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' initial spend phase 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] That is, the template co-pay in the gap (which legally still exists) will be the same as the template co-pay in the initial spend phase, 25%. 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.
We evaluated 10 well-known Medicare supplement insurance plans, and after careful review identified the eight best options for 2019. To draw our conclusions, we checked with customers in the market, reviewed data and consulted insurance experts. In summary, no one plan is best for all situations, so we recommend shopping around using a Medicare expert like United Medicare Advisors to compare plans. The eight Medicare supplement insurance companies we think are worth your consideration include: United Medicare Advisors, Cigna, Mutual of Omaha, Medicare.net, Humana, Blue Cross Blue Shield, Aetna and AARP by United Healthcare.
We are not an insurance agency and are not affiliated with any plan. We connect individuals with insurance providers and other affiliates (collectively, “partners”) to give you, the consumer, an opportunity to get information about insurance and connect with agents. By completing the quotes form or calling the number listed above, you will be directed to a partner that can connect you to an appropriate insurance agent who can answer your questions and discuss plan options.
These coverage gaps mean that a particularly bad health year could leave a patient with tens of thousands of dollars in hospital bills. That's why most people purchase Medicare supplement insurance, also called Medigap, or enroll in Part C, a Medicare Advantage Health Plan. Both options are offered by private insurance companies. They do, however, have to follow Medicare guidelines in what they are allowed to sell.
Massachusetts, Minnesota, and Wisconsin standardize their Medicare Supplement insurance plans differently from the rest of the country. In all states, insurance companies that sell Medicare Supplement insurance aren’t required to offer all plan types. However, any insurance company that sells Medigap insurance is required by law to offer Medigap Plan A. If an insurance company wants to offer other Medigap plans, it must sell either Plan C or Plan F in addition to any other plans it would like to sell.
Both House Republicans and President Obama proposed increasing the additional premiums paid by the wealthiest people with Medicare, compounding several reforms in the ACA that would increase the number of wealthier individuals paying higher, income-related Part B and Part D premiums. Such proposals are projected to save $20 billion over the course of a decade,[147] and would ultimately result in more than a quarter of Medicare enrollees paying between 35 and 90 percent of their Part B costs by 2035, rather than the typical 25 percent. If the brackets mandated for 2035 were implemented today,[when?] it would mean that anyone earning more than $47,000 (as an individual) or $94,000 (as a couple) would be affected. Under the Republican proposals, affected individuals would pay 40 percent of the total Part B and Part D premiums, which would be equivalent of $2,500 today.[148]
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:

Part A's inpatient admitted hospital and skilled nursing coverage is largely funded by revenue from a 2.9% payroll tax levied on employers and workers (each pay 1.45%). Until December 31, 1993, the law provided a maximum amount of compensation on which the Medicare tax could be imposed annually, in the same way that the Social Security payroll tax works in the U.S.[16] Beginning on January 1, 1994, the compensation limit was removed. Self-employed individuals must pay the entire 2.9% tax on self-employed net earnings (because they are both employee and employer), but they may deduct half of the tax from the income in calculating income tax.[17] Beginning in 2013, the rate of Part A tax on earned income exceeding US$200,000 for individuals (US$250,000 for married couples filing jointly) rose to 3.8%, in order to pay part of the cost of the subsidies mandated by the Affordable Care Act.[18]


There are other proposals for savings on prescription drugs that do not require such fundamental changes to Medicare Part D's payment and coverage policies. Manufacturers who supply drugs to Medicaid are required to offer a 15 percent rebate on the average manufacturer's price. Low-income elderly individuals who qualify for both Medicare and Medicaid receive drug coverage through Medicare Part D, and no reimbursement is paid for the drugs the government purchases for them. Reinstating that rebate would yield savings of $112 billion, according to a recent CBO estimate.[135] Some have questioned the ability of the federal government to achieve greater savings than the largest PDPs, since some of the larger plans have coverage pools comparable to Medicare's, though the evidence from the VHA is promising. Some also worry that controlling the prices of prescription drugs would reduce incentives for manufacturers to invest in R&D, though the same could be said of anything that would reduce costs.[133] However the comparisons with the VHA point out that the VA only covers about half the drugs as Part D.
Medicare supplement Plan F has also been the #1 seller with Baby Boomers for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)
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.[78] and at what cost.[79] 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.
Health Maintenance Organization (HMO) plans: One of the most popular types of managed-care plans, this type of Medicare Advantage plan comes with a provider network that you must use to be covered by the plan (with the exception of medical emergencies). If you use non-network providers, you may have to pay the full cost for your care. You’re also required to have a primary care physician; if you need to see a specialist, you’ll need to a get a referral from your primary care doctor first.
There is some controversy over who exactly should take responsibility for coordinating the care of the dual eligibles. There have been some proposals to transfer dual eligibles into existing Medicaid managed care plans, which are controlled by individual states.[143] But many states facing severe budget shortfalls might have some incentive to stint on necessary care or otherwise shift costs to enrollees and their families to capture some Medicaid savings. Medicare has more experience managing the care of older adults, and is already expanding coordinated care programs under the ACA,[144] though there are some questions about private Medicare plans' capacity to manage care and achieve meaningful cost savings.[145]
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**NY: In New York, the Excess Charge is limited to 5%; PA and OH: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state.
As of January 1, 2016, Medicare's unfunded obligation over the 75 year timeframe is $3.8 trillion for the Part A Trust Fund and $28.6 trillion for Part B. Over an infinite timeframe the combined unfunded liability for both programs combined is over $50 trillion, with the difference primarily in the Part B estimate.[88][90] These estimates assume that CMS will pay full benefits as currently specified over those periods though that would be contrary to current United States law. In addition, as discussed throughout each annual Trustees' report, "the Medicare projections shown could be substantially understated as a result of other potentially unsustainable elements of current law." For example, current law effectively provides no raises for doctors after 2025; that is unlikely to happen. It is impossible for actuaries to estimate unfunded liability other than assuming current law is followed (except relative to benefits as noted), the Trustees state "that actual long-range present values for (Part A) expenditures and (Part B/D) expenditures and revenues could exceed the amounts estimated by a substantial margin."
The dual-eligible population comprises roughly 20 percent of Medicare's enrollees but accounts for 36 percent of its costs.[139] There is substantial evidence that these individuals receive highly inefficient care because responsibility for their care is split between the Medicare and Medicaid programs[140]—most see a number of different providers without any kind of mechanism to coordinate their care, and they face high rates of potentially preventable hospitalizations.[141] Because Medicaid and Medicare cover different aspects of health care, both have a financial incentive to shunt patients into care the other program pays for.

A couple of major insurers have already announced new plans to replace Minnesota Cost Plans in certain counties. Typically, these new plans offer broader network coverage within an HMO. One major carrier expects about 200,000 of their Minnesota customers to lose access to a Cost Plan. On the other hand, this change may open opportunities for other companies to expand their own market shares with Minnesota Medicare Advantage plans that can offer greater flexibility, such as PPOs with nationwide networks.


If you plan to travel a lot or simply want to choose doctors without concerns over only picking providers on an HMO or PPO network, you might compare Medigap plans. With a supplement, you will have to buy Medicare Part D to cover most prescription medications. This may cost somewhat more, but some folks prefer to choose their drug plan separately from the rest of their medical benefits.
Several measures serve as indicators of the long-term financial status of Medicare. These include total Medicare spending as a share of gross domestic product (GDP), the solvency of the Medicare HI trust fund, Medicare per-capita spending growth relative to inflation and per-capita GDP growth; general fund revenue as a share of total Medicare spending; and actuarial estimates of unfunded liability over the 75-year timeframe and the infinite horizon (netting expected premium/tax revenue against expected costs). The major issue in all these indicators is comparing any future projections against current law vs. what the actuaries expect to happen. For example, current law specifies that Part A payments to hospitals and skilled nursing facilities will be cut substantially after 2028 and that doctors will get no raises after 2025. The actuaries expect that the law will change to keep these events from happening.
More limited income-relation of premiums only raises limited revenue. Currently, only 5 percent of Medicare enrollees pay an income-related premium, and most only pay 35 percent of their total premium, compared to the 25 percent most people pay. Only a negligible number of enrollees fall into the higher income brackets required to bear a more substantial share of their costs—roughly half a percent of individuals and less than three percent of married couples currently pay more than 35 percent of their total Part B costs.[149]
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The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A and Part B, you can select other coverage options like a Medigap (Medicare Supplement) plan from approved private insurers. The best time to buy a Medigap policy is the six month period that starts the first day of the month that you turn 65 or older and enrolled in Part B. After this period, your ability to buy a Medigap policy may be limited and it may be more costly. Each state handles things differently, but there are additional open enrollment periods in some cases.
However, you may have to wait up to six months for coverage if you have a pre-existing health condition. The insurer through which you buy your Medigap policy can refuse to cover out-of-pocket costs for pre-existing conditions during that period. After six months, the Medigap policy must cover the pre-existing condition. The exception to this rule is if you buy a Medigap policy during your open enrollment period and have had continuous "creditable coverage," or a health insurance policy for the six months before buying a policy. The Medigap insurance company cannot withhold coverage for a pre-existing condition in that case.

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" from a Medicare perspective, 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, often in advance of treatment.[63]


These coverage gaps mean that a particularly bad health year could leave a patient with tens of thousands of dollars in hospital bills. That's why most people purchase Medicare supplement insurance, also called Medigap, or enroll in Part C, a Medicare Advantage Health Plan. Both options are offered by private insurance companies. They do, however, have to follow Medicare guidelines in what they are allowed to sell.
On August 1, 2007, the US House United States Congress voted to reduce payments to Medicare Advantage providers in order to pay for expanded coverage of children's health under the SCHIP program. As of 2008, Medicare Advantage plans cost, on average, 13 percent more per person insured for like beneficiaries than direct payment plans.[111] Many health economists have concluded that payments to Medicare Advantage providers have been excessive. The Senate, after heavy lobbying from the insurance industry, declined to agree to the cuts in Medicare Advantage proposed by the House. President Bush subsequently vetoed the SCHIP extension.[112]

Medicare supplement Plan F has also been the #1 seller with Baby Boomers for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)
Less expensive plans have fewer benefits and higher out-of-pocket costs. More expensive plans include extra benefits, like some Medicare deductibles, additional hospital benefits, at-home recovery, and more. You have to decide what sort of plan makes the most sense for you. If you drop your Medigap policy, there is no guarantee you will be able to get it back.
This concept is basically how public Medicare Part C already works (but with a much more complicated competitive bidding process that drives up costs for the Trustees, but is very advantageous to the beneficiaries). Given that only about 1% of people on Medicare got premium support when Aaron and Reischauer first wrote their proposal in 1995 and the percentage is now 35% on the way to 50% by 2040 according to the Trustees, perhaps no further reform is needed.
The 2003 payment formulas succeeded in increasing the percentage of rural and inner city poor that could take advantage of the OOP limit and lower co-pays and deductibles—as well as the coordinated medical care—associated with Part C plans. In practice however, one set of Medicare beneficiaries received more benefits than others. The MedPAC Congressional advisory group found in one year the comparative difference for "like beneficiaries" was as high as 14% and have tended to average about 2% higher.[47] The word "like" in the previous sentence is key. MedPAC does not include all beneficiaries in its comparisons and MedPAC will not define what it means by "like" but it apparently includes people who are only on Part A, which severely skews its percentage comparisons—see January 2017 MedPAC meeting presentations. The differences caused by the 2003-law payment formulas were almost completely eliminated by PPACA and have been almost totally phased out according to the 2018 MedPAC annual report, March 2018. One remaining special-payment-formula program—designed primarily for unions wishing to sponsor a Part C plan—is being phased out beginning in 2017. In 2013 and since, on average a Part C beneficiary cost the Medicare Trust Funds 2%-5% less than a beneficiary on traditional fee for service Medicare, completely reversing the situation in 2006-2009 right after implementation of the 2003 law and restoring the capitated fee vs fee for service funding balance to its original intended parity level.
Even if your prescriptions are covered, there may be hurdles to accessing them, so check the plan's rules. Starting in 2019, Medicare Advantage plans are allowed to require "step therapy," which means, in certain cases, you’ll need to try a less expensive drug before you'll be covered for a more expensive one. Or you may be steered toward a preferred pharmacy instead of your local drugstore.
A Medigap policy (also called Medicare Supplement Insurance) is private health insurance that’s designed to supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance and deductibles. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share.
The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A and Part B, you can select other coverage options like a Medigap (Medicare Supplement) plan from approved private insurers. The best time to buy a Medigap policy is the six month period that starts the first day of the month that you turn 65 or older and enrolled in Part B. After this period, your ability to buy a Medigap policy may be limited and it may be more costly. Each state handles things differently, but there are additional open enrollment periods in some cases.
The 10 different Medicare Supplement (Medigap) plans available in most states have standardized benefits across each plan letter. For example, Medigap Plan A will have the same benefits regardless of which state you live in or which insurance company you buy from. If you live in Massachusetts, Minnesota, or Wisconsin, the Medigap plans in these states are standardized differently.
In 2003 Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which President George W. Bush signed into law on December 8, 2003. Part of this legislation included filling gaps in prescription-drug coverage left by the Medicare Secondary Payer Act that was enacted in 1980. The 2003 bill strengthened the Workers' Compensation Medicare Set-Aside Program (WCMSA) that is monitored and administered by CMS.
The answer really depends on what you are looking for: supplemental health insurance plans designed for seniors or Medicare supplement plans. Although they are often confused because of their similar terminology, they are very different. So before we give you the cost of supplemental health insurance for seniors, let’s review the differences between these two lines of products.
As you can see, you have a lot of good choices if you want to compare Medicare Advantage plans in Minnesota for 2019. Calling all of these companies can be difficult and can take forever, but you don’t have to do that to find pricing information. Instead, you can pull it all up with our quote request form, making a comparison easier than it might have ever been before.
The 10 different Medicare Supplement (Medigap) plans available in most states have standardized benefits across each plan letter. For example, Medigap Plan A will have the same benefits regardless of which state you live in or which insurance company you buy from. If you live in Massachusetts, Minnesota, or Wisconsin, the Medigap plans in these states are standardized differently.
These Medigap insurance policies are standardized by CMS, but are sold and administered by private companies. Some Medigap policies sold before 2006 may include coverage for prescription drugs. Medigap policies sold after the introduction of Medicare Part D on January 1, 2006 are prohibited from covering drugs. Medicare regulations prohibit a Medicare beneficiary from being sold both a public Part C Medicare health plan and a private Medigap Policy. As with public Part C health plans, private Medigap policies are only available to beneficiaries who are already signed up for Original Medicare Part A and Part B. These policies are regulated by state insurance departments rather than the federal government although CMS outlines what the various Medigap plans must cover at a minimum. Therefore, the types and prices of Medigap policies vary widely from state to state and the degree of underwriting, discounts for new members, open enrollment and guaranteed issue also varies widely from state to state.
If you have a Medicare Advantage plan, you’re still enrolled in the Medicare program; in fact, you must sign up for Medicare Part A and Part B to be eligible for a Medicare Advantage plan. The Medicare Advantage plan administers your benefits to you. Depending on the plan, Medicare Advantage can offer additional benefits beyond your Part A and Part B benefits, such as routine dental, vision, and hearing services, and even prescription drug coverage.
Medicare supplement plans are related to Medicare. Like Medicare’s “Parts”, each plan letter offers different benefits and has a different premium amount. They are designed to fill the “coverage gaps” in Original Medicare benefits (hence the name Medigap). These products will cover healthcare expenses otherwise left out of Original Medicare coverage, like coinsurance and deductibles. However, Medigap plans do not include dental, vision, or any other supplemental health insurance benefits.
The total cost for Gracie’s surgery, hospital stay and follow-up care is $70,000. Medicare pays its share of the bills and sends the remainder of about $14,000 to Gracie’s supplemental insurance carrier. The carrier pays the entire bill, and Gracie owes absolutely nothing for any of these Part A and Part B services. Her only out-of-pocket spending would be for medications.
Nearly one in three dollars spent on Medicare flows through one of several cost-reduction programs.[20] Cost reduction is influenced by factors including reduction in inappropriate and unnecessary care by evaluating evidence-based practices as well as reducing the amount of unnecessary, duplicative, and inappropriate care. Cost reduction may also be effected by reducing medical errors, investment in healthcare information technology, improving transparency of cost and quality data, increasing administrative efficiency, and by developing both clinical/non-clinical guidelines and quality standards.[21]
Choice: Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.
Coverage by beneficiary spending is broken up into four phases: deductible, initial spend, gap (infamously called the "donut hole"), and catastrophic. Under a CMS template, there is usually a $100 or so deductible before benefits commence (maximum of $415 in 2019) followed by the initial spend phase where the templated co-pay is 25%, followed by gap phase (where originally the templated co-pay was 100% but that will fall to 25% in 2020 for all drugs), followed by the catastrophic phase with a templated co-pay of about 5%. The beneficiaries' OOP spend amounts vary yearly but are approximately as of 2018 $1000 in the initial spend phase and $3000 to reach the catastrophic phase. This is just a template and about half of all Part D plans differ (for example, no initial deductible, better coverage in the gap) with permission of CMS, which it typically grants as long as the sponsor provides at least the actuarial equivalent value. 

The intention of both the 1997 and 2003 law was that the differences between fee for service and capitated fee beneficiaries would reach parity over time and that has mostly been achieved, given that it can never literally be achieved without a major reform of Medicare because the Part C capitated fee in one year is based on the fee for service spending the previous year.
Payment for physician services under Medicare has evolved since the program was created in 1965. Initially, Medicare compensated physicians based on the physician's charges, and allowed physicians to bill Medicare beneficiaries the amount in excess of Medicare's reimbursement. In 1975, annual increases in physician fees were limited by the Medicare Economic Index (MEI). The MEI was designed to measure changes in costs of physician's time and operating expenses, adjusted for changes in physician productivity. From 1984 to 1991, the yearly change in fees was determined by legislation. This was done because physician fees were rising faster than projected.
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