Medicare Advantage (Part C) Plans in Minnesota
Medicare Advantage (Part C) Plans in Minnesota
Medicare Advantage is another way to receive your Medicare Part A and Part B benefits through a private insurance plan. Most plans also include Part D drug coverage. A low premium and extra benefits can be attractive — but they do not tell you whether a plan is right for you.
Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare offered by private insurers that bundles Part A, Part B, and usually Part D into one plan.
Medicare Advantage, also called Medicare Part C, is offered by private insurance companies approved by Medicare. Most plans also include Part D prescription drug coverage — these are commonly called MAPD plans. Many plans also include benefits that Original Medicare does not cover, such as routine dental, vision, hearing, or fitness benefits.
The important question is how the plan works with your doctors, prescriptions, expected medical costs, and lifestyle.
See how I help you compare Medicare coverageWhat Does Medicare Advantage Cover?
Medicare Advantage plans must cover the medically necessary services covered by Original Medicare. Most plans also include Medicare Part D prescription drug coverage.
If you elect the Medicare hospice benefit, Original Medicare generally covers the care related to your terminal illness even if you remain enrolled in a Medicare Advantage plan.
Depending on the plan, additional benefits may include:
- Routine dental
- Routine vision
- Hearing benefits
- Fitness programs
- Other health and wellness benefits
Benefits vary by plan and can change from year to year.
Who Can Enroll?
To enroll in a Medicare Advantage plan, you must have Medicare Part A and Part B and live in the plan's service area. You can join or change plans only during an applicable Medicare enrollment period.
Need help getting started with Medicare? See how I help youHMO, PPO, and Other Plan Types
Most Medicare Advantage plans you encounter will be an HMO or PPO.
Generally requires you to receive non-emergency care from doctors, hospitals, and other providers in the plan's network. Referrals for specialists may also be required.
Generally gives you greater flexibility to use out-of-network providers, but you usually pay more when you do. Referrals are generally not required.
Neither structure is automatically better. What matters is whether the specific plan works with the doctors, hospitals, and specialists that are important to you.
Other Medicare Advantage structures, including Private Fee-for-Service (PFFS) plans, may also be available depending on your area. PFFS plans have different provider and payment rules.
Special Needs Plans
Some Medicare Advantage plans are designed specifically for people with certain health or financial circumstances. You may have additional options if you have both Medicare and Medicaid, have certain severe or disabling chronic conditions, or live in — or require the level of care provided by — certain long-term care facilities. These are called Special Needs Plans, or SNPs. All SNPs include Medicare Part D prescription drug coverage.
Learn about Medicare Special Needs PlansYour Doctors Matter
Provider networks can vary from one Medicare Advantage plan to another.
Before considering a plan, I look at the doctors, specialists, clinics, and hospitals you actually use.
A plan with attractive benefits is not very attractive if an important doctor or hospital is not in the network.
Medicare itself recommends checking whether your doctors and pharmacies participate in a plan before enrolling.
Your Prescriptions Matter
Most Medicare Advantage plans include Part D prescription coverage. Each plan can have different:
- Formularies
- Drug tiers
- Pharmacy costs
- Prescription deductibles
- Prior authorization requirements
- Step therapy
- Quantity limits
That is why I compare plans using the medications you actually take, including dosage and frequency. Medicare drug plans may use these coverage rules for specific medications.
The plan with the lowest premium is not necessarily the plan with the lowest total cost.
Understand Your Costs
Medicare Advantage plans can have their own premiums, deductibles, copays, and coinsurance.
A low or even $0 plan premium does not mean your health care is free.
You continue to pay your Medicare Part B premium, and depending on the plan you may also have costs when you receive care. Those costs may include:
- Medical deductibles
- Primary care and specialist copays
- Emergency room and ambulance costs
- Outpatient surgery costs
- Hospital copays
- Coinsurance for certain services
The important number is not just the premium. It is the combination of what you pay each month and what you may have to pay when you actually need medical care.
Maximum Out-of-Pocket
Every Medicare Advantage plan has an annual Maximum Out-of-Pocket (MOOP) for covered Part A and Part B services. Once you reach your plan's applicable limit, you no longer pay the covered Part A and Part B cost sharing for the remainder of the calendar year.
The MOOP varies by plan and can change from year to year. I consider it one of the most important numbers to understand when comparing Medicare Advantage coverage.
Prescription drug costs are separate from the medical MOOP.
See current Medicare costsPay Particular Attention to Hospital Costs
Hospitalization can create substantial out-of-pocket costs under some Medicare Advantage plans. A plan may charge an inpatient copay for each of the first several days of a hospital admission.
When I compare plans, I look closely at:
- Inpatient hospital copays
- Emergency room costs
- Ambulance costs
- Outpatient surgery
- Specialist costs
- Maximum out-of-pocket exposure
The important question is: What happens financially if you have a bad medical year?
Hospital Indemnity Coverage
Separate Hospital Indemnity Insurance may help soften the financial impact of hospital copays by paying defined cash benefits for covered hospital services according to the terms of the policy. Hospital Indemnity is separate insurance and is not part of Medicare Advantage.
Learn about hospital indemnity insurancePrior Authorization
Medicare Advantage plans may require prior authorization before certain services, treatments, or medical equipment are covered.
Prior authorization does not mean a service will be denied. It means the plan's approval may be required before certain services or supplies are covered. Medicare notes that prior authorization is typical for some services and supplies under Medicare Advantage.
If you have significant ongoing health care needs or an upcoming procedure, this can be an important consideration.
Travel and Snowbirds
If you travel frequently or spend part of the year outside Minnesota, we need to look carefully at how a plan handles care away from home. HMO and PPO rules differ. Some plans may also provide additional travel provisions.
Medicare specifically recommends checking coverage if you live in another state for part of the year before choosing a plan. For snowbirds and frequent travelers, provider access away from Minnesota can be an important part of the decision.
Medicare Advantage Plans Can Change
Medicare Advantage plans can change from one year to the next. Changes may include:
- ·Premiums
- ·Deductibles
- ·Copays and coinsurance
- ·Provider networks
- ·Prescription coverage
- ·Supplemental benefits
That is why Medicare Advantage coverage should be reviewed periodically rather than treated as a decision that never needs to be revisited.
Is Medicare Advantage Right for You?
There is no single Medicare Advantage plan that is best for everyone. Before choosing a plan, consider:
- Are your doctors and hospitals in the network?
- Are your medications covered?
- What will your prescriptions cost?
- What are the hospital copays?
- What is your maximum out-of-pocket exposure?
- Are prior authorization requirements important to your situation?
- Will the plan work with your travel habits?
- Does the overall cost fit your budget?
Those questions matter more than simply finding the plan with the lowest premium or the longest list of extra benefits.
Compare Your Medicare Options
I compare Medicare coverage using your actual doctors, prescriptions, and circumstances before we review the options together.
That comparison may include Medicare Advantage as well as Original Medicare with Medicare Supplement and Part D coverage.
Medicare Advantage plan availability, benefits, provider networks, formularies, and costs vary by plan and can change.