You’ll instead pay copays for services as you go along. Medicare Advantage plans in Minnesota often include Part D drug coverage rolled into the plan. Some plans also have extras like routine vision, dental, hearing and gym memberships. Each plan works a little differently. We can run a list of plans available in your county to help you review all options.
Some Medicare Advantage plans have a $0 monthly premium, while others come with a higher monthly premium. You must continue to pay your Part B premium, which is expected to be $134 per month for most beneficiaries in 2018. Medicare Advantage plans are similar to individual health insurance policies you may have received through your employer or signed up for on your own through the individual insurance market, in that they have different monthly premiums, provider networks, copays, coinsurance and out-of-pocket limits. The trade-off for a lower premium (or $0 premium) could be higher copays or coinsurance.
If you have individual market coverage, purchased in the exchange or outside the exchange, you'll need to contact the exchange or your insurer to ask them to cancel your coverage when you transition to Medicare. Prior to the ACA, individual market insurers typically wouldn't insure anyone over the age of 64, so plans were automatically terminated when people turned 65. That is no longer the case, so enrollees need to make sure that they actively cancel their individual market coverage when they switch to Medicare.

And Minnesota residents also account two-thirds of the national total enrollment in Medicare Cost plans. 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 is only about a third of the 625,072 people who have Medicare Cost plans in 2018 — the other two-thirds are in Minnesota).
Plans are required to limit out-of-pocket (OOP) spending by a beneficiary for Parts A and B to no more than $6,700 (as of 2016) per year for in-network providers. The OOP limit may be higher for out of network providers in a PPO; out of network providers are typically not permitted in an HMO. The average OOP limit in 2016 was around $5000. Note that an OOP limit is not a deductible as is often reported; it is instead a financial-protection benefit. It is rare for a Medicare Advantage beneficiary to reach the annual OOP limit.

IMPORTANT: The federal Centers for Medicare & Medicaid Services (CMS) had not released the 2018 Medicare Part A and Medicare Part B premiums, deductibles and coinsurance amounts prior to the print deadline for the 2018 edition of Health Care Choices. As a result, the printed edition of Health Care Choices contains 2017 Medicare Part A and B cost sharing amounts.

But be aware that your benefits and premium could change from one year to the next. So even if you’re confident that you want to keep your current coverage for the following year, it’s important to make sure you understand any changes that may apply, and that you’ve double checked to make sure that your current plan is still the best available option. The available plans and what they cover changes from one year to the next, so even if the plan you have now was the best option when you shopped last year, it’s important to verify that again before you lock yourself in for another year.


Part B premiums can change each year. Sometimes they stay the same from one year to the next, but the general trend has been upwards over time. So the part B penalty will generally also increase from one year to the next. If you're paying 10 percent or 30 percent or 50 percent more than the standard rates, the dollar amount of that penalty will increase as the standard premiums increase over time.
PrimeWest Senior Health Complete (HMO SNP) is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in PrimeWest Senior Health Complete (HMO SNP) depends on contract renewal. Prime Health Complete (HMO SNP) is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in Prime Health Complete (HMO SNP) depends on contract renewal.
During your Medigap Open Enrollment Period, you have a “guaranteed-issue right” to buy any Medigap plan sold in your state. This means that insurance companies cannot reject your application for a Medicare Supplement insurance plan based on pre-existing health conditions or disabilities. They also cannot charge you a higher premium based on your health status. Outside of this open enrollment period, you may not be able to join any Medigap plan you want, and insurers can require you to undergo medical underwriting. You may have to pay more if you have health problems or disabilities.
If you want to obtain Medicare coverage for 2019, it’s important to remember when the open enrollment period is. If you are 65 or about to turn 65, have End Stage Renal Disease, have Amyotrophic Lateral Sclerosis, or qualify for disability, you can enroll in Medicare. Individuals interested in Medicare insurance need to be US citizens or legal, permanent residents of five years or more.

The legislation that introduced Medicare Advantage also created a competition clause that banned Medicare Cost plans from operating in areas where they faced substantial competition from Medicare Advantage plans, but the implementation of the competition clause was delayed for many years. In 2015, legislation (MACRA) called for the competition clause to be implemented as of 2019.


OptumRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use OptumRx home delivery for a 90-day supply of your maintenance medication. $0 copay may be restricted to particular tiers, preferred medications, or mail order prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage.

American Indians can continue to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.

Initial Coverage Election Period: You can enroll into a Medicare Advantage plan or Medicare Advantage Prescription Drug plan when you first become eligible for Medicare. Your Initial Coverage Election Period (ICEP), is a seven-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If you fall into this category, you may enroll into a Medicare Advantage plan 3 months before your month of eligibility, during the month of eligibility, and 3 months after the month of eligibility. For example, if your Medicare Part A and Part B coverage begins in May, your Medicare Advantage plan ICEP is February through August.
Unfortunately, this does not guarantee that you can return to the Medigap plan you had before. Unless this was your first time ever in a Medicare Advantage plan, then you will usually have to answer health questions and go through medical underwriting to get re-approved for Medigap. Consider this before dropping any Medigap plan to go to Medicare Advantage.

Though Medigap plans cover only fees not covered by standard Medicare plans, Medicare Advantage, also known as Medicare part C, is a Medicare supplement that typically offers policyholders coverage for services and service providers not included in the Medicare service basket. In 2011, approximately 345,000 Minnesota residents were enrolled in a Medicare Advantage plan, up 11% from the previous year. Plans vary from provider to provider both in terms of coverage and in terms of price so Minnesota residents should research their options carefully before making a commitment.


Medicare Part A provides payments for in-patient hospital, hospice, and skilled nursing services. Part B provides payments for most physician and surgical services, even some in hospitals and skilled nursing facilities, as well as for medically-necessary outpatient hospital services such as ER, surgical center, laboratory, X-rays and diagnostic tests, certain preventative medical services, and certain durable medical equipment and supplies. Part C health plans, including Medicare Advantage plans, not only cover the same medical services as Parts A and B but also typically include an annual physical exam and vision and/or dental coverage of some sort not covered under Original Medicare Parts A and B. Less often, hearing and wellness benefits not found in Original Medicare are included in a Medicare Advantage plan. The most important difference between a Part C health plan and FFS Original Medicare is that all Part C plans, including capitated-fee Medicare Advantage plans, include a limit on how much a beneficiary will have to spend annually out of pocket; that amount is unlimited in Original Medicare Parts A and B.
American Indians can continue to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.
Preferred Provider Organization (PPO) plans: Medicare Advantage PPO plans offer a network of doctors and hospitals for beneficiaries to choose from. Unlike an HMO, you have the option to receive care from health-care providers outside of the plan’s network, but you’ll pay higher out-of-pocket costs. Medicare Advantage PPOs don’t require you to have a primary care doctor, and you don’t need referrals for specialist care.
As this short list of co-pays demonstrates, out-of-pocket costs will quickly build up over the year if you get sick. The Medicare Advantage plan may offer a $0 premium, but the out-of-pocket surprises may not be worth those initial savings if you get sick. “The best candidate for Medicare Advantage is someone who's healthy," says Mary Ashkar, senior attorney for the Center for Medicare Advocacy. "We see trouble when someone gets sick."
So if you delay your enrollment, you could be paying higher premiums when you eventually do enroll, and you'll have to wait until an open enrollment period in order to have access to coverage. If you're only enrolled in Part A, for example, and you get diagnosed with a serious illness in April, you'll have to wait until the following January to have Part D coverage, and until the following July—more than a year in the future—to have Part B coverage. 
Medicare Advantage plans from UnitedHealthcare offer combinations of benefits and features designed to fit a variety of budgets and healthcare needs. In fact, 1 in 5 Medicare beneficiaries trust UnitedHealthcare with their coverage1. Whether it's our long-standing relationship with AARP®, our 40 years of serving people just like you, or Renew—our member-only Health & Wellness Experience—we're making it a little easier for you to live a happier, healthier life. Learn more here.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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