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Advantage Plans

Medicare Advantage (Part C) Plans in Minnesota

There are a variety of Medicare Advantage plan options including:

  1. Health Maintenance Organizations (Local HMOs)
    1. You must use the plan’s network of providers, except in an emergency or urgently needed care, to get coverage, or you may have to pay the charges in full on your own.
    2. Local HMO plans may require referrals to see a specialist, but some Local HMO Medicare Advantage plans include a point-of-service self-referral option, which gives you some flexibility with going to out-of-network providers. Point-of-Service (POS) plans have an option that allows visits to out-of-network providers at an additional cost. If the POS plan offers Medicare Part D coverage, enrollees must get it from the POS plan. If you enroll in a stand alone plan, you will be disenrolled from the Local HMO Medicare Advantage plan.
    3. Whether or not the Local HMO Medicare Advantage plan includes Part D coverage, you cannot enroll in a separate stand alone Part D plan or you will be disenrolled from your Local HMO Medicare Advantage plan.
    4. Every company offering Local HMO Medicare Advantage plans in Minnesota must offer at least one plan option that includes standard Medicare Part D coverage. If you enroll in a Local HMO Medicare Advantage plan and want Part D coverage included, you will want to enroll in a Local HMO Medicare Advantage plan option that includes Part D coverage.
    5. If Part D is not included in the plan option you choose, you will not have Medicare Part D drug coverage.
      1. This may work fine for you if you have Medicare Part D creditable coverage (refer to Part D information) such as Veterans Administration prescription drug coverage, employer group health, union or retiree plan coverage for prescription drugs that provides coverage that is at least as good as the standard Medicare Part D coverage.
      2. If you do not have creditable prescription drug coverage and decide to enroll in Medicare Part D at a later date, you will most likely be required to pay a premium penalty. Refer to Medicare Part D for additional information.
  2. Preferred Provider Organizations (PPO)
    1. With the Preferred Provider Organization Medicare Advantage plan, you can see any doctor or provider that accepts Medicare.
    2. You don’t need a referral to see a specialist but you may pay more if you go outside the network.
    3. Whether or not the PPO Medicare Advantage plan includes Part D coverage, you cannot enroll in a separate stand alone Part D plan or you will be disenrolled from your PPO Medicare Advantage plan.
    4. Every company offering PPO Medicare Advantage plans in Minnesota, must offer at least one plan option that includes standard Medicare Part D coverage. If you enroll in a PPO Medicare Advantage plan and want Part D coverage included, you would want to enroll in a PPO Medicare Advantage plan option that includes Part D coverage.
  3. Private-Fee-for-Service plans (PFFS)
    1. Since 2011, there have been three types of contractors required for PFFS plans. These include direct contractors, deemed contractors and non-contracting contractors.
    2. Direct contractors contract with a PFFS plan to deliver services to the PFFS plan's members. Deemed contractors are providers who agree to the PFFS plan terms and conditions of payment before providing services to a PFFS plan member. Non-contracting contractors are usually providers furnishing emergency services to PFFS plan members.
    3. You may have out-of-pocket costs for co-pays and deductibles and the provider is allowed to bill you for these costs.
    4. Be sure to understand the plan’s cost-sharing terms before enrolling.
    5. The PFFS Medicare Advantage plan available in Minnesota includes Part D drug coverage but if it did not, you could enroll in a separate stand alone Medicare Part D plan.
  4. Special Needs Plans (SNPs)
    1. There are several different types of Medicare Advantage Special Needs Plans (SNP) available in Minnesota:
      1. Medicare Advantage Special Needs Plans for Chronic Conditions.
      2. Medicare Advantage Special Needs Plans for people age 65 and older with Medicare and Medical Assistance (Medicaid) – MSHO
      3. Medicare Advantage Special Needs Plans for people under age 65 with Medicare and Medical Assistance (Medicaid) - SNBC
  5. Note: SNBC plans do not require Medicare enrollment to be eligible, but you must be enrolled in Medical Assistance (Medicaid). If you are enrolled in Medicare, you must be enrolled in both Part A and Part B.

  6. Medicare Savings Accounts (not available in MN in 2012) Other Medicare Health Plans
  7. Medicare Cost Plans
    1. These are plans that provide Medicare A, B and often Part D coverage and have some important differences when compared to other Medicare Advantage plan options:
      1. Cost Plans have networks of providers to use in order to receive the maximum amount of coverage with the lowest out-of-pocket cost.
      2. Cost Plan enrollees may obtain Medicare-covered services outside of the Cost Plan network. Providers will be paid by Original Medicare for the services and you will be responsible for Medicare deductibles and co-insurance.
      3. Cost Plan enrollment periods are not bound to Medicare Advantage enrollment periods so enrollment is possible if the plan is open to new enrollees. You can also disenroll from the plan at any time and return to Original Medicare.
      4. Cost Plans are allowed to include Medicare Part D coverage, but they are not required to offer it. When a Cost Plan offers Part D, the Part D coverage is much like Local HMO Medicare Advantage Plan Part D coverage.
      5. Cost Plan enrollees in plans that do not offer Part D coverage are allowed to enroll in a separate stand alone Medicare Part D plan.