Medicare Advantage Plans In Minnesota

Fact Checked
Published: 6/4/2021

Minnesota residents can receive Medicare coverage in two ways: through Original Medicare, delivered through the federal government, or a Medicare Advantage Plan, offered by private insurance companies. Original Medicare covers medically necessary services, such as hospital stays and physician visits. If you remain in Original Medicare, you won't have extra benefits, such as vision, dental, or hearing, but you can add on a separate Part D prescription drug plan. Medicare Advantage, also known as Medicare Part C, combines the same services covered by Original Medicare and includes a mix of additional benefits, depending on the plan. Many people choose Medicare Advantage for the convenience of all-in-one health coverage.





  • In 2019, there were 69 Medicare Advantage Plans available in Minnesota.
  • 56% of the total Medicare population in Minnesota is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $9,126 per beneficiary in Minnesota, which is 10% lower than the national average.
  • Available Medicare Advantage Plans range from 15 to 48 across Minnesota’s 87 counties.

While your choice of Medicare Advantage Plans depends on where you live, each service area offers multiple options. The plans vary by costs, benefits, and type, so you can choose one that fits your budget and health needs. The four main types of Medicare Advantage Plans are HMO, PPO, PPFS, and SNP.

Medicare Advantage Plans in Minnesota

Types of Medicare Advantage Plans

To narrow your choices, think about how you want to receive your health care. Insurance companies structure plans differently and may limit the health care providers you can use. Plans also vary in cost, with different monthly premiums, deductibles, copays, and out-of-pocket limits. Here’s a quick overview of the main types of plans available through Minnesota’s Medicare Advantage program.

Health Maintenance Organizations (HMO)

With an HMO plan, the insurance company has agreements with health care providers in your service area. To have your costs covered by the plan, you can only use doctors, hospitals, and providers that are part of this network. You must also have a primary care doctor in the network to oversee your health, order lab tests, and determine if you should see a specialist. If your current primary care doctor isn’t part of the HMO’s network, you must change to one that is.

Preferred Provider Organizations (PPO)

PPOs negotiate rates with certain health care providers, but you may see any provider you wish. Your costs are typically lower if you use one of the plan’s preferred providers. Under a PPO plan, you aren’t required to be under the care of a primary doctor, and you don’t need a referral to see a specialist.

Private Fee-For-Service Plans (PFFS)

Under Original Medicare, doctors set their fees, and the cost is shared between you and Medicare. With a PFFS plan, the insurance company sets the fee it pays for each service and the amount that you pay. If you have this type of plan, you can see any doctor who accepts the plan’s fee structure. Similar to a PPO, you don’t need a primary care physician and can see a specialist without a referral if you feel it’s necessary.

Special Needs Plans (SNP)

SNPs are designed for beneficiaries with certain chronic illnesses or who live in a nursing home. You may only enroll in an SNP if you qualify and there’s one available in your service area. There are SNPs for people with HIV/AIDS, heart disease, diabetes, and other conditions, and plan benefits are tailored to suit their needs. For example, the plan may work with specialists and cover prescription drugs related to the condition.

Enrollment and eligibility for Medicare Advantage Plans in Minnesota

Eligibility

If you’re already receiving Social Security benefits, you’re automatically enrolled in Original Medicare Part A for hospital insurance and Medicare Part B for medical insurance when you turn 65. Otherwise, you must sign up for Medicare separately through Social Security.

Once you’re enrolled in both Parts A and B, you’re eligible to switch your Medicare coverage to a Medicare Advantage Plan. You can join a plan in your service area, as long as you’re not also enrolled in Medigap, or Medicare Supplement Insurance, at the same time.

As of 2021, individuals with end-stage renal disease are also eligible to sign up for a Medicare Advantage Plan.

Enrollment periods

You can only join or move between Medicare Advantage Plans at certain times of the year.

  • Your first opportunity to enroll in Medicare Advantage begins three months before the month you turn 65. Known as your Initial Enrollment Period, this window spans seven months, ending three months after the month you turn 65.
  • You can enroll in a Medicare Advantage plan once a year during the Open Enrollment Period, from October 15th to December 7th. During this window, you can move from Original Medicare to Medicare Advantage or from one Medicare Advantage Plan to another.
  • You can change between Medicare Advantage Plans or return to Original Medicare once a year during the Medicare Advantage Enrollment Period, from January 1st to March 31st. You must already be enrolled in a Medicare Advantage Plan to make changes during this period.

Prescription drug coverage

Medicare doesn’t require you to buy prescription drug coverage, but if you don’t obtain it when you’re first eligible for Medicare insurance, you may have a permanent late enrollment penalty charged on premiums later. If there’s a chance you want prescription drug coverage at a future date, you may want to consider enrolling now.

Drug coverage isn’t part of basic Medicare, but you can supplement your Original Medicare Part A and B coverage with a separate Part D Prescription Drug Plan. This plan is available through private insurers and helps pay for the medication your doctor prescribes. Prescription drug coverage comes with most, but not all, Medicare Advantage Plans. However, the only Medicare Advantage Plan type you can add a Part D plan to is PFFS.

Medicare Advantage Resources in Minnesota

There’s plenty of information available online about Medicare coverage, but sometimes it’s helpful to consult with a knowledgeable source in person. Here are organizations and agencies in Minnesota that can help answer your Medicare questions.

Senior LinkAge Line

This state-wide resource offers free, unbiased health insurance counseling to help you understand and compare Medicare plans. Assistance includes completing forms and applying for programs, such as Medical Assistance and Medicare Extra Help. The phone line is available Monday to Friday, from 8 a.m. to 4:30 p.m.

Contact Information: Website | 800-333-2433

Trellis

Trellis is the designated Area Agency on Aging for the Twin Cities metro area and assists seniors with understanding Medicare options through private, one-on-one medical health insurance counseling. Whether you’re new to Medicare or already have Medicare and want to explore your options, you can book a one-hour counseling appointment. You can also register for free online presentations to learn about various Medicare topics.

Contact Information: Website | 800-333-2433

Minnesota Department of Human Services (DHS)

The DHS administers programs to help low-income seniors who may have difficulty affording Medicare. Support includes Medicare Savings Programs and Medicare Assistance, which is the state’s Medicaid program.

Contact Information: Website | 800-333-2433

Southern Minnesota Regional Legal Services (SMRLS)

SMRLS provides free legal assistance to Minnesota residents aged 60 and older in social and economic need. The organization helps protect residents when it comes to basic needs, including health care. The phone line is staffed by intake screeners who determine if callers qualify for support. If SMRLS can help you, your call is transferred to an attorney. SMRLS serves 33 counties in southern Minnesota, including the east metro.

Contact Information: Website | 1-888-575-2954

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