Medicare in Minnesota

The Medicare fall enrollment period is upon us — Oct. 15 through Dec. 7 —  affecting millions of Americans already enrolled in the government insurance program known as Original Medicare.

This is the time to review your coverage for 2015 and enroll in — or change — your Part D Prescription Drug Plan or Medicare Advantage plan.

(And from Jan. 1 through Feb. 14, 2015, you can choose to drop your Medicare Advantage plan if it’s not working for you, and return to Original Medicare.)

But first, let’s review how Medicare works in Minnesota.

Simply put, Medicare is a government insurance program. It provides hospital coverage, through Medicare Part A, and outpatient medical coverage, through Part B, to people 65 and older, plus certain younger people with disabilities and people with end-stage renal disease. These two parts, A and B combined, are called Original Medicare.

Medicare Part A is premium-free to people who paid Social Security taxes for at least 10 years, or whose spouses did so. However, if you or your spouse haven’t worked for at least 10 years, you’ll be required to pay a monthly premium.

Medicare beneficiaries pay a monthly premium for Part B. With Original Medicare, you also pay separate co-pays for Part A and a deductible for Part B, plus 20 percent coinsurance for most medical services covered under Part B. And, with Original Medicare, there’s no limit to the amounts you could be responsible for paying out of pocket.

So, as you can see, Original Medicare offers important benefits, but doesn’t cover all of your medical costs or every need you might have. For example, Medicare doesn’t cover routine dental or vision services, dentures, hearing aids or prescription drugs.

To close up some of those cost and coverage gaps, many Minnesotans enroll in a Medicare Supplement plan — also called a Medigap plan — offered by private insurance companies. Some people also add dental and vision plans from private insurers because Medigap plans don’t typically cover those services. To cover medications, many Minnesotans enroll in a Medicare Part D Prescription Drug Plan, also offered by private insurance companies.

Newcomers to Medicare as well as seniors currently enrolled in Medicare should compare companies’ drug plans annually to see which plan offers better benefits for their specific medications.

In 2014, eHealth found that, on average, people who compared Part D drug plans using their specific drug regimen could have saved more than $80 a month by switching to the plan with the lowest total out-of-pocket costs.

Another way to covering costs is the option of a Medicare Advantage plan, sometimes called Part C.

Medicare Advantage plans, also offered by private insurance companies, cover the same hospital and medical benefits as Medicare Part A and Part B, but may also cover some of your out-of-pocket costs and offer additional benefits.

If that weren’t enough, Minnesota has yet another option known as a Medicare Cost Plan, a unique plan that combines the features of Medigap plan and a Medicare Advantage plan, depending on the services involved.

While Medicare Advantage and Medicare Cost plans sound similar in terms of providing the same benefits as Original Medicare, they do work differently. Medicare Advantage plans can also include dental and vision benefits, plus prescription drug coverage. They also put a cap on your out-of-pocket expenses each year, unlike Original Medicare.

Medicare Cost Plans offered in Minnesota can include prescription drug benefits, but don’t always — and they never cover vision or dental. They can be relatively lower in cost than other plans, but to enjoy the maximum savings, you have to use the plan’s preferred provider network. Finally, you can enroll in Cost Plans at any time, which is not the case for Medigap and Medicare Advantage plans.

This annual enrollment period does not apply to people signing up for Medicare for the first time.

First-timers have different enrollment periods determined by the Social Security Administration. (See ssa.gov or call 800-772-1213 to determine your eligibilty.)

Perhaps the most important thing to note when you first sign up for Original Medicare is that you’ll have only six months — starting from when you first enroll in both Parts A and B of Medicare — to enroll in Medigap or Minnesota Select Plan without going through an underwriting process, said Kimberlee Bluhm, the director of Medicare programs at Senior Community Services in Minnetonka, which offers free Medicare consulting and classes.

Private insurance companies enrolling Medicare-eligible people in Medigap plans after that six-month window closes are allowed to ask significantly more questions.  And they can potentially reject Medigap applicants based on their answers to the underwriting questions, Bluhm said.

When it comes time to chose a plan or make adjustments to your existing plan in Minnesota, here are some factors to consider.

Are your medical needs being covered by your current Medicare plan?

Are your out-of-pocket costs — including premiums, deductibles, copayments and coinsurance — manageable for you?

Do you have a preferred doctor, or are you willing to try a new doctor if it could mean a cost savings?

Will you need to travel from a small town to big-city Minneapolis to get specialist care?

Could you save money on medicines in 2015 by changing your Part D drug plan?

Minnesota residents have choices when it comes to Medigap plans. Most popular are the Basic Plan and an Extended Basic Plan:

The Minnesota Medigap Basic plan generally covers:

There are four optional riders (additional coverage) for the Basic plan that you can get, covering:

The Minnesota Medigap Extended Basic plan includes the Basic plan coverage, plus:

Minnesota also offers Medicare Select plans, which are managed-care Medicare Supplement plans that may offer lower premiums and deductibles than other Medigap plans.

They require participants to use specified networks of hospitals, clinics, and, sometimes, doctors.

Medicare Select is available in all 87 Minnesota counties.

Finally, Minnesota also offers five high-deductible Medigap plans known as F, K, L, M and N.

They each have a different deductible and are offered by a variety of private insurance companies.

When comparing and buying any Medicare private insurance plan during this fall’s enrollment period, choose your agency with care.

Only give your personal information when it’s needed to doctors, other health-care providers, plans approved by Medicare and to people in the community who work with Medicare, such as your State Health Insurance Assistance Program (SHIP), Social Security or Senior Community Services.

Safeguard your Medicare card, and be aware it bears your Social Security number. If you want to carry it, keep only a photocopied version with you, with all but the last four numbers blacked out.

Call the customer service number on the back of your Medicare card if you have any questions or concerns.

Senior Community Services is offering numerous “Navigating Medicare” classes throughout the Twin Cities now through December. Classes are non-biased and don’t include sales pitches for specific health plans. See seniorcommunity.org or call 952-767-7887 for more information or for a free Medicare-counseling appointment.

The Minnesota Board on Aging and Minnesota Senior Linkage Line provide advocacy, research and services for Minnesota seniors and their families. Call 800-333-2433 or see mnaging.org.

The Minnesota Department of Human Services operates Medicare Savings Programs for low-income Minnesotans. Call 651-431-2000 (TTY/TDD: 800-627-3529) or see mn.gov/dhs.

The Minnesota Department of Commerce offers information about Medicare in Minnesota. Call 651-539-1500 or see mn.gov/commerce/insurance/topics.

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