Traditional Medicare (Parts A and B) does its best to provide senior citizens with the medical care they need during their retirement years. However, there are gaps in this coverage which you will be required to pay out-of-pocket, should you require those services. If you don’t cover those gaps with some sort of supplemental insurance coverage, you may be in for some devastatingly expensive medical bills. This article will explain the ins and outs of one particular type of Medicare supplement insurance policy: Medicare Advantage (Medicare Part C).
Federal Regulations for Medicare Advantage
Sometimes, Medicare Advantage is referred to as a “Medicare replacement” policy due to how it works. When you enroll in Medicare Advantage, the federal government is no longer responsible for paying out claims on your Medicare benefits – that responsibility is transferred to your new Medicare Advantage insurance provider. But don’t worry; there are laws in place to make sure that your policy provides equal or greater coverage than Medicare alone. Many providers add a wide variety of additional coverages and benefits, because that is what attracts the most customers.
Medicare Advantage Enrollment In Minnesota
A whopping 56% of seniors in Minnesota who are eligible for Medicare benefits are on a Medicare Advantage insurance plan instead of any other Medicare plan. That means that only 44% of seniors in the state are either on Medicare Parts A & B alone, on an employer health plan from their working days, or enjoying some sort of alternative health care benefits.
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
Living in Minnesota, your rates will be significantly different than a senior living in California, for example. Based on statistical information for your area, the chart below lists some average rates which seniors could pay for a Medicare Advantage policy:
Most Popular Medicare Advantage Plans in Minnesota
Our site is a database of information about anything and everything related to Medicare. We have organized this information and rated Medicare Advantage companies near you using our 5-star rating system. The higher the number of stars, the more likely they are to be affordable, excel at healthcare management, and maintain good financial stability.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
One of the more complicated aspects of Medicare Advantage is the fact that you can only receive medical care from within your plan’s provider network. Or, if you need to go outside your network, there will likely be expensive and difficult restrictions. If you are curious about an Advantage plan, make sure you talk to your doctor first and see whether or not they are available in a provider network near you. Don’t commit to a plan before you find out if you can get the medical care you need while your policy is active.
Where you generally need to get your care and services from for:
- HMO Plans – An HMO plan (Health Management Organization) is a smaller network of doctors and facilities established by your insurance provider to get you the best care for a low cost. You start by picking a primary care physician and then, when necessary, getting additional care from the specialists your primary recommends. You have the option to get emergency care out-of-network, as well as some pre-approved point-of-service treatment; otherwise, going outside your network will cost you big time.
- PPO Plans – PPO plans are usually more expensive, but give you more choice. PPO is short for “Preferred Provider Organization”, which means you can choose almost any provider who accepts your insurance. You also don’t need pre-approval from a primary care physician before seeing other doctors or specialists. You will get the most affordable care from the providers in your network, but some of your costs will still be shared with your insurance company if you go out-of-network.
- PFFS Plans – Private Fee For Service plans are much more flexible than HMOs, but not quite as flexible as PPOs. You’ll have more providers and facilities to choose from; whether they agree to treat you is another matter. They’ll have to agree to your insurance company’s payment terms first, or you’ll be the one paying. And your doctor’s office can change their mind at any time, so it’s always good to call ahead.
- Special Needs Plans – If you have a severe chronic condition or have other special needs like hospice care, you may decide on a Special Needs Plan. These plans come with limited networks, like an HMO. But the doctors and facilities included in the network are specifically picked because of your specific medical needs. You’ll get similar exceptions when it comes to emergency care. But it can be harder to negotiate plan-approved out-of-network treatment.
Finding a doctor who accepts your Medicare Advantage plan
- HMO Plans – While Medicare Advantage insurance policies make larger networks more available, some seniors may be happy with a limited network due to its reduced costs. And you’ll still have the same emergency exception and point-of-service options with Medicare Advantage that you would a truly private plan.
- PPO Plans – Thanks to government assistance through Medicare Part C, seniors on a tighter budget may be able to afford access to a PPO network on a Medicare Advantage policy. It won’t be as cheap as an HMO Medicare Advantage policy, but it will still be very affordable and you won’t have to worry about paying 100% out of pocket for out of network care.
- PFFS Plans – Besides a reduced base cost of the plan, there’s very little difference between a regular PFFS insurance plan and a PFFS Medicare Advantage plan. You’ll still have to be vigilant about keeping in touch with your preferred doctors and facilities in order to get the most affordable care.
- Special Needs Plans – Getting a Medicare Advantage SNP plan can be very helpful for keeping healthcare costs low. Hospice care or chronic conditions (like ESRD) can be expensive even on a regular SNP; but staying in-network on a Medicare Advantage SNP can make your care much more affordable.
If you already have a doctor (or doctors) you like and want to keep, you should check to make sure they’re in-network before picking a Medicare Advantage plan. Use the Medicare.gov Physician Search Tool to double-check before you rush to choose a plan that forces you to switch care providers.
Drug, Vision and Dental Coverage
If you need ancillary coverage options – such as prescription drugs, vision, or dental coverage – Medicare Advantage is one of the few supplement insurance policies which can help you with that. MAPD plans are policies which include Medicare Part D prescription drug coverage. Additionally, you can add extras such as dental or vision onto almost any available Advantage plan. But the convenience of bundling all of your coverage under one single plan will likely come with a slightly higher price tag, depending on how many options you add.
- Do you want a Medicare Advantage plan that also provides vision coverage? Most will give you the option to add it onto your policy, but it’ll add to the cost. You may also be limited to a specific network of eye doctors and facilities. But there’s a good chance it’ll be more affordable than a private plan.
- Even more important than vision coverage is dental care. And Medicare Advantage may be able to help you with that, too. Like most things with a Medicare Advantage plan, you might not be able to see any dentist you like. But you should definitely check with your insurance plan to see what dentists and dental networks are available to you.
Enrollment Options & Best Time To Enroll
Enrolling in a Medicare Advantage plan is similar to the Medicare enrollment process (especially if you are still within your Initial Enrollment Period). However, your provider may still want to ask you some questions about your health, or screen you for pre-existing conditions. Most of the time, this shouldn’t prevent you from obtaining coverage. However, serious conditions such as End Stage Renal Disease can make it substantially more likely to get rejected. But you have options, and your state department of insurance can explain them to you. You may also take a look at our Medicare Advantage Enrollment Options page for additional enrollment details.
- Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
- Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
- Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.
What Medicare Advantage Plan Is Best For Me?
You should do the best you can to accurately anticipate your future healthcare needs. It’s the easiest way to choose a Medicare Advantage plan that gives you what you need while staying on the right side of affordable. And if the company is financially stable with good customer service ratings, that’s even better.
Of course, it’s not about finding the right plan. It’s about finding the right plan quickly enough to enroll within the limited Medicare Advantage enrollment period. We’d be more than happy to help answer any questions you may have, as well as point you in the right direction towards the best provider.