Medigap in Minnesota

Medigap, also known as Medicare supplement insurance, covers some or all of the deductibles, coinsurance, and copays associated with Original Medicare. Exact coverages vary based on the exact Medigap plan selected. Minnesota residents have a different set of Medigap plans than the standard plans offered in most other states. Residents of Wisconsin and Massachusetts also have their own state-set plans. Minnesota’s plans also reflect state-enforced regulations on all Medigap offerings.

What Are Medicare Supplement Plans?

Medicare supplement plans work alongside Original Medicare to cover some of the out-of-pocket costs associated with Original Medicare, including coinsurance and deductibles. These plans are offered by private insurance companies, though every plan is standardized by Medicare and state regulations. For example, every Medigap Basic Plan in Minnesota must cover the same minimum benefits, no matter which insurance company offers it.

Medigap can only be used with Original Medicare. Those with Medicare Advantage are not eligible to purchase Medigap. Original Medicare offers Part A (hospital insurance) and Part B (medical insurance) benefits to those who are 65 years or older, or who have specific disabilities or terminal illness, such as End-Stage Renal Disease.

Depending on your healthcare needs, enrolling in a Medigap policy can help you save money in the long run, even though you must pay a monthly premium to keep your Medigap policy active. For example, if you had heart surgery, your medical provider bills Original Medicare first for the procedure. After that, there is a remaining balance, including your portion of the coinsurance for the procedure after Original Medicare paid its share. Your Medicare supplement plan helps to cover some or all of that remaining portion, which can help save you significantly more than the cost of the plan’s monthly premium.

Bear in mind that although Medicare supplement plans cover many costs that Original Medicare does not, it does not provide coverage for:

• Routine dental and vision services
• Long-term health care services
• Costs for hearing aids and eyeglasses

Your Medigap Plan Options in Minnesota

Benefits	Basic Plan	Extended Basic Plan	Basic Plan with Riders	Plan K	Plan L	Plan M	Plan N
Basic benefits	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Minnesota-mandated benefits	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Medicare Part A: Inpatient deductible	No	Yes	Optional	50%	75%	50%	Yes
Medicare Part A: Skilled Nursing Facility coinsurance	Yes (100 days)	Yes (120 days)	Yes (100 days)	50%	75%	Yes	Yes
Medicare Part B deductible	No	Yes, but only for those eligible for Medicare prior to January 1, 2020	Optional, but only for those eligible for Medicare prior to January 1, 2020	No	No	No	No
Outpatient mental healthcare	50%	50%	50%	N/A	N/A	N/A	N/A
Usual and customary fees	No	80%, then 100% after reaching out-of-pocket maximum	Optional	N/A	N/A	N/A	N/A
Medicare preventative care	Yes	Yes	Yes	N/A	N/A	N/A	N/A
Coverage in foreign country	No	80%, then 100% after reaching out-of-pocket maximum	No	N/A	N/A	N/A	N/A
Foreign travel emergency care	80%	80%, then 100% after reaching out-of-pocket maximum	80%	N/A	N/A	N/A	N/A

Basic Plan

The Basic Plan in Minnesota covers the following:

• This plan covers up to 50% of outpatient mental healthcare, though some plans may cover up to 100%. For example, an individual may receive treatment such as individual or group therapy. You are also not required to stay overnight and may return home on the same day.
• This plan covers up to 20% of physical therapy costs. If you are injured or ill and need physical therapy sessions to regain functionality or self-sufficiency, Medigap will pay for a portion of those costs.
• This plan covers 100 days of skilled nursing care. This type of care may be offered in a hospital, nursing home, or other certified assisted living locations. However, note that skilled nursing care refers to medically necessary care and does not include custodial care.
• This plan covers state-mandated benefits, such as flu shots, immunizations, and medical screenings. These preventative services can keep you healthy.

Extended Basic Plan

The Extended Basic Plan offers the same benefits as the Basic Plan, but with some additions, including the following:

• This plan includes coverage for Original Medicare’s Part A deductible, which is $1,600 in 2023. Part A includes inpatient hospital stays, home health care, lab tests, and surgery. With the Extended plan, you do not pay the deductible for these services out of pocket.
• This plan includes 80% coverage for routine care in a foreign country. Original Medicare does not cover healthcare received outside of the country. However, if you need health coverage while traveling in a foreign country, the Extended Basic plan may cover up to 80% of a routine medical procedure or prescription drug.
• This plan includes coverage for 20 extra days of skilled nursing care. This means with the Extended Basic plan, you have 120 total days covered for skilled nursing care.
• The 80% coverage of the Extended Basic plan’s benefits may increase to 100% coverage once you have spent $1,000 out of pocket within the year.

Basic Plan with Riders

There are four riders that may be added on to the Basic plan. Riders add more coverage to the Basic Plan at an additional price. Depending on how many riders you opt to add, it may be more cost effective than changing to an Extended Basic plan.

• Part A inpatient deductible coverage: While the Extended Basic plan includes this, you may also purchase it as a rider for a Basic plan if you do not wish to change plans entirely.
• Part B medical deductible coverage: This provides coverage for the deductible on Part B’s medically necessary and preventative care. The Part B deductible is $226 in 2023.
• Usual and customary fee coverage: This provides coverage for the amount usually charged for a medical service in a set geographic area.
• Non-preventative care coverage: This provides coverage for labs and other diagnostic tools not considered to be routine preventative care. For example, if your doctor discovers a mass and requests an x-ray or scan, this would be considered non-preventative care.

Medicare SELECT

Unlike Basic and Extended Basic plans, Medicare SELECT requires individuals to only use specific hospitals, doctors, and clinics within their network to receive their full benefits. These plans tend to have lower premiums than other Medigap options.

You may consider Medicare SELECT if your preferred healthcare providers are already within the plan’s network and if you do not intend to travel often, thereby limiting the amount of time you would be outside the plan’s coverage area.

Other Medigap Plans Available

There are Minnesota-specific versions of Medigap Plans K, L, M, and N.

• Medigap Plan K in Minnesota: Instead of paying all of the costs per covered benefit, Medigap Plan K pays a set percentage of it. Once you reach the cap on your out-of-pocket costs for the year, the plan may then pay 100% of your costs for the rest of the year.
• Medigap Plan L in Minnesota: Much like Plan K, Plan L pays a percentage of your medical bill. The difference is that the covered percentage is higher and your out-of-pocket cost maximum is lower than with Plan K.
• Medigap Plan M in Minnesota: If you are hospitalized, this plan may cover half of your Part A deductible.
• Medigap Plan N in Minnesota: Plan N helps cover the cost of coinsurance, and may cover the remaining 20% of your medical bill after Original Medicare has paid 80% of it. However, Plan N does not cover Part B deductibles or Part B excess charges.

Medigap Eligibility in Minnesota

To be eligible for all Medigap options in Minnesota, you must be enrolled in both Part A and Part B of Original Medicare and be at least 65 years old. However, those who are eligible for Medicare but are under 65 years old have at least one Medigap option from every insurer who offers Medigap plans at all.

When to Enroll in Medigap in Minnesota

There is only one true enrollment period in Minnesota for those interested in joining a Medigap plan: your individual enrollment period. This period lasts for 6 months and begins the month you have Medicare Part B and are 65 years old or older. For example, if you turned 65 in January but did not enroll in Medicare Part B until July, your 6-month individual enrollment period would begin in July and last until the last day of December.

During your individual enrollment period, you have a guaranteed issue right to a policy. This means that despite your health history, insurers must offer every plan and accept your application. Outside of this enrollment period, you can still apply to enroll in a Medigap plan at any time, but your application may be denied based on your health status.

Medigap vs. Medicare Advantage

When determining whether a Medigap plan or Medicare Advantage plan is better, you should keep your budget, anticipated health needs, and in the case of Medicare SELECT plans, the availability of network healthcare providers in mind.

Medigap plans may help you save money on your health expenses if you frequently see a doctor, have recurring health needs or medications, and prefer to have nationwide access to healthcare. Because Medigap works with Original Medicare, which is accepted by any doctor who takes Medicare regardless of insurance network, it offers a wider range of coverage. Even if the doctor is out of state or in a different city, Medigap may continue to provide coverage.

Those seeking coverage for more benefits may find Medicare Advantage more suitable. Medicare Advantage plans typically have additional benefits beyond what Original Medicare offers, such as Part D prescription drug coverage and some dental and vision coverage. The plan may also be beneficial if you do not see a doctor as often and are fine with a limited network of healthcare providers.

Ultimately, look to how you need to utilize your healthcare to determine whether Original Medicare with Medigap would better suit your needs or if Medicare Advantage is a better choice.