Some Medicare Cost Plans are Going Away in Minnesota Next Year. What Coverage Options Will You Have Going Forward?
Because of a recent change in federal law, if you are age 65 or older and you live in Minnesota, you may have to enroll in a new Medicare health plan next year. Before making a commitment to a new Medicare plan going forward, it is important to make sure of what your other viable options are, as well as to have a good understanding of which alternate plans may or may not be right for you.
A Medicare cost plan is a unique type of Medicare health care coverage in which an enrollee has coverage for many of the expenses that are not covered by Original Medicare. These plans are oftentimes described as “hybrid” plans.
That is because they are a cross between a Medicare Advantage (Medicare Part C) plan and a Medicare Supplement (Medigap) plan. In some cases, Medicare cost plan beneficiaries describe these plans as the best of both worlds.
With a Medicare cost plan, enrollees who use providers that are listed in certain networks will have lower costs for their health care services. (Although there is an option to use out-of-network providers, and to be covered under Part A and Part B of Medicare – which is also referred to as Original Medicare).
Medicare cost plans are only available in certain areas of the U.S. – which includes Minnesota. With such plans, you can still join – even if you only have Medicare Part B coverage. You are also allowed to join any time that a Medicare cost plan is accepting new members. Likewise, you can leave a Medicare cost plan at any time and return to having Original Medicare coverage.
Approximately one-third of the Medicare enrollees in the state of Minnesota have a Medicare cost plan. (3) To be eligible for a Medicare cost plan, you must be enrolled in Medicare Part B. In addition, you must:
⦁ Reside as a permanent resident in the service area of the Medicare cost plan you are considering, and
⦁ Not have end stage renal disease (in most cases).
In order to confirm whether or not you have a Medicare cost plan, the best route is to contact your plan directly. You can do so by calling the phone number of the back of your plan’s member ID card.
If you are a member of a Medicare cost plan and you also want to have prescription drug benefits, you may be able to get them via the cost plan’s overall coverage. If prescription drug benefits are not provided within your Medicare cost plan, you may instead be able to purchase a stand-alone Medicare Part D prescription drug plan. (1)
Sort of, but no. Similar to Medicare Advantage plans, because Medicare cost plans are offered via private insurance carriers, the actual benefits that are provided can differ from one plan to another. But in general, there are typically two types of Medicare cost plans – those what offer both Part A and Part B benefits, and those that offer only Medicare Part B benefits.
If you are enrolled in a Medicare cost plan that covers both Part A and Part B benefits, then your out-of-pocket expenses will generally be lower if you opt to use doctors and other providers that are listed in the plan’s network. If, however, you choose a provider that is not included in the plan’s network, your services will be covered through Original Medicare (and not by your Medicare cost plan).
If you are in a Medicare cost plan that only offers Medicare Part B coverage, it is likely that it is sponsored by your (or your spouse’s) employer or union. These plans will also not typically include benefits for prescription drugs.
While there are some Medicare cost plan enrollees who will be affected by the new legislation, this is not the case for all. In some cases, for instance, some cost plan beneficiaries will be able to remain in their current plan in 2019.
According to the Minnesota Commerce Department, below is a breakdown of the counties where Medicare cost plans will continue beyond the year 2018 in Minnesota, and those where cost plans will not be continued.
For those Minnesota Medicare cost plan members who are not able to remain in their current plan, there will be an automatic transition to a Medicare Advantage plan next year. These Medicare Advantage plans will typically be offered by the same insurance carrier as your current Medicare cost plan, provided that the Centers for Medicare and Medicaid Services (CMS) determines that the Medicare Advantage plan provides benefits that are similar to the current Medicare cost plan.
Should you fall into this category, you will not be forced to go into the new Medicare Advantage plan, though. Rather, you will be allowed to opt out of the chosen plan and select either a different Medicare Advantage plan, or a Medicare Supplement plan.
United Healthcare just published a really nice summary blog post on this topic, specific to Minnesota. You can check them out by clicking here. Just be forewarned – they’re in this to sell you a brand new MAPD or Medicare Supplement plan so think twice before submitting any personal information to them or clicking any other embedded links.
Over the next few months, there are some important dates to be mindful of as they pertain to Medicare cost plan enrollees, starting in early September. These dates include:
⦁ September 1, 2018 – If you are a Minnesota Medicare cost plan enrollee whose plan is ending and you will not be transitioned automatically to a Medicare Advantage plan, you will be receiving information in the mail from Medicare that will let you know about this change in coverage, as well as provide you with details about your other Medicare coverage alternatives.
⦁ September 15, 2018 – Those who will automatically be transitioned from a Medicare cost plan into a Medicare Advantage plan will be notified by the cost plan’s insurance carrier about this change.
⦁ October 1, 2018 – On October 1, 2018, you can start to shop and compare Medicare plans for the year 2019. Information regarding such plans will be available on Medicare’s website at ⦁ www.Medicare.gov, under the Plan Finder tab.
⦁ October 15 through December 7, 2018 – October 15th through December 7th is the annual enrollment period (or AEP) for Medicare. It is during this time period that you can opt to change Medicare plans for the following year. This includes the coverage you have for Medicare Parts A and B, as well as for Medicare Part D prescription drug coverage.
⦁ November 2, 2018 through March 4, 2019 – If you lost your Medicare cost plan and you returned to having coverage under Medicare Parts A and B, you can purchase a Medicare Supplement insurance plan during this time period, without having to go through the underwriting process. This means that you cannot be denied, or even charged more, for a Medicare Supplement plan, even if you have an adverse health condition.
⦁ December 8, 2018 through February 28, 2019 – This is the time frame for the Medicare Special Enrollment Period for those who are losing their Medicare cost plans. During this time, you can enroll in a different Medicare Advantage plan or Medicare Part D prescription drug plan for next year (as versus the one that was automatically chosen for you).
⦁ January 1, 2019 through March 31, 2019 – During the first three months of 2019, those who are currently enrolled in a Medicare Advantage plan may change to a different Medicare Advantage plan, or alternatively, switch back over to Original Medicare coverage (Medicare Part A and Part B). (4)
Getting through the Medicare enrollment maze can be somewhat confusing. So, if you still have questions or you would like additional information, visit the Minnesota’s commerce department websites for updates. You can click here for the latest updates. You can also work with a Medicare insurance agent who specializes in Medicare coverage.
If you live in Minnesota, Medicare cost plans are currently only offered through three insurance carriers. These are:
⦁ Blue Cross and Blue Shield of Minnesota
There are various brand names that each of these insurance carriers have given to their Medicare cost plans. For instance, HealthPartners has several Medicare cost plans, including:
⦁ Freedom Active
⦁ Freedom Active with Rx
⦁ Freedom Balance
⦁ Freedom Balance with Rx
⦁ Freedom Basic
⦁ Freedom Ultimate
⦁ Freedom Ultimate with Rx
⦁ Freedom Ultimate with Enhanced Rx
⦁ Freedom Vital
⦁ Freedom Vital with Rx
Likewise, the Medicare cost plans that can be purchased through Blue Cross and Blue Shield of Minnesota are:
⦁ Platinum Blue Core
⦁ Platinum Blue Core with Rx
⦁ Platinum Blue Choice
⦁ Platinum Blue Choice with Rx
⦁ Platinum Blue Complete
⦁ Platinum Blue Complete with Rx
Medica’s Medicare cost plans currently include the following:
⦁ Medica Prime Solution Value
⦁ Medica Prime Solution Value with Rx
⦁ Medica Prime Solution Value with Rx2
⦁ Prime Solution Basic
⦁ Prime Solution Basic with Rx
⦁ Prime Solution Basic with Rx 2
⦁ Prime Solution Enhanced
⦁ Prime Solution Enhanced with Rx
⦁ Prime Solution Enhanced with Rx 2 (2)
⦁ Other Medicare health plans. Medicare.gov. (https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/other-health-plans/other-medicare-health-plans.html)
⦁ Update on Medicare Cost Plans for 2019. MN Commerce Department. (https://mn.gov/commerce/media/news/?id=17-343500)