Part B also helps with durable medical equipment (DME), including canes, walkers, lift chairs, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered.[41]


The PPACA also made some changes to Medicare enrollee's' benefits. By 2020, it will close the so-called "donut hole" between Part D plans' coverage limits and the catastrophic cap on out-of-pocket spending, reducing a Part D enrollee's' exposure to the cost of prescription drugs by an average of $2,000 a year.[114] This lowered costs for about 5% of the people on Medicare. Limits were also placed on out-of-pocket costs for in-network care for public Part C health plan enrollees.[115] Most of these plans had such a limit but ACA formalized the annual out of pocket spend limit. Beneficiaries on traditional Medicare do not get such a limit but can effectively arrange for one through private insurance.
Most Medicare enrollees do not pay a monthly Part A premium, because they (or a spouse) have had 40 or more 3-month quarters in which they paid Federal Insurance Contributions Act taxes. The benefit is the same no matter how much or how little the beneficiary paid as long as the minimum number of quarters is reached. Medicare-eligible persons who do not have 40 or more quarters of Medicare-covered employment may buy into Part A for an annual adjusted monthly premium of:
Republicans believe that a Medicare program that was created for seniors and paid for by seniors their entire lives should always be protected and preserved. I am committed to resolutely defending Medicare and Social Security from the radical socialist plans of the Democrats. For the sake of our country, our prosperity, our seniors and all Americans — this is a fight we must win.
Medicare Advantage offers at least the same coverage as Original Medicare, and may offer additional benefits. It may be one way of adding coverage for routine vision, or dental services, dentures, and more. Some Medicare Advantage plans have a $0 premium. However, regardless of how much you pay for a Medicare Advantage plan, you must continue pay your Medicare Part B premium.
Special Needs Plans (SNPs) are designed for people with special health care or financial needs. All Special Needs Plans include drug coverage. They may also include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four main types of Special Needs Plans:
Medicare Advantage Disenrollment Period: If, after enrolling in a Medicare Advantage plan, you change your mind, you can switch back to Original Medicare from January 1 through February 14 each year. If you would be losing prescription coverage as a result of the switch, you can also enroll into a stand-alone Medicare Part D Prescription Drug Plan during this time, if you wish.
Medicare Advantage is a type of health insurance that provides coverage within Part C of Medicare in the United States. Medicare Advantage plans pay for managed health care based on a monthly fee per enrollee (capitation), rather than on the basis of billing for each medical service provided (fee-for-service, FFS) for unmanaged healthcare services. Most such plans are health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Medicare Advantage plans finance at a minimum the same medical services as "Original Medicare" Parts A and B Medicare finance via fee-for-service. Part C plans, including Medicare Advantage plans, also typically finance additional services, including additional health services, and most importantly include an annual out of pocket (OOP) spend limit not included in Parts A and B. A Medicare Advantage beneficiary must first sign up for both Part A and Part B of Medicare.
As an alternative to obtaining Original Medicare coverage directly from the government, you may want to consider Medicare Advantage (sometimes referred to as Medicare Part C) in Minnesota. Medicare Advantage plans are offered by private insurance companies that contract with CMS to provide all Original Medicare benefits except hospice care, which is paid by Medicare Part A. Many Medicare Advantage plans also include extra benefits such as routine dental and vision care.

Enrollment in the public Part C health plan program, including plans called Medicare Advantage since 2005, grew from zero in 1997 (not counting the pre-Part C demonstration projects) to over 21 million in 2018.[4] That 21,000,000-plus represents about 35% of the people on Medicare. But today over half the people fully signing up for Medicare for the first time, are choosing a public Part C plan of some type.
For doctors and medical procedures (Part B) at the hospital and at home: You would pay 20% of all costs after meeting your $147 deductible. Unlike many other health insurance policies, there is no cap or maximum out-of-pocket amount on what you could owe. The American Heart Association says that the average cost of heart surgery is $62,509 – in that case, your Part B copay would be over $12,000. 
But the costs per person that had once been too low to attract beneficiaries then became too high to afford long term. So in 2009, the Medicare Payment Advisory Commission (MedPAC) reported that Medicare would spend 14 percent more on Medicare Advantage beneficiaries per person that year than they did per person for "like beneficiaries" under traditional Medicare, theoretically adding an additional 3% ($14 billion) to the cost of the overall Medicare program compared to spending without Part C,[5] This lack of parity and disconnect with the original goal of Part C was primarily caused by so-called Private Fee for Service (PFFS) plans (designed primarily for the rural and urban poor), special needs plans (SNPs), and Employer Group plans (which primarily served retired union members). A special situation relative to Puerto Rico contributed to the imbalance at that time. However the lack of parity also applied to a lesser degree to HMO and PPO plans nationwide.

Because Medicare offers statutorily determined benefits, its coverage policies and payment rates are publicly known, and all enrollees are entitled to the same coverage. In the private insurance market, plans can be tailored to offer different benefits to different customers, enabling individuals to reduce coverage costs while assuming risks for care that is not covered. Insurers, however, have far fewer disclosure requirements than Medicare, and studies show that customers in the private sector can find it difficult to know what their policy covers.[75] and at what cost.[76] Moreover, since Medicare collects data about utilization and costs for its enrollees—data that private insurers treat as trade secrets—it gives researchers key information about health care system performance.
Medicare Part B premiums are commonly deducted automatically from beneficiaries' monthly Social Security checks. They can also be paid quarterly via bill sent directly to beneficiaries. This alternative is becoming more common because whereas the eligibility age for Medicare has remained at 65 per the 1965 legislation, the so-called Full Retirement Age for Social Security has been increased to 66 and will go even higher over time. Therefore, many people delay collecting Social Security and have to pay their Part B premium directly.

Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis (but also when on an unadmitted observation status in a hospital). Part B is optional. It is often deferred if the beneficiary or his/her spouse is still working and has group health coverage through that employer. There is a lifetime penalty (10% per year on the premium) imposed for not enrolling in Part B when first eligible or if not covered by programs of the Veterans Health Administration.
Original Medicare provides no similar OOP spending cap and the exposure of an Original Medicare beneficiary to a financial catastrophe is unlimited (but also rare). Once the OOP maximum is reached for an individual, the plan pays 100% of medical services for the remainder of the calendar year (with no lifetime maximum). This OOP limit does not apply to a Part C plan's Part-D-like self-administered drug coverage (which uses another means of addressing catastrophic costs).

The Patient Protection and Affordable Care Act ("PPACA") of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. The most substantial provisions slowed the growth rate of payments to hospitals and skilled nursing facilities under Parts A of Medicare, through a variety of methods (e.g., arbitrary percentage cuts, penalties for readmissions).
Now that you have an idea of the type of Medicare plan options for Minnesotans, would you like some assistance looking for a plan that fits? I’d be happy to help, and you can click on the “View profile” link below to view my profile if you’d like. How about setting up a phone call with me, or having me send you some information by email? You can click on the links below to do that. Some folks prefer to research plans on their own; you can do that easily by clicking on the Compare Plans option on the right.
Medicare.gov provides tools that will allow you to compare plans, but the decision is complicated. Insurance agent Graves recommends that you “work with a licensed insurance agent who can show you both Medicare Supplement Plans and Advantage Plans from multiple companies. Each type has its positives.” The questions to cover, he says: “You need to understand the costs, doctor networks, coverage levels and maximum out-of-pocket for each. Enroll in what suits your situation best.” Organizations such as Consumer Reports and the Medicare Rights Center can also help you research your decision.
Preferred Provider Organization (PPO) plans: This type of Medicare Advantage plan offers more provider flexibility. PPOs typically have a preferred provider network, but you may also use out-of-network doctors if you choose, although your cost sharing may be higher. Unlike HMOs, you don’t need referrals for specialist care and you aren’t required to have a primary care doctor.
ACA provided bonus payments to plans with ratings of 4 (out of 5) stars or more. The Obama administration launched an $8.35 billion demonstration project in 2012 that increased the size of the bonus payments and increased the number of plans receiving bonus payments, providing bonus payments to the majority of Medicare Advantage plans.[6] According to the Government Accountability Office (GAO) this demonstration project cost more than the previous 85 demonstration projects beginning in 1995 combined.[7]

MA plans feature a network of doctors and hospitals that enrollees must use to get the maximum payment, whereas supplements tend to provide access to a broader set of health care providers, said Shawnee Christenson, an insurance agent with Crosstown Insurance in New Hope. While that might sound good to beneficiaries, supplements can come with significantly higher premiums, Christenson said.


Some applicants might be able to apply during a special enrollment period. A special enrollment period applies to any applicants who did not register for Medicare in MN because they previously had insurance from some other source, such as a job or a spouse. If they end up unexpectedly losing that other insurance source, they are able to appeal for a special enrollment period.
California's Medicaid program Medi-Cal is a public health insurance program that provides free or low-cost health care coverage to low-income individuals including families with children, seniors, persons with disabilities, children in foster care, pregnant women, single adults and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal pays for medical visits, hospital care, prescription drugs, pregnancy-related treatment, dental and eye care, and other medical services for individuals who do not have healthcare coverage.
Generally, if you already receive Social Security payments, at age 65 you are automatically enrolled in Medicare Part A (Hospital Insurance). In addition, you are generally also automatically enrolled in Medicare Part B (Medical Insurance). If you choose to accept Part B you must pay a monthly premium to keep it. However, you may delay enrollment with no penalty under some circumstances, or with penalty under other circumstances.
Remember, Medicare Advantage plans may offer additional benefits that are not offered in Original Medicare coverage. Beneficiaries who need prescription drug coverage may prefer the convenience of having all of their Medicare coverage included under a single plan, instead of enrolling in a stand-alone Medicare Prescription Drug Plan for Medicare Part D coverage. However, every person’s situation is different, so it’s a good idea to review your specific health needs, and compare Medicare Advantage plans in your area to find a plan option that best suits your needs.

If you live in the designated service area of the specific plan, and already have Part A and Part B, you may join a Medicare Advantage plan (note that there are some rural areas of the country where no Medicare Advantage plans are available). If you have union or employer-sponsored insurance, you may be able to add an Advantage plan, but be forewarned that in some cases you may lose your employer or union coverage when you enroll in an Advantage plan.
The CBO projected that raising the age of Medicare eligibility would save $113 billion over 10 years after accounting for the necessary expansion of Medicaid and state health insurance exchange subsidies under health care reform, which are needed to help those who could not afford insurance purchase it.[133] The Kaiser Family Foundation found that raising the age of eligibility would save the federal government $5.7 billion a year, while raising costs for other payers. According to Kaiser, raising the age would cost $3.7 billion to 65- and 66-year-olds, $2.8 billion to other consumers whose premiums would rise as insurance pools absorbed more risk, $4.5 billion to employers offering insurance, and $0.7 billion to states expanding their Medicaid rolls. Ultimately Kaiser found that the plan would raise total social costs by more than twice the savings to the federal government.[134]
MedicareWire.com is privately owned and operated. We are a non-government resource, providing information about senior health insurance, Medicare, life insurance and other senior products for consumer research and education. This website and its contents are for informational purposes only. If you're looking for the government's Medicare website, please browse to www.medicare.gov.
If you’re looking for a Medicare Advantage Prescription Drug plan (that is, a Medicare Advantage plan with prescription drug coverage), you might want to make sure it covers the prescriptions you take. Each Medicare Advantage Prescription Drug plan has its own formulary (list of covered prescription drugs). The formulary may change at any time; you will receive notice from your plan when necessary.
Like other types of health insurance, each Medicare Advantage plan has different rules about coverage for treatment, patient responsibility, costs and more. Joining a Medicare Advantage plan may make someone ineligible to continue receiving health care coverage through their employer or union, so if employer-based coverage fits a consumer's needs, they may want to hold off on enrolling in Medicare.

There have been a number of criticisms of the premium support model. Some have raised concern about risk selection, where insurers find ways to avoid covering people expected to have high health care costs.[122] Premium support proposals, such as the 2011 plan proposed by Rep. Paul Ryan (R–Wis.), have aimed to avoid risk selection by including protection language mandating that plans participating in such coverage must provide insurance to all beneficiaries and are not able to avoid covering higher risk beneficiaries.[123] Some critics are concerned that the Medicare population, which has particularly high rates of cognitive impairment and dementia, would have a hard time choosing between competing health plans.[124] Robert Moffit, a senior fellow of The Heritage Foundation responded to this concern, stating that while there may be research indicating that individuals have difficulty making the correct choice of health care plan, there is no evidence to show that government officials can make better choices.[120] Henry Aaron, one of the original proponents of premium supports, has recently argued that the idea should not be implemented, given that Medicare Advantage plans have not successfully contained costs more effectively than traditional Medicare and because the political climate is hostile to the kinds of regulations that would be needed to make the idea workable.[119]
AARP and its affiliates are not insurers. AARP does not employ or endorse agents, producers or brokers. AARP Member Advantages is the name for a collection of products, services and insurance programs available to AARP members from trusted third parties. AARP member benefits, including all goods, services and discounts on this site, are provided by third parties, not by AARP and its affiliates. Providers pay a royalty fee to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. Provider offers are subject to change and may have restrictions. Please contact the provider directly for details.

Currently, people with Medicare can get prescription drug coverage through a Medicare Advantage plan or through the standalone private prescription drug plans (PDPs) established under Medicare Part D. Each plan established its own coverage policies and independently negotiates the prices it pays to drug manufacturers. But because each plan has a much smaller coverage pool than the entire Medicare program, many argue that this system of paying for prescription drugs undermines the government's bargaining power and artificially raises the cost of drug coverage.

Overall health care costs were projected in 2011 to increase by 5.8 percent annually from 2010 to 2020, in part because of increased utilization of medical services, higher prices for services, and new technologies.[82] Health care costs are rising across the board, but the cost of insurance has risen dramatically for families and employers as well as the federal government. In fact, since 1970 the per-capita cost of private coverage has grown roughly one percentage point faster each year than the per-capita cost of Medicare. Since the late 1990s, Medicare has performed especially well relative to private insurers.[83] Over the next decade, Medicare's per capita spending is projected to grow at a rate of 2.5 percent each year, compared to private insurance's 4.8 percent.[84] Nonetheless, most experts and policymakers agree containing health care costs is essential to the nation's fiscal outlook. Much of the debate over the future of Medicare revolves around whether per capita costs should be reduced by limiting payments to providers or by shifting more costs to Medicare enrollees.
If you’re ready to start browsing plan options, eHealth’s Medicare plan comparison tool may be useful. You can find Medicare plan options based on location, insurance company, premium cost, and more. Our plan finder tool is a convenient way for you to compare plan details side-by-side to ensure that the most important aspects of your health-care needs are covered.

Special Needs Plans (SNPs) are designed for people with special health care or financial needs. All Special Needs Plans include drug coverage. They may also include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four main types of Special Needs Plans:

In most instances, prescription drug coverage is included in Medicare Advantage plans, with the exception of the MSA plan. If you want to have prescription drug coverage and you’re choosing an HMO or PPO Medicare Advantage plan, it’s important to select a plan that includes prescription coverage (most of them do), because you can’t purchase stand-alone Medicare Part D (drug coverage) if you have an HMO or PPO Advantage plan. SNPs are required to cover prescriptions. PFFS plans sometimes cover prescriptions, but if you have one that doesn’t, you can supplement it with a Medicare Part D plan.

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 Request a Call 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.
Two distinct premium support systems have recently been proposed in Congress to control the cost of Medicare. The House Republicans' 2012 budget would have abolished traditional Medicare and required the eligible population to purchase private insurance with a newly created premium support program. This plan would have cut the cost of Medicare by capping the value of the voucher and tying its growth to inflation, which is expected to be lower than rising health costs, saving roughly $155 billion over 10 years.[125] Paul Ryan, the plan's author, claimed that competition would drive down costs,[126] but the Congressional Budget Office (CBO) found that the plan would dramatically raise the cost of health care, with all of the additional costs falling on enrollees. The CBO found that under the plan, typical 65-year-olds would go from paying 35 percent of their health care costs to paying 68 percent by 2030.[127]
With Medicare Advantage plans, the essential Medicare Part A and Part B benefits – except hospice services – are automatically covered. (If you need hospice services, that’s covered under Original Medicare, even if you’re enrolled in a Medicare Advantage plan.) Advantage plans also cover urgent and emergency care services, and in many cases, the private plans cover vision, hearing, health and wellness programs and dental coverage.
Those with other health insurance coverage (a union or employer-sponsored health plan, for example) should get more information about their existing coverage before enrolling in a Medicare Advantage plan. It is possible you could lose your existing coverage once you enroll in a Medicare Advantage plan. Furthermore, if you discontinue the other plan for Medicare Part C coverage, you may not be able to reinstate your original coverage if you change your mind It is generally a good idea to check with your current benefits administrator before you enroll in another health-care plan.

For each person who chooses to enroll in a Part C Medicare Advantage or other Part C plan, Medicare pays the health plan a set amount every month ("capitation"). The capitated fee associated with a Medicare Advantage plan is specific to each county in the United States and is primarily driven by a government-administered benchmark/bidding process that uses that county's average per-beneficiary FFS costs from a previous year as a starting point to determine the benchmark.
Part B Late Enrollment Penalty If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a special enrollment period.[71]
In 1977, the Health Care Financing Administration (HCFA) was established as a federal agency responsible for the administration of Medicare and Medicaid. This would be renamed to Centers for Medicare and Medicaid Services (CMS) in 2001. By 1983, the diagnosis-related group (DRG) replaced pay for service reimbursements to hospitals for Medicare patients.
Medicare Medical Savings Account (MSA) plans: These plans combine a high-deductible Medicare Advantage plan with a medical savings account. Every year, your MSA plan deposits money into a savings account that you can use to pay for medical expenses before you’ve reach the deductible. After your reach the deductible, your plan will begin to pay for Medicare-covered services. These plans don’t cover prescription drugs; if you want Medicare Part D coverage, you may enroll in a stand-alone Medicare Prescription Drug Plan.
Medicare’s online plan-finder tool includes information about Medicare Advantage plans. To enroll in a Medicare Advantage plan, a consumer must provide the information on their Medicare card, including their Medicare number and the dates when their Part A and Part B coverage began. A consumer can change Medicare Advantage plans during a specified open enrollment period in the fall that typically spans from mid-October to early December.
You’re eligible for Medicare if you’re age 65 or older, receiving disability benefits, or have certain conditions, like end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease). You must be either a United States citizen or a legal permanent resident of at least five years. In some instances, you may not have to take any action in order to enroll. This may happen if you’re turning 65 and already receive Social Security benefits or Railroad Retirement Board benefits.

We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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.
Medicare's unfunded obligation is the total amount of money that would have to be set aside today such that the principal and interest would cover the gap between projected revenues (mostly Part B premiums and Part A payroll taxes to be paid over the timeframe under current law) and spending over a given timeframe. By law the timeframe used is 75 years though the Medicare actuaries also give an infinite-horizon estimate because life expectancy consistently increases and other economic factors underlying the estimates change.
Footnote: Medi-Cal is California's Medicaid program, which pays for medical services for children and adults with limited income and resources. Data for 2013 were preliminary as of August 2015. Data include children/youth enrolled in both Medi-Cal and Medicare. Figures may not match data by age and by race/ethnicity, which reflect average monthly enrollment over a fiscal year. Please visit the California Dept. of Health Care Services for more information.
Those with other health insurance coverage (a union or employer-sponsored health plan, for example) should get more information about their existing coverage before enrolling in a Medicare Advantage plan. It is possible you could lose your existing coverage once you enroll in a Medicare Advantage plan. Furthermore, if you discontinue the other plan for Medicare Part C coverage, you may not be able to reinstate your original coverage if you change your mind It is generally a good idea to check with your current benefits administrator before you enroll in another health-care plan.
There have been a number of criticisms of the premium support model. Some have raised concern about risk selection, where insurers find ways to avoid covering people expected to have high health care costs.[122] Premium support proposals, such as the 2011 plan proposed by Rep. Paul Ryan (R–Wis.), have aimed to avoid risk selection by including protection language mandating that plans participating in such coverage must provide insurance to all beneficiaries and are not able to avoid covering higher risk beneficiaries.[123] Some critics are concerned that the Medicare population, which has particularly high rates of cognitive impairment and dementia, would have a hard time choosing between competing health plans.[124] Robert Moffit, a senior fellow of The Heritage Foundation responded to this concern, stating that while there may be research indicating that individuals have difficulty making the correct choice of health care plan, there is no evidence to show that government officials can make better choices.[120] Henry Aaron, one of the original proponents of premium supports, has recently argued that the idea should not be implemented, given that Medicare Advantage plans have not successfully contained costs more effectively than traditional Medicare and because the political climate is hostile to the kinds of regulations that would be needed to make the idea workable.[119]
The Minnesota Department of Commerce: provides beneficiaries with information about Medicare Part D Prescription Drug Plans and other insurance options available to them. The office is a resource for information about protection from Medicare fraud and how to report fraud. Additional links are included for federal offices that deal with Medicare and brochures that explain how to enroll in Part D Prescription Drug Plans. This government office also offers downloads of premium guides for supplemental plans available to current Medicare beneficiaries in Minnesota.
If you are a Minnesota resident enrolled in Original Medicare (Part A and Part B), you have options to also enroll in a Medicare Supplement Insurance plan in Minnesota (also called Medigap or MedSupp) to cover health costs not covered under Original Medicare. Costs not covered under Original Medicare might include deductibles, copayments, coinsurance, and other out-of-pocket costs. Most states, including Minnesota, offer Medigap policies with letters corresponding with different Medicare Supplement Insurance plans with certain standardized benefits.

OptumRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use OptumRx home delivery for a 90-day supply of your maintenance medication. $0 copay may be restricted to particular tiers, preferred medications, or mail order prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage.
On September 12, 2013, the Centers for Medicare & Medicaid Services (CMS) announced a new partnership with the State of Minnesota to test new ways of improving care for Medicare-Medicaid enrollees. Building on the state's Minnesota Senior Health Options (MSHO) program, CMS and Minnesota will work together to improve the beneficiary experience in health plans that maintain contracts with both CMS as Medicare Advantage Special Needs Plans and with the state to deliver Medicaid services.   

Congress also attempted to reduce payments to public Part C Medicare health plans by aligning the rules that establish Part C plans' capitated fees more closely with the FFS paid for comparable care to "similar beneficiaries" under Parts A and B of Medicare. Primarily these reductions involved much discretion on the part of CMS and examples of what CMS did included effectively ending a Part C program Congress had previously initiated to increase the use of Part C in rural areas (the so-called Part C PFFS plan) and reducing over time a program that encouraged employers and unions to create their own Part C plans not available to the general Medicare beneficiary base (so-called Part C EGWP plans) by providing higher reimbursement. These two types of Part C plans had been identified by MedPAC as the programs that most negatively affected parity between the cost of Medicare beneficiaries on Parts A/B/C and the costs of beneficiaries not on Parts A/B/C. These efforts to reach parity have been more than successful. As of 2015, all beneficiaries on A/B/C cost 4% less per person than all beneficiaries not on A/B/C. But whether that is because the cost of the former decreased or the cost of the latter increased is not known.


Some people don’t realize this and join Medicare Advantage plans without the help of an agent. Therefore they  don’t know about all of these rules. Sometimes they find themselves enrolled into a plan that their doctor doesn’t accept or that doesn’t include one of their medications. This happens most often in January after a person has used the Annual Election Period to join a Medicare Advantage plan.
OptumRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use OptumRx home delivery for a 90-day supply of your maintenance medication. $0 copay may be restricted to particular tiers, preferred medications, or mail order prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage.
Notice: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365  days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

You can enroll in Medicare as soon as you meet the eligibility requirements. In Minnesota, you are allowed to enroll in Original Medicare three months before you turn 65 years of age, even if you are not retired or collecting benefits from Social Security. Keep in mind that the Social Security Administration usually enrolls you automatically in Original Medicare when you request Social Security benefits at age 65. It is advisable to postpone enrolling in Medicare Part B if you, or your spouse, have coverage through an employer or union. This will save you from paying Part B premiums while you have coverage. However, if you are eligible and choose not to enroll in Medicare Part B (even though you do not have coverage from a current employer), you will have to pay a ten percent penalty for each year that your enrollment is delayed.

But that has not been the case at all. Medicare Advantage enrollment continues to grow each year. There were 19 million Advantage enrollees in 2017, which is about a third of all Medicare beneficiaries, who totaled about 58 million in 2017). The number of Medicare Advantage plans available has been fairly steady since 2011 (2,034 in 2016, up from 1,945 in 2015; but down from a high of 2,830 in 2009). The majority of beneficiaries still have at least one zero-premium plan available to them, and the average enrollee could select from among 21 plans in 2018, which was slightly higher than it had been at any point since 2011 (but this is still down significantly from 48 plans in 2009).
Since the mid-1990s, there have been a number of proposals to change Medicare from a publicly run social insurance program with a defined benefit, for which there is no limit to the government's expenses, into a program that offers "premium support" for enrollees.[118][119] The basic concept behind the proposals is that the government would make a defined contribution, that is a premium support, to the health plan of a Medicare enrollee's choice. Insurers would compete to provide Medicare benefits and this competition would set the level of fixed contribution. Additionally, enrollees would be able to purchase greater coverage by paying more in addition to the fixed government contribution. Conversely, enrollees could choose lower cost coverage and keep the difference between their coverage costs and the fixed government contribution.[120][121] The goal of premium Medicare plans is for greater cost-effectiveness; if such a proposal worked as planned, the financial incentive would be greatest for Medicare plans that offer the best care at the lowest cost.[118][121]
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers. But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).

You might wonder why a beneficiary would choose to enroll in a Medicare Advantage plan. A Medicare Advantage plan is required to cover everything that Original Medicare covers (except for hospice care), including emergency and urgent care. Hospice care is covered by Original Medicare, and hospice benefits continue to be covered by Original Medicare even if you have a Medicare Advantage plan. But, there can be some differences between Original Medicare and a Medicare Advantage plan. Those differences can be in how much you pay out of your own pocket when you receive health care. For example, you might have lower copayments and coinsurance or a smaller deductible.
The PPACA also made some changes to Medicare enrollee's' benefits. By 2020, it will close the so-called "donut hole" between Part D plans' coverage limits and the catastrophic cap on out-of-pocket spending, reducing a Part D enrollee's' exposure to the cost of prescription drugs by an average of $2,000 a year.[114] This lowered costs for about 5% of the people on Medicare. Limits were also placed on out-of-pocket costs for in-network care for public Part C health plan enrollees.[115] Most of these plans had such a limit but ACA formalized the annual out of pocket spend limit. Beneficiaries on traditional Medicare do not get such a limit but can effectively arrange for one through private insurance.
Retirement of the Baby Boom generation — which by 2030 is projected to increase enrollment to more than 80 million as the number of workers per enrollee declines from 3.7 to 2.4 — and rising overall health care costs in the nation pose substantial financial challenges to the program. Medicare spending is projected to increase from $523 billion in 2010 to just over $1 trillion by 2022.[20] Baby-boomers' health is also an important factor: 20% have five or more chronic conditions, which will add to the future cost of health care. In response to these financial challenges, Congress made substantial cuts to future payouts to providers as part of PPACA in 2010 and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and policymakers have offered many additional competing proposals to reduce Medicare costs further.
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