Medicare in Minnesota

Medicare provides health insurance to those aged 65 and over and younger people with certain disabilities or permanent kidney failure. In Minnesota, 1,113,957 people are eligible for this coverage, making up almost a fifth of the population. This represents a 3.16% increase in the number of people eligible for coverage in 2022, outpacing the national growth of 2.66%. Medicare Advantage Plans are a little more popular than the Original Medicare program in Minnesota, with about 53% of beneficiaries opting for coverage through private health insurance companies in 2023. By comparison, in 2022, 50% of Medicare beneficiaries chose this alternative. Nationally, about 48% of beneficiaries have Medicare Advantage, which is up by 6.9% over those who chose this coverage in 2022.

Original Medicare features two parts to provide robust coverage for beneficiaries. Part A hospital coverage pays for inpatient hospital services, nursing home care, home health care and hospice. Part B medical coverage pays for durable medical equipment, medical transportation services, routine checkups and diagnostic and screening services. Most people don’t pay for Part A coverage, but if someone hasn’t paid Medicare taxes for at least a decade, they may have a monthly premium of either $278 or $506. The Part B monthly premium is $164.90.

Medicare Advantage Plans also provide this coverage, and in some cases, they have additional benefits that make them popular among Minnesota residents. These plans are available through private health insurance companies and encompass all Medicare Parts A and B benefits and, in some cases, include prescription drug, vision and dental coverage. Because these plans aren’t standardized, monthly premiums, deductibles and rules about seeking specialists or out-of-network providers may vary. In 2023, the number of Medicare beneficiaries with Medicare Advantage is 9.64% higher than in 2022, highlighting the popularity of these plans. 

This guide offers a comprehensive overview of the various programs and resources available in Minnesota to assist seniors in customizing their health care coverage. It aims to empower them to make well-informed decisions about health care options. 

Options for Medicare Coverage in Minnesota

While Original Medicare offers basic coverage many Minnesota residents can depend on, some people need additional coverage not provided through the traditional program. Seniors have additional options if they’d like to create a policy that meets special needs. They can explore Advantage plans and other insurance policies offered by private insurance companies and apply for financial aid if they qualify. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services, and it’s open to those aged 65 and over, along with those who have certain medical conditions or end-stage renal disease. While this program can make health care services accessible to many seniors by providing robust coverage, there are cost-sharing obligations. Part A has a $1,600 deductible for every hospital stay, and beneficiaries must pay a portion of their costs for stays beyond 60 days. Part B has a $226 deductible beneficiaries must pay annually before their benefits kick in. After that, they pay 20% of their medical expenses..

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage Plans are available through private health insurance companies that agree to Medicare’s coverage requirements, providing an alternative way for beneficiaries to get coverage. All plans include the benefits guaranteed in Parts A and B, and many plans have coverage for dental services, vision care and prescription drugs. Plans also may have out-of-pocket limits, providing significant savings for some beneficiaries, and many have $0 deductibles or low monthly premiums. There are four basic plans available, including HMOs, PPOs, PFFS plans and SNPs, although the plans an individual has access to depends on where they live.

Who Should Consider Medicare Advantage

Medicare Advantage is an ideal choice for people who:

• Are generally healthy , so may benefit from lower premiums
• Would like to add vision or dental coverage to their Medicare benefits
• Want more control over their out-of-pocket expenses

Top 10 Medicare Advantage Plans in Minnesota

Minnesota residents have plenty of Medicare Advantage plans to choose from. The following table can help seniors narrow their choices by offering the best plans based on enrollment numbers, ratings and level of coverage. It also reviews costs as of August 2023. More information on Medicare C plans is provided on the Medicare Advantage plans in Minnesota page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Minnesota

Enrolling in Medicare can be difficult to navigate, especially when considering private coverage options. Minnesota residents have access to several agencies that offer counseling and support services to help them determine which coverage options are right for them, learn more about their benefits and complete their applications. Anyone with questions regarding Medicare enrollment, prescription drug coverage or researching Medicare Supplement plans in the state can contact one of these agencies.