitals that enrollees must use to get the maximum payment, whereas supplements tend to provide access to a broader set of health care providers, said Shawnee Christenson, an insurance agent with Crosstown Insurance in New Hope. While that might sound good to beneficiaries, supplements can come with significantly higher premiums, Christenson said.
A “Welcome to Medicare” packet is mailed out a few months before you turn 65. If you are not yet 65 but receive disability benefits from the Social Security Administration, or receive certain disability benefits from the Railroad Retirement Board, then you become eligible for Medicare as soon as you enter into the 25th straight month of receiving those benefits.
See whether you would prefer a Medicare Advantage plan. Medicare Advantage plans have to offer at least the basic benefits that Original Medicare offers, but some Medicare Advantage plans might also offer coverage for things that Original Medicare doesn’t cover. Use the Medicare Plan Finder to see if there’s a Medicare Advantage plan that meets your needs.
Once you feel fully informed about how to qualify for Medicaid in MN and how to follow the application guidelines for Medicaid, all that will be left to do is apply and enroll. Missing out on the marketplace’s open enrollment period does not mean that beneficiaries will be lacking insurance for long, because if qualifying events occur, Special Enrolment Periods (SEP) may launch. Minnesota shares Medicaid benefit requirements with other states that allow enrollment during SEPs, in the sense that the triggering events for SEPs are the same.

Senior LinkAge Line, at (800) 333-2433, is a free statewide service of the Minnesota Board on Aging in partnership with Minnesota’s Area Agencies on Aging. Senior LinkAge Line provides help to older Minnesotans, their families and friends, helping them connect to local services, find answers and get the help they need. The Senior LinkAge Line does not sell or market any Medicare or insurance product.


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More than 44 million individuals in the U.S. are enrolled in Medicare, and Medicare eligibility in Minnesota is high, with more than 746,500 people receiving Medicare benefits. That means approximately 14 percent of the state’s total population is eligible for Medicare, with over 237,000 individuals enrolled in a Medicare Advantage plan and 753,000 people receiving Medicare Part D to help cover the cost of their prescriptions.
You should pay special attention to the Medicare Open Enrollment Period (OEP), which is also called the Medicare Annual Election Period (AEP). Medicare recipients can enroll in, make changes to or disenroll from a Medicare Advantage plan (Medicare Part C) or a Medicare Prescription Drug plan (Medicare Part D) during this period, which runs from October 15 to December 7 every year. Plan elections made during the 2018 Medicare Open Enrollment Period go into effect January 2019.
The state was the first to participate in a demonstration program to pilot Medicare Cost plans in the 1970s, and the plans have remained popular over the decades. They didn’t catch on in many other states, however, and Medicare + Choice came on the national scene in the 1990s, replaced by Medicare Advantage in 2003 (there are still Medicare Cost plans in Arizona, California, Colorado, District of Columbia, Florida, Iowa, Maryland, North Dakota, Nebraska, New York, South Dakota, Texas, Virginia, and Wisconsin, but their total enrollment was only about a third of the 625,072 people who had Medicare Cost plans in 2018 — the other two-thirds were in Minnesota).
Medicare beneficiaries and their caregivers in Minnesota can receive free, confidential, and unbiased one-on-one health insurance counseling through the State Health Insurance and Assistance Program (SHIP). Senior Medicare Patrol (SMP) is another program which aims to empower seniors to identify, help prevent, and report instances of Medicare waste, fraud and/or abuse.
“It’s important for consumers to review their Medicare coverage and make sure the plan is both affordable and provides access to doctors, clinics, hospitals and pharmacies they want and need,” said Kari Benson, executive director of the Minnesota Board on Aging, which operates the Senior LinkAge Line. “Line specialists can help by providing comprehensive, unbiased Medicare counseling.”
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.

MA plans often include dental, vision and health-club benefits that aren’t part of many supplements. Yet people who buy a supplement have the option of buying “stand-alone” Part D prescription drug coverage from any one of several insurers — a feature touted as one of the selling points for Cost plans, too. People in MA plans, by contrast, are limited to Part D plans sold by their MA carrier, Christenson said.
In the fall of 2013, prior to the launch of the ACA’s exchanges, Minnesota’s total Medicaid/CHIP enrollment stood at 873,040. There were 144,481 new Medicaid enrollments through MNsure, the state-run exchange, from October 2013 through April 2014, and total enrollment in Minnesota’s Medicaid program had grown to 1,066,787 by August 2014, an increase of more than 22 percent over the enrollment total prior to October 2013. Many of these enrollees were already eligible prior to 2014, but were not aware of their eligibility.
A federal law passed in 2003 created a “competition” requirement for Medicare Cost plans, which stipulated the plans could not be offered in service areas where there was significant competition from Medicare Advantage plans. Congress delayed implementation of the requirement several times until a law passed in 2015 that called for the rule to take effect in 2019.
The best time to enroll in a Medigap plan is during the six-month Medigap open enrollment period which begins the month you’re 65 and you are enrolled in Part B. If you apply for coverage outside of your open enrollment period, you may be required to provide your health history and be medically underwritten. This means you could be denied coverage, or it may cost more.
You should pay special attention to the Medicare Open Enrollment Period (OEP), which is also called the Medicare Annual Election Period (AEP). Medicare recipients can enroll in, make changes to or disenroll from a Medicare Advantage plan (Medicare Part C) or a Medicare Prescription Drug plan (Medicare Part D) during this period, which runs from October 15 to December 7 every year. Plan elections made during the 2018 Medicare Open Enrollment Period go into effect January 2019.
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.
In the 1980s, in an effort to control costs, Minnesota began implementing PMAP, or pre-paid medical assistance programs.  PMAPs provide blocks of Medicaid funding to non-profit HMOs and a variety of rural health programs across the state. The program was instituted as a demonstration project in 1983, but has continued to be the mechanism by which Medicaid funds are dispersed to providers in Minnesota for three decades.
More than 44 million individuals in the U.S. are enrolled in Medicare, and Medicare eligibility in Minnesota is high, with more than 746,500 people receiving Medicare benefits. That means approximately 14 percent of the state’s total population is eligible for Medicare, with over 237,000 individuals enrolled in a Medicare Advantage plan and 753,000 people receiving Medicare Part D to help cover the cost of their prescriptions.
You have eight months to take action. Your SEP begins when your employer coverage ends or when your employment ends, whichever is first. Contact Social Security or your employer for more information. If you are age 65 and have COBRA through a previous employer, you should enroll in Medicare Part B. You will not get an SEP when COBRA ends.Be sure to enroll in Part B during the first eight months of your COBRA coverage to avoid the late enrollment penalty.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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