To qualify for Medicare coverage, two main requirements must be met. Most applicants receive Medicare once they turn 65 years of age. As long as these applicants are able to collect Social Security benefits, then they will meet Minnesota Medicare qualifications. Any individual who is collecting Railroad Retirement benefits will also meet Medicare qualifications.
Part C sponsors annually submit bids that allow them to participate in the program. All bids that meet the necessary requirements are accepted. The bids are compared to the pre-determined benchmark amounts set, which are the maximum amount Medicare will pay a plan in a given county, by law. If a plan's bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. (Because of the county-specific nature of the framework and the bidding process leading to these differences, the same sponsor might offer the same benefits under the same brandname in adjacent counties at different prices.) If the bid is lower than the benchmark, the plan and Medicare share the difference between the bid and the benchmark; the plan's share of this amount is known as a "rebate," which must be used by the plan's sponsor to provide additional benefits or reduced costs to enrollees. A rebate cannot contribute to "profit" ("profit" is in quotes because most Medicare Advantage plans are administered by non-profit organizations, primarily integrated health delivery systems).
A “Welcome to Medicare” packet is mailed out a few months before you turn 65. If you are not yet 65 but receive disability benefits from the Social Security Administration, or receive certain disability benefits from the Railroad Retirement Board, then you become eligible for Medicare as soon as you enter into the 25th straight month of receiving those benefits.

As part of a broad set of overall reforms aimed to control the total cost of Medicare (e.g., large cuts in hospital and skilled nursing facility payments under Part A; adding surtaxes to Part D), the Patient Protection and Affordable Care Act (ACA) changed Trustee payments to Medicare Advantage and other Part C plans—versus what they otherwise would have been—by adjusting the way the statutory county benchmarks that kick off the annual Part C Medicare Advantage bidding process were calculated. The intention was to bring the capitated payments closer to the average costs of care per person under Original Medicare.
This benchmark/bidding/rebate process accounts for from 97% to 100% of the cost of the given Medicare Advantage plan to the Medicare Trust Funds. The individual fee for each Part C beneficiary is also uplifted or downsized slightly (approximately 1%-3% in either direction on average) from the county-specific fee based on a risk-based formula tied to the personal health characteristics of the capitated individual. The theory is that the risk-based formula will not affect spending, but in practice it almost always increases cost per beneficiary by one or two percent, either because the Medicare Advantage plan is diligent in upcoding to a beneficiary's specific risks or because patients on Original FFS Medicare, where providers have no incentive to code at all, are undercoded .
If you’ve been in in the Medicare Advantage plan for less than a year, you’re still in your trial period and you do have the option to enroll in a guaranteed issue Medigap plan when you switch back to Original Medicare; if you enrolled in Medicare Advantage when you were first eligible and are switching back to Original Medicare within a year, you can enroll in any Medigap plan sold in your state.  If you dropped your Medigap plan to enroll in a Medicare Advantage plan and you switch back within a year, you can enroll in the Medigap plan you had before, or if it’s no longer available, you can enroll in any plan A, B, C, F, K, or L sold in your state.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.

Sicker people and people with higher medical expenditures are more likely to switch from Medicare Advantage plans to Original Medicare. This statistic is primarily driven by people on Medicaid in custodial care at nursing home; such people no longer have need of any Medicare supplement, either a public Part C plan or a private Medigap or group retirement plan.[15] The Part C risk adjusted payments to Medicare Advantage plans are designed to limit this churn between types of Medicare (managed vs. FFS), but it is unclear how effective that policy is.[16]
Your information and use of this site is governed by our updated Terms of Use and Privacy Policy. By entering your name and information above and clicking the Call Me button, you are consenting to receive calls or emails regarding your Medicare Advantage, Medicare Supplement Insurance, and Prescription Drug Plan options (at any phone number or email address you provide) from an eHealth representative or one of our licensed insurance agent business partners, and you agree such calls may use an automatic telephone dialing system or an artificial or prerecorded voice to deliver messages even if you are on a government do-not-call registry. This agreement is not a condition of enrollment.

There are two ways for providers to be reimbursed in Medicare. "Participating" providers accept "assignment," which means that they accept Medicare's approved rate for their services as payment (typically 80% from Medicare and 20% from the beneficiary). Some non participating doctors do not take assignment, but they also treat Medicare enrollees and are authorized to balance bill no more than a small fixed amount above Medicare's approved rate. A minority of doctors are "private contractors," which means they opt out of Medicare and refuse to accept Medicare payments altogether. These doctors are required to inform patients that they will be liable for the full cost of their services out-of-pocket in advance of treatment.[60]
Upon receiving beneficiary eligibility information from DPSS, Health Care Options mails each recipient an enrollment packet. The packet contains enrollment materials as well as explains that the beneficiary must choose a health plan, what health plans are available, and that if the enrollment form is not completed and received at Health Care Options in 30 days a health plan will be chosen for them. When Health Care Options chooses a health plan for the beneficiary, it is called default or "automatic assignment." 

Your information and use of this site is governed by our updated Terms of Use and Privacy Policy. By entering your name and information above and clicking this button, you are consenting to receive calls or emails regarding your Medicare Advantage, Medicare Supplement Insurance, and Prescription Drug Plan options (at any phone number or email address you provide) from an eHealth representative or one of our licensed insurance agent business partners, and you agree such calls may use an automatic telephone dialing system or an artificial or prerecorded voice to deliver messages even if you are on a government do-not-call registry. This agreement is not a condition of enrollment.
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