1) Medically Needy Pathway – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills in comparison to their monthly income. In Minnesota, this program is referred to as a “Spenddown” program. Basically, persons must pay down their “excess income,” (their income over the Medicaid eligibility limit, which is often referred to as a deductible) on medical bills. This may include health insurance costs, such as Medicare premiums, as well as bills to cover medical services. Once one has paid down his or her excess income to the Medicaid eligibility limit, he or she will receive Medicaid benefits for the remainder of the spenddown period. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.

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.


It’s important to note that not every Medicare Prescription Drug Plan covers the same list of medications. Each plan lists covered medications in formulary. Formularies may vary among plans. So, when you’re shopping for a plan in Minnesota, you can make a list of your medications and compare it to the plan’s formulary to make sure the plan will suit your needs. The formulary may change at any time. You will receive notice from your plan when necessary.
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.
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.
Minnesota is one of just three states in the country (Massachusetts and Wisconsin are the others) that offers its own version of Medicare Supplement insurance. Minnesota has two plans available: the Minnesota Basic Plan and the Minnesota Extended Basic Plan. In  most other states, up to 10 types of standardized plans are available. Medicare Supplement plans are also known as Medigap policies and may help pay Original Medicare out-of-pocket costs, such as copayments and deductibles.
Federal guidelines call for an annual open enrollment period (October 15 to December 7) for Medicare Advantage and Medicare Part D coverage in every state. And as of 2019, there’s also a Medicare Advantage open enrollment period (January 1 through March 31) that allows people who already have Medicare Advantage to switch to a different Advantage plan or switch to Original Medicare. But while these provisions apply nationwide, plan availability and price are different from one state to another.

Minnesota law prevents Medigap insurers from imposing pre-existing condition waiting periods if the enrollee signs up during their initial six-month open enrollment window. For those who apply after that, Medigap insurers are not allowed to impose pre-existing condition waiting periods if the enrollee wasn’t diagnosed or treated for the condition in the 90 days prior to enrolling in the Medigap plan.
Veterans who receive VA coverage and are eligible for Medicare can also consider enrolling in Medicare Part A and Part B. If you have VA benefits as well as Medicare coverage, your options for care and your coverage net can be widened. Your qualified care would be covered under Medicare Part A and/or Part B, even if you go to a non-VA hospital or doctor.
There’s a new premium bracket for the highest-income Part B and Part D enrollees. Under the terms of the Bipartisan Budget Act of 2018, enrollees with income of $500,000 or more ($750,000 or more for a married couple) will pay a new, higher premium for Part B and Part D coverage in 2019 and future years. For reference, in 2018, the highest income bracket starts at $160,000 ($320,000 for a married couple). The Medicare Trustees’ report projected a Part B premium of $460.70/month for Part B enrollees in the new highest bracket in 2019, and an additional $82.90/month added to the Part D premiums charged by the insurer that provides the Part D coverage.
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For some services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage or Medicare Cost plans, you may have to pay a monthly premium, unless you qualify to get help paying for your Medicare premiums, copayments, and deductibles through MA, a Medicare Savings Program (MSP), or the Low Income Subsidy (LIS).

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.
In February 2013, Governor Mark Dayton signed HF9, a bill that expanded access to Medicaid Assistance (Minnesota’s Medicaid program) under the ACA. News reports in 2013 widely reported that Medicaid expansion was expected to provide health coverage for 35,000 newly-eligible Minnesota residents. But Families USA projected estimated in April 2017 that 222,900 people were enrolled in Medicaid in Minnesota due to expansion.
MNsure NavigatorsMNsure has partnered with a number of trusted organizations across Minnesota. The employees of these organizations, known as navigators, are trained to provide face-to-face help with Medicaid applications. MNsure navigators can help residents apply for MinnesotaCare, Medical Assistance or a qualified health plan (with or without cost-sharing and premium tax reductions.). You can call MNsure or use the MNsure navigator online finder to find a navigator in your area.
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Medicare prescription drug coverage is optional and does not occur automatically. You can receive coverage for prescription drugs by either signing up for a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage, also known as a Medicare Advantage Prescription Drug plan. Medicare prescription drug plans and Medicare Advantage plans are available through private insurers. Please note that you cannot have both a stand-alone Medicare prescription drug plan and a Medicare Advantage plan that includes drug coverage.

Medicare Part B premiums likely to increase slightly for 2019. Medicare Part B premiums for the coming year aren’t finalized until the fall, but the Medicare Trustees Report that was issued in June 2018 projected an estimated standard Part B premium of $135.50/month in 2019 (see Table V.E2). Even if that premium is finalized, the actual amounts that people pay for Medicare Part B in 2019 will depend on the cost of living adjustment (COLA) that applies to Social Security benefits in 2019.For perspective, for In 2017, most Medicare Part B enrollees paid an average of $109/month for their Part B premium, although enrollees with income above $85,000 had higher premiums. But the standard premium for Medicare Part B was $134/month in 2017. The reason most enrollees paid an average of only $109/month was because the cost of living adjustment (COLA) for Social Security wasn’t large enough to cover the full increase in Part B premiums. For 70 percent of Part B enrollees, their premiums are deducted from their Social Security checks, and net Social Security checks cannot decrease from one year to the next (the “hold harmless” provision). The COLA for 2017 was only enough to cover about four dollars in additional Part B premiums, so the $134/month premium for 2017 only applied to enrollees to whom the “hold harmless” provision didn’t apply. The COLA for 2018 was larger, but still not quite high enough to cover the full increase to $134/month for all enrollees. People who are “held harmless” pay an average of $130/month for Part B in 2018, while the standard premium remains at $134/month. So while there’s still a small difference between what people pay in Part B depending on whether they’re “held harmless,” the difference is not as stark as it was in 2016 and 2017. The difference has mostly leveled out for 2018 (except those with high incomes, who always pay more).Assuming the standard premium increases slightly to about $135.50/month in 2019, and assuming the COLA is adequate to cover an increase of roughly $5.50/month (from the roughly $130/month that the majority of enrollees pay in 2018, to $135.50/month in 2019), that premium amount will apply to all enrollees except those with high incomes (Medicaid covers Part B premiums for some low-income enrollees, regardless of what the standard premium is).
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.

Senior LinkAge Line, at 1-800-333-2433, 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.  


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.
Minnesota also prohibits Medigap insurers from basing premiums on an enrollee’s age. Premiums for Medigap plans in Minnesota only vary based on tobacco use and where the enrollee lives. These rating rules also apply to people who are eligible for Medicare before the age of 65, which is somewhat unusual; most of the states that have guaranteed access to Medigap for under-65 enrollees do allow the insurers to charge those enrollees higher premiums.

Enrollment issues can also be classed as a qualifying event for Medicaid benefits in MN. To avoid delays and confusion regarding the requirements for Medicaid, it might be worth paying for a short-term health insurance policy until enrolment for Medicaid application guidelines opens again. So long as beneficiaries are aware of how to qualify for Medicaid in Minnesota, financial woes and health worries can become a thing of the past.
You’ll have the opportunity to disenroll from your Medicare Advantage plan and return to Original Medicare during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. You cannot use this period to switch Medicare Advantage plans or make other changes. However, if you decide to drop your Medicare Advantage plan, you can also use this period to join a stand-alone Medicare prescription drug plan, since Original Medicare doesn’t include prescription drug coverage.
If you make a change, it will take effect on the first day of the following month. You’ll have to wait for the next period to make another change. You can’t use this Special Enrollment Period from October–December. However, all people with Medicare can make changes to their coverage from October 15–December 7, and the changes will take effect on January 1.
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.
Final decisions haven’t been made on exactly which counties in Minnesota will lose Cost plans next year, the government said. But based on current figures, insurance companies expect that Cost plans are going away in 66 counties across the state including those in the Twin Cities metro. They are expected to continue in 21 counties, carriers said, plus North Dakota, South Dakota and Wisconsin.
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.
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As is the case nationwide, enrollment in private Medicare plans grew in Minnesota in 2018. As of December 2018, there were 581,822 Minnesota Medicare beneficiaries with private Medicare coverage, which amounts to nearly 58 percent of the state’s Medicare population. Nationwide, most people with private Medicare plans are enrolled in Medicare Advantage plans, but Medicare Cost plans are another type of private Medicare coverage, and as of 2018, Minnesota residents accounted for two-thirds of the national total enrollment in Medicare Cost plans.

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:

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.
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.
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. 

Unlike Medical Assistance, MNCare has a small monthly premium that ranges as high as $80, but calculated on a sliding scale and not applicable to some enrollees. The preferred enrollment method is through MNsure. Like Medical Assistance, enrollment in MinnesotaCare is open year-round. By September 2016, average monthly enrollment in MinnesotaCare was a little over 100,000. As of 2015, a quarter of the insureds were new enrollees, while the rest were already on MinnesotaCare in 2014.

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Only one switch during this time frame is allowed each year — you can change your mind multiple times during the enrollment period in the fall, but can only switch to a different Medicare Advantage plan (or back to Original Medicare) once in the first quarter of the new year. But if you sign up for a Medicare Advantage plan in the fall and then decide you don’t like it once it takes effect in January, you have until the end of March to make a change.
If you are under 65 and receiving certain disability benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Original Medicare, Part A and Part B, after 24 months of disability benefits. The exception to this is if you have end-stage renal disease (ESRD). If you have ESRD and had a kidney transplant or need regular kidney dialysis, you can apply for Medicare. If you have amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease), you will automatically be enrolled in Original Medicare in the same month that your disability benefits start.
“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.”
Surprisingly, a large percentage of these new enrollees were not newly eligible. In fact, they had always been eligible, they just were not well-versed on the topic of “What are the Medicaid application guidelines?” Enrollment figures shrunk from 1,066,787 to 1,019,309 by August 2015, before creeping back up to 1,026,023 in July the following year.
If you’re already enrolled in a Medicare Part D prescription plan or a Medicare Advantage Plan and you don’t want to make changes to your coverage for the coming year, you don’t need to do anything during open enrollment, assuming your current plan will continue to be available. If your plan is being discontinued and isn’t eligible for renewal, you will receive a non-renewal notice from your carrier prior to open enrollment. If you don’t, it means you can keep your plan without doing anything during open enrollment.
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