Medicare is a health insurance plan sponsored by the federal government. To qualify, people must be one of the following: 

• Age 65 or older and a U.S. citizen or a permanent legal resident of the U.S. for at least five continuous years; 
• Under age 65 with certain disabilities; or
• Any age with End-Stage Renal Disease. 

Medicare Part A covers inpatient hospital, skilled nursing facility, home health care and hospice care.

Medicare Part B covers almost all reasonable and necessary medical services, including doctors’ services, laboratory and x-ray services, durable medical equipment (wheelchairs, hospital beds, etc.), ambulance services, outpatient hospital care, home health care, blood and medical supplies. 

Medicare Part C is called “Medicare Advantage” (or MA) and is an optional plan that is offered by private insurance companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. Medicare Advantage combines the benefits of Medicare Parts A and B, as well as, in some cases, prescription drug coverage provided by Part D, and may provide some additional benefits. 

Medicare Part D is the optional prescription drug coverage offered by private insurance companies and available to all people with Medicare.

A Medicare Cost Plan is a type of Medicare health plan that has been popular with Minnesota seniors for many years. Like Medicare Advantage, it is offered by private insurance companies approved by Medicare. A Cost Plan includes Medicare Part A and B coverage, but with greater flexibility in seeing non-network providers. A Cost Plan may also include the option of separate Part D prescription drug coverage.

A Medicare Supplement policy (sometimes known as Medigap or MedSupp) is a private insurance policy designed to supplement Original Medicare Parts A and B by covering out-of-pocket costs such as deductibles, copayments and coinsurance. 

Changes in Medicare for 2020

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Counties Where Cost Plans Will Continue in 2019

A Medicare Cost Plan is a type of Medicare health plan that has been popular with Minnesota seniors for many years. Like Medicare Advantage, it is offered by private insurance companies approved by Medicare. A Cost Plan includes Medicare Part A and B coverage, but with greater flexibility in seeing non-network providers. A Cost Plan may also include the option of separate Part D prescription drug coverage. A Medicare Supplement policy (sometimes known as Medigap or MedSupp) is a private insurance policy designed to supplement Original Medicare Parts A and B by covering out-of-pocket costs such as deductibles, copayments and coinsurance.

What you need to know

What is a Medicare Cost Plan?

A Cost Plan is a type of Medicare plan that has been popular with Minnesota seniors for many years. 

In Minnesota, Cost Plans are currently offered by just three insurers: 

• Blue Cross and Blue Shield of Minnesota
• HealthPartners 
• Medica

Their Cost Plans have various brand names. A list can be found at the bottom of this page. 

How do I tell if I have a Cost Plan? 

• Most Minnesota seniors do NOT have Medicare Cost Plans.
• You can confirm whether you have a Medicare Cost Plan by calling the number on the back of your health plan member card.
• On January 1, 2019, Medicare cost plans were discontinued from being offered in 66 Minnesota counties, due to a change in federal law.

What changes will Minnesota seniors experience with Medicare Cost Plans in 2020?

• Medicare Cost Plan coverage will remain in effect for Minnesota in the same 21 counties that were available last year, until December 31, 2020. Seniors in those 21 Minnesota counties will be able to remain with their current Cost Plans, if available, or enrollee into another cost plan. Seniors in the 66 counties, that were discontinued, will not be able to enrollee into a Cost Plan  for 2020. See the map of affected counties.

Are you eligible for a Medicare Cost Plan? 

You must be enrolled in Medicare Part B before you can enroll in a Medicare Cost Plan. In addition, you must:

• Live in an area where Medicare Cost Plans are available
• Find a plan that is accepting new members
• Agree to the rules and guidelines of the plan

Important Dates

October 1, 2019
This is when seniors can begin to compare plans for 2020. Detailed Medicare plan offerings for 2020 will be available on the www.Medicare.gov Plan Finder tool, including information on cost, coverage and other benefits. 

In addition, the Minnesota Board on Aging’s 2020 edition of Health Care Choices for Minnesotans on Medicare will be available at this time. The publication provides information on all Minnesota Medicare options for 2020. To get a free copy, call the Senior LinkAge Line® at 1-800-333-2433. 

October 15 – December 7, 2019
The Medicare Annual Enrollment Period is when all seniors can choose to enroll or switch to a  new Medicare plan for 2020, including a Medicare Advantage plan or Medicare Part D prescription drug plan. 

What are the brand names of Medicare Cost Plans in Minnesota?

Blue Cross and Blue Shield of Minnesota

• Platinum Blue Choice
• Platinum Blue Choice with Rx
• Platinum Blue Complete
• Platinum Blue Complete with Rx
• Platinum Blue Core
• Platinum Blue Core with Rx 

HealthPartners

• Freedom Balance 
• Freedom Basic
• Freedom Ultimate 
• Freedom Vital

Medica

• Prime Solution Basic
• Prime Solution Basic with Rx
• Prime Solution Basic with Rx 2
• Prime Solution Enhanced
• Prime Solution Enhanced with Rx
• Prime Solution Enhanced with Rx 2
• Prime Solution Standard
• Prime Solution Thrift
• Prime Solution Thrift with Rx
• Medica Prime Solution Value
• Medica Prime Solution Value with Rx

Medicare Part D plans, which provide prescription drug coverage, are offered by private insurance companies with a Medicare contract. (It is also possible to receive prescription drug coverage through a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage)

Medicare Part D is an optional benefit. However, if you do not enroll when you are first eligible and do not have existing equivalent drug coverage, you may have to pay a premium penalty if you enroll at a later time.

Each Part D plan is different. Each can cover different drugs and have different costs. 

More details on Part D plans in Minnesota can be found in Health Care Choices for Minnesotans on Medicare – an annual publication by the Minnesota Board on Aging and Senior LinkAge Line® that outlines Medicare options in Minnesota.

To find and compare Part D plans, you can also use the Medicare Prescription Drug Plan Finder at Medicare.gov.

What Plan D Providers May and May Not Do

Medicare Plan D providers have to follow Medicare rules that limit how they promote their plans. 

Unfortunately, some plan representatives may break the rules and use high-pressure sales tactics or false promises to try to enroll you in a plan that may not cover the drugs you take. Or scammers may pretend to be Part D providers in order to get your personal information — such as your Medicare number — to commit identity theft.

• To protect consumers, the law is very specific about what Medicare Plan D providers may and may not do. For example:
• Medicare Part D plan representatives may not market through unsolicited contact, including:
  • Telemarketing calls, including voice mail messages
  • Emails or texts
  • Door-to-door solicitations, including leaflets or flyers at your home or car
  • Approaching you in common areas, like parking lots, hallways, lobbies and sidewalks.
• Medicare Part D plan representatives may enroll you on the phone only if YOU call them. You can be on the safe side by calling Medicare first (toll-free at 1-800-633-4227) to verify the legitimacy of any provider you may be tempted to call. Medicare doesn't recommend any particular prescription drug plan; it simply verifies that a provider is legitimate.
• Providers may come to your home only if you have invited them to do so.
• Providers may ask you how you want to pay your premiums, but they may not ask you for payment on the phone or through the internet.
• You may set up a direct payment plan if you want to, but the provider first has to mail you the information to do so.
• Legitimate providers will not charge you any fees to enroll in a plan. 
• You will never be called by Medicare, the Commerce Department or The Senior LinkAge Line® to get you to sign up for a Part D plan. If you receive such a call, it is a scam.

Report scams and suspicious activity to Medicare by calling 1-800-MEDICARE (1-800-633-4227). You can also call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-772-3379. The MEDIC helps prevent inappropriate activity and fights fraud, waste, and abuse in Medicare plans.

A Medicare Supplement policy (also known as Medigap or MedSupp) is health insurance that:

• Is sold by private insurance companies to supplement Original Medicare.
• Helps to pay your share of the costs of Medicare-covered services (coinsurance, copayments and deductibles as applicable to the plan coverage).
• May cover certain costs not covered by Original Medicare such as medical care needed while traveling outside of the U.S.
• Covers Minnesota state-mandated benefits 

Medicare Supplement policies sold in Minnesota must be reviewed and approved by the Minnesota Commerce Department.

Multiple types of Medicare Supplement policies are available in Minnesota:

• Basic
• Basic with riders
• Medicare SELECT
• Extended Basic
• Supplement Plan with 50 percent coverage
• Supplement Plan with 75 percent coverage
• Supplement Plan with 50 percent Part A deductible coverage
• Supplement Plan with $20 AND $50 Co-payment Medicare Part B coverage
• Supplement Plan with high deductible coverage

What kind of changes will Minnesota seniors experience with Medicare Supplement Plans in 2020?

Part B Deductible 

The federal requirements, Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) was signed into law on April 16, 2015. MACRA prohibits the sale of Medigap policies that cover Part B deductibles to “newly eligible” Medicare beneficiaries. 

Newly eligible Medicare Beneficiaries are defined as those individuals who: (a) have attained age 65 on or after January 1, 2020; or (b) first become eligible for Medicare due to age, disability or end-stage renal disease, on or after January 1, 2020.

All states were required to adopt these changes to implement MACRA to be effective January 1, 2020.

On May 17th, our Governor Tim Walz signed the MACRA conformity legislation. This new legislation amended our current Medicare Supplement laws to show compliance with MACRA. 

*Due to the MACRA requirements, the Basic Plan and the Extended Basic Plan will not include the Part B Deductible for those newly eligible on or after January 1, 2020. 

Who is considered a "newly eligible" Medicare beneficiary under MACRA?

MACRA defines "newly eligible" as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.

How much is the Medicare Part B deductible? 

For 2019, the Medicare Part B deductible is $185. For more information, please contact Medicare or your local Social Security office.

If I currently have a Medicare Supplement plan, what do I need to do? How will MACRA affect me? 

Current enrollees (those eligible for Medicare prior to January 1, 2020) are not affected. Current enrollees can continue with their plan and may continue to buy plans beyond January 1, 2020.

Before you make any plan changes, please consult your agent or broker, or call the Senior LinkAge Line® at 1-800-333-2433. Detailed Medicare plan offerings for 2020 will also be available on the www.Medicare.gov Plan Finder tool, including information on cost, coverage and other benefits. 

How are people eligible for Medicare on the basis of disability impacted by these changes? 

Current beneficiaries (those eligible for Medicare prior to January 1, 2020) are not impacted. The restrictions under MACRA apply to persons who qualify for Medicare as a result of a disability on or after January 1, 2020.

Medicare Supplement policies sold in Minnesota must be reviewed and approved by the Minnesota Commerce Department.

Multiple types of Medicare Supplement policies are available in Minnesota:

• Basic
• Basic with optional riders (Preventive Care, Part A Deductible, Part B Excess Charges, and Part B Deductible – for other than a newly eligible individual)
• Medicare SELECT (Limited Network)
• Extended Basic
• Supplement Plan with 50 percent coverage
• Supplement Plan with 75 percent coverage
• Supplement Plan with 50 percent Part A deductible coverage
• Supplement Plan with $20 AND $50 Co-payment 
• Supplement Plan with high deductible coverage

More details on these policies can be found in Health Care Choices for Minnesotans on Medicare – an annual publication by the Minnesota Board on Aging and Senior LinkAge Line® that outlines Medicare options in Minnesota.

Policy Basics

• You must have Original Medicare Part A and Part B to buy a policy.
• You will pay a premium to the insurance company (in addition to Medicare Part B).
• Policies are sold by insurance companies and licensed insurance agents.
• Policies are guaranteed renewable, even if you have health problems in the future. The insurance company cannot cancel your policy as long as you pay your premiums.
• If you move out of state, your coverage can continue as long as you pay your premiums.

Open Enrollment Period

• It is best to enroll during your initial six-month Medicare Supplement Open Enrollment Period. 
• This period begins on the first day of the month you are enrolled in Medicare Part B and ends six months later.
• If you enroll during this period, you have guaranteed issue rights, meaning the insurance company is required by law to sell or offer a policy to you.
• If you apply for a policy outside this period, you will likely be asked to complete a health questionnaire by the insurance company and your application may be denied.

How to Purchase a Policy

• Contact the licensed insurance company or agent selling the policy you want to purchase.
• The insurance company must provide you with an outline of coverage.
• You can return the policy within 30 days of receipt and receive a full refund.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private insurance companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. 

You must be eligible for Medicare Parts A and B and live in the plan’s service area to be eligible to enroll. People with End-Stage Renal Disease (permanent kidney failure) generally cannot join a Medicare Advantage Plan.

Policy Basics

• A Medicare Advantage Plan will provide all of your Medicare Part A and Part B coverage. This is different than a Medicare Supplement (Medigap) policy, which helps cover Part A and Part B out-of-pocket costs such as deductibles, copayments and coinsurance.
• A Medicare Advantage Plan may require you to use certain health care providers (the provider network). Seeing providers outside the network can significantly increase your out-of-pocket costs.
• Many Medicare Advantage Plans offer extra benefits such as vision, dental or wellness coverage.
• Most Medicare Advantage Plans offer Part D prescription drug benefits.

In addition to your Medicare Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. Different Medicare Advantage Plans have different costs and benefits, which can also change from year to year. It is important to compare plans and understand these different costs and benefits before you enroll.

More details about Medicare Advantage plans can be found in Health Care Choices for Minnesotans on Medicare – an annual publication by the Minnesota Board on Aging and Senior LinkAge Line® that outlines Medicare options in Minnesota.

There are different types of Medicare Advantage Plans available in Minnesota:

HMO Point-of-Service (HMO POS) plans typically require you to choose a primary care doctor and to get a referral from this primary doctor to see a specialist. You may also be required you to use only the plan’s provider network (except in an emergency), otherwise you pay extra costs. Some plans may include a self-referral option that allows some flexibility to go to out-of-network providers.

Preferred Provider Organization (PPO) plans have provider networks, but you are allowed to see any provider that accepts Medicare (usually for a higher cost). You do not need a referral to see a specialist, but you may pay more if you go outside the plan’s network. 

Private Fee-for-Service (PFFS) plans generally allow you to go to any provider as long as they accept the plan’s payment terms. The plan determines how much it will pay providers and how much you must pay when you get care. Medicare Part D prescription drug coverage may or may not be provided, but you can enroll in a standalone Part D plan if coverage is not provided.

Special Needs Plans (SNPs) provide focused and specialized health care for specific groups of people, such as seniors who have both Medicare and Medicaid, or non-seniors with disabilities who have Medical Assistance. 

Minnesota seniors will be receiving new Medicare cards beginning the summer of 2018. 

To help protect your identity, Medicare is removing Social Security numbers from Medicare cards. Instead, the new cards will have a unique Medicare Number. This will happen automatically. You don’t need to do anything or pay anyone to get your new card.

Medicare will mail your card, at no cost, to the address you have on file with the Social Security Administration. If you need to update your official mailing address, visit your online Social Security account or call 1-800-772-1213. When you get your new card, your Medicare coverage and benefits will stay the same.

When you get your new card, be sure to destroy your old card. Don’t just toss it in the trash. Shred it. If you have a separate Medicare Advantage or other health insurance card, keep that because you will still need it for treatment.

As the new Medicare cards start being mailed, be on the lookout for Medicare scams. Here are some tips:

• You do not have to pay for your new Medicare card. Medicare is mailing new cards at no charge. If anyone contacts you claiming to represent Medicare or another government agency and is trying to make you pay for a new card, it is a scam.
• Do not give your Medicare number to an untrusted source. Scammers call pretending to be from Medicare or another government agency asking for personal information in exchange for your new card. Cards are being shipped automatically and do not require you to share your Medicare number to receive one. Only share your Medicare number with doctors or trusted people who work with Medicare.
• Never share financial information with someone you don’t know. If someone contacts you asking for your bank or credit card information with the promise of a rebate or bonus because of your new Medicare card, it is a scam.
• Do not believe anyone who threatens to cancel your Medicare if you don’t give them your Medicare number. Your eligibility and access to Medicare services are not affected by the new Medicare cards. 
• Destroy your old card. Once you receive your new Medicare card, the old one is not needed. Destroy your old Medicare card by shredding it—remember: it has your Social Security number on it!
• Guard your new card. Even though the new Medicare card doesn’t have your Social Security number on it, you should safeguard the card just as you would any other important records or credit cards.

For more information about changes to your Medicare card, go to medicare.gov/newcard

If you believe you have been contacted by a scammer, report the incident to 1-800-MEDICARE (1-800-633-4227).

• Premium Table: Medicare Supplement (Medigap) (.pdf)
  Premium Table for Medicare Supplement Insurance marketed in Minnesota. Rates may vary due to rounding, discounts or fees.
• Premium Table: Medicare Select (.pdf)
  Premium Table for Medicare Select insurance marketed in Minnesota. Rates may vary due to rounding, discounts or fees.
• Premium Table: Individual Plan Medicare Products (.pdf)
  Premium Table for Individual Medicare Cost Plan Insurance marketed in Minnesota. Rates may vary due to rounding.

Not sure if Medicare will cover your medical test or service? There’s now an app for that!

The Centers for Medicare & Medicaid Services (CMS) has launched a smartphone app that gives consumers direct, convenient access to some of the most-used content on Medicare.gov, including accurate cost and coverage information.

You can use your mobile device to get accurate, consistent Original Medicare coverage information while at your doctor’s office, the hospital or the comfort of your own home.

The “What’s Covered” app lets you (or your caregiver) quickly see whether Medicare covers a specific medical item or service. The app delivers general cost, coverage and eligibility details for items and services covered by Medicare Part A and Part B. (If you have Medicare Advantage, this app will NOT have information about your specific plan.)

Search or browse to learn what’s covered and not covered; how and when to get covered benefits; and basic cost information. You can also get a list of covered preventive services.

Download Medicare’s “What’s Covered” app for free at either Google Play or the Apple App Store.