The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/ coinsurance may change on January 1 of each year.
Under federal law, insurers cannot deny you Medigap insurance when you initially enroll in Medicare at age 65, and they must renew your coverage annually as long as you pay your premiums. But if you try to buy Medigap insurance outside of that initial enrollment period, insurers in many states can deny coverage or charge you higher premiums based on your health or pre-existing conditions.
All insurance companies that sell Medigap policies are required to make Plan A available, and if they offer any other policies, they must also make either Plan C or Plan F available as well, though Plan F is scheduled to sunset in the year 2020. Anyone who currently has a Plan F may keep it. Many of the insurance companies that offer Medigap insurance policies also sponsor Part C health plans but most Part C health plans are sponsored by integrated health delivery systems and their spin-offs, charities, and unions as opposed to insurance companies. The leading sponsor of both public Part C heatlh plans and private Medigap plans is AARP.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/ coinsurance may change on January 1 of each year.
The Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS), administers Medicare, Medicaid, the Children's Health Insurance Program (CHIP), the Clinical Laboratory Improvement Amendments (CLIA), and parts of the Affordable Care Act (ACA) ("Obamacare").[12] Along with the Departments of Labor and Treasury, the CMS also implements the insurance reform provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and most aspects of the Patient Protection and Affordable Care Act of 2010 as amended. The Social Security Administration (SSA) is responsible for determining Medicare eligibility, eligibility for and payment of Extra Help/Low Income Subsidy payments related to Parts C and D of Medicare, and collecting most premium payments for the Medicare program.
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.
The current disenrollment opportunity applies only to people who have a Medicare Advantage plan. (If you already chose original Medicare, you have to stick with it for 2019.) So if you’re unhappy with your Advantage plan—maybe you find it more expensive than you expected or it doesn’t cover all the services you need—now is the time to make a change.

Another wrinkle is that people who want a supplement might have a better chance of getting into the coverage during the transition out of their Medicare Cost plan, when the supplement is provided on a “guaranteed issue” basis. Later, insurance companies can ask questions about a senior’s health status and deny coverage depending on the answers, said Greiner of the Minnesota Board on Aging.
Original Medicare, Part A and Part B, is a government health insurance program for those who qualify by age or disability. Part A is hospital insurance, and Part B is medical insurance. There are some out-of-pocket costs associated with Original Medicare, such as copayments, coinsurance, and deductibles. To help with those costs, if you’re enrolled in Original Medicare, you can purchase a Medicare Supplement (Medigap) insurance plan. 

As long as you buy a Medigap plan during this six-month Medigap Open Enrollment Period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for basic benefits to begin. However, you may have to wait up to six months for the Medigap policy’s benefits to include your pre-existing condition*. Original Medicare will generally still cover a pre-existing condition even if your Medicare Supplement insurance plan doesn’t pay for your out-of-pocket costs.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
"I enjoy working with and supporting individuals who are curious and motivated to move through the "stuck places" we all find ourselves in from time to time. I believe that our bodies have an inherent wisdom that, when listened to through mindfulness, will help direct and focus the therapy. While I specialize in treating childhood trauma, I also work with individuals dealing with anxiety, depression, relationship/personal growth challenges, as well as people struggling with illness and physical pain. I find great joy in walking with people on their journeys towards a more authentic, vibrant self...your own "True North"!"

Price Transparency: You can find out if Blue Cross Blue Shield offers Medicare supplement insurance your state and zip code with a simple online search through their website. If one of their affiliated companies (like Anthem) offers coverage in your area, your search will denote that. Prices aren’t readily available, however, especially when compared with other company’s websites. You’ll need to call for a quote
Yes. Some plans offer discounts if you’re married (studies show that married couples tend to be healthier – as they encourage each other to eat nutritious meals, exercise, and see a doctor). You can also possibly cut your rate if you’re a non-smoker, as you’ll likely have fewer health risks. Or you may be able to save by paying annually or via electronic funds transfer. Even if the website or brochure you’re studying doesn’t mention anything about discounts – ask.
The maximum length of stay that Medicare Part A covers in a hospital admitted inpatient stay or series of stays is typically 90 days. The first 60 days would be paid by Medicare in full, except one copay (also and more commonly referred to as a "deductible") at the beginning of the 60 days of $1340 as of 2018. Days 61–90 require a co-payment of $335 per day as of 2018. The beneficiary is also allocated "lifetime reserve days" that can be used after 90 days. These lifetime reserve days require a copayment of $670 per day as of 2018, and the beneficiary can only use a total of 60 of these days throughout their lifetime.[27] A new pool of 90 hospital days, with new copays of $1340 in 2018 and $335 per day for days 61–90, starts only after the beneficiary has 60 days continuously with no payment from Medicare for hospital or Skilled Nursing Facility confinement.[28]
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.
Because of how Part D works and depending on income, a patient could pay between 35 percent and 85 percent of the cost of some of their prescription drugs if they need enough medication to push them into the notorious doughnut hole, when Part D's full prescription-drug coverage runs out after a person has spent $3,750, until their medication costs exceed $5,000 per year. (In 2019, coverage will end at $3,750 and begin again at $5,000.) During the coverage gap, the patient would be responsible for 25 percent of covered, brand-name prescription drugs.
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.
Since the Medicare program began, the CMS (that was not always the name of the responsible bureaucracy) has contracted with private insurance companies to operate as intermediaries between the government and medical providers to administer Part A and Part B benefits. Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation. Beginning in 1997 and 2005, respectively, these Part A and B administrators (whose contracts are bid out periodically), along with other insurance companies and other companies or organizations (such as integrated health delivery systems, unions and pharmacies), also began administering Part C and Part D plans.
We found policies that ranged in price from less than $100/month for basic coverage to thousands for maximum protection. There’s no “normal” number, as there are so many factors in play like where you live, your age and needs. A ballpark figure is a couple hundred dollars a month for standard coverage. However, it’s basic economics – the more supplemental insurance you want, the greater the cost.
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.
After you meet your Medicare Part A deductible, Part A requires a coinsurance payment of $341 per day (in 2019) for days 61-90 of an inpatient hospital stay. The coinsurance is $682 per day for a hospital stay that lasts longer than 90 days, but only for up to 60 additional lifetime reserve days. After that point, Medicare Part A holds you responsible for all costs.
"I enjoy working with and supporting individuals who are curious and motivated to move through the "stuck places" we all find ourselves in from time to time. I believe that our bodies have an inherent wisdom that, when listened to through mindfulness, will help direct and focus the therapy. While I specialize in treating childhood trauma, I also work with individuals dealing with anxiety, depression, relationship/personal growth challenges, as well as people struggling with illness and physical pain. I find great joy in walking with people on their journeys towards a more authentic, vibrant self...your own "True North"!"
The SGR was the subject of possible reform legislation again in 2014. On March 14, 2014, the United States House of Representatives passed the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015; 113th Congress), a bill that would have replaced the (SGR) formula with new systems for establishing those payment rates.[59] However, the bill would pay for these changes by delaying the Affordable Care Act's individual mandate requirement, a proposal that was very unpopular with Democrats.[60] The SGR was expected to cause Medicare reimbursement cuts of 24 percent on April 1, 2014, if a solution to reform or delay the SGR was not found.[61] This led to another bill, the Protecting Access to Medicare Act of 2014 (H.R. 4302; 113th Congress), which would delay those cuts until March 2015.[61] This bill was also controversial. The American Medical Association and other medical groups opposed it, asking Congress to provide a permanent solution instead of just another delay.[62]
Of the 35,476 total active applicants who participated in The National Resident Matching Program in 2016, 75.6% (26,836) were able to find PGY-1 (R-1) matches. Out of the total active applicants, 51.27% (18,187) were graduates of conventional US medical schools; 93.8% (17,057) were able to find a match. In comparison, match rates were 80.3% of osteopathic graduates, 53.9% of US citizen international medical school graduates, and 50.5% of non-US citizen international medical schools graduates.[107]
"I enjoy working with and supporting individuals who are curious and motivated to move through the "stuck places" we all find ourselves in from time to time. I believe that our bodies have an inherent wisdom that, when listened to through mindfulness, will help direct and focus the therapy. While I specialize in treating childhood trauma, I also work with individuals dealing with anxiety, depression, relationship/personal growth challenges, as well as people struggling with illness and physical pain. I find great joy in walking with people on their journeys towards a more authentic, vibrant self...your own "True North"!"
Part B also helps with durable medical equipment (DME), including but not limited to 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 are also covered.[44]
Roughly nine million Americans—mostly older adults with low incomes—are eligible for both Medicare and Medicaid. These men and women tend to have particularly poor health – more than half are being treated for five or more chronic conditions[136]—and high costs. Average annual per-capita spending for "dual-eligibles" is $20,000,[137] compared to $10,900 for the Medicare population as a whole all enrollees.[138]
Because the federal government is legally obligated to provide Medicare benefits to older and disabled Americans, it cannot cut costs by restricting eligibility or benefits, except by going through a difficult legislative process, or by revising its interpretation of medical necessity. By statute, Medicare may only pay for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member", unless there is another statutory authorization for payment.[75] Cutting costs by cutting benefits is difficult, but the program can also achieve substantial economies of scale in terms of the prices it pays for health care and administrative expenses—and, as a result, private insurers' costs have grown almost 60% more than Medicare's since 1970.[citation needed][Original research?][76] Medicare's cost growth is now the same as GDP growth and expected to stay well below private insurance's for the next decade.[77]

Medicare beneficiaries in Michigan who are enrolled in Original Medicare (Part A and B) may find that these plans do not cover all of their health expenses. However, Medicare beneficiaries in Michigan may opt to enroll in a Medicare Supplement plan, also known as Medigap, which may cover expenses such as copayments, deductibles, coinsurance, and possibly other out-of-pocket expenses. Most states offer ten standard Medigap policy options.
Core Plan covers the Part A coinsurance plus coverage for the first 90 days per benefit period (not including the Medicare Part A deductible) and the 60 Medicare lifetime reserve days, plus coverage for 365 additional days after Medicare benefits end, Part B coinsurance, first 3 pints of Blood each year, Part A Hospice coinsurance and certain state-mandated services.
If you decide to sign up for a Medigap policy, a good time to do so is during the Medigap Open Enrollment Period, a six-month period that typically starts the month you turn 65 and have Medicare Part B. If you enroll in a Medigap plan during this period, you can’t be turned down or charged more because of any health conditions. But if you apply for a Medigap plan later on, you may be subject to medical underwriting; your acceptance into a plan isn’t guaranteed.

The Omnibus Budget Reconciliation Act of 1989 made several changes to physician payments under Medicare. Firstly, it introduced the Medicare Fee Schedule, which took effect in 1992. Secondly, it limited the amount Medicare non-providers could balance bill Medicare beneficiaries. Thirdly, it introduced the Medicare Volume Performance Standards (MVPS) as a way to control costs.[56]

If you have Original Medicare and a Medicare Supplement plan, Original Medicare will pay first, and your Medigap policy will fill in the cost gaps. For example, suppose you have a $5,000 ambulance bill, and you have already met the yearly Medicare Part B deductible. Medicare Part B will pay 80% of your ambulance bill. If you have a Medicare Supplement plan that covers Part B copayments and coinsurance costs, then your Medigap policy would then pay the remaining 20% coinsurance of your $5,000 ambulance bill. Some Medicare Supplement plans may also cover the Part B deductible.
Medicare overview information on this website was developed by the Blue Cross and Blue Shield Association to help consumers understand certain aspects about Medicare. Viewing this Medicare overview does not require you to enroll in any Blue Cross Blue Shield plans. To find out about premiums and terms for these and other insurance options, how to apply for coverage, and for much more information, contact your local Blue Cross Blue Shield company. Each Blue Cross Blue Shield company is responsible for the information that it provides. For more information about Medicare including a complete listing of plans available in your service area, please contact the Medicare program at 1-800-MEDICARE (TTY users should call 1-877-486-2048) or visit www.medicare.gov.
Enrollment in public Part C health plans, including Medicare Advantage plans, grew from about 1% of total Medicare enrollment in 1997 when the law was passed (the 1% representing people on pre-law demonstration programs) to about 36% in 2018. Of course the absolute number of beneficiaries on Part C has increased even more dramatically on a percentage basis because of the large increase of people on Original Medicare since 1997. Almost all Medicare beneficiaries have access to at least two public Medicare Part C plans; most have access to three or more.
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.
If you decide to sign up for a Medigap policy, a good time to do so is during the Medigap Open Enrollment Period, a six-month period that typically starts the month you turn 65 and have Medicare Part B. If you enroll in a Medigap plan during this period, you can’t be turned down or charged more because of any health conditions. But if you apply for a Medigap plan later on, you may be subject to medical underwriting; your acceptance into a plan isn’t guaranteed.

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.


MedMutual Advantage are HMO and PPO plans offered by Medical Mutual of Ohio with a Medicare contract. Enrollment in a MedMutual Advantage plan depends on contract renewal. This information is not a complete description of benefits. Call 1-866-406-8777 (TTY 711) for more information. Out-of-network/non-contracted providers are under no obligation to treat Medical Mutual members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries.
Beneficiaries may enroll in a Medicare Supplement insurance plan in California during their six-month Medigap Open Enrollment Period, beginning on the first day of the month that they are 65 or older and enrolled in Medicare Part B. During this time, beneficiaries aren’t subject to medical underwriting, which means they cannot be charged higher premiums or denied coverage based solely on medical history or a current medical condition. However, if a beneficiary adds or changes a Medicare Supplement insurance plan at any other time, medical underwriting guidelines will generally apply.
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]
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.
Dig into the details of plans that look promising—you want to make sure your medical treatment will actually be covered. Call the insurance companies or check their websites to learn what doctors and hospitals are in the plan’s network. Then double-check this information by calling your healthcare providers directly to make sure they take that insurance plan.
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 has four basic parts: A, B, C, and D. Taken together, Parts A (hospital care), B (doctors, medical procedures, equipment), and D (prescription drugs) provide basic coverage for Americans 65 and older. What's relevant for this article is what these parts don't cover, such as deductibles, co-pays, and other medical expenses that could wipe out your savings should you become seriously ill. That's where Part C comes in. Also known as Medicare Advantage, it's one of two ways to protect against the potentially high cost of an accident or illness. The other option is Medicare Supplement Insurance, also called Medigap coverage. Here's a look at the two options. 

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 also has an important role driving changes in the entire health care system. Because Medicare pays for a huge share of health care in every region of the country, it has a great deal of power to set delivery and payment policies. For example, Medicare promoted the adaptation of prospective payments based on DRG's, which prevents unscrupulous providers from setting their own exorbitant prices.[80] Meanwhile, the Patient Protection and Affordable Care Act has given Medicare the mandate to promote cost-containment throughout the health care system, for example, by promoting the creation of accountable care organizations or by replacing fee-for-service payments with bundled payments.[81]


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.
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.
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.
In addition, both Minnesota Medigap plans and Medicare plans usually come with a package of membership benefits. These extra benefits may help members save money on such non-Medicare expenses as memberships to fitness clubs, dental care, glasses, and even over-the-counter vitamins and medicine. These membership benefits aren’t insurance, but they may offer the same sort of discounts that people enjoy when they have to pay for in-network services with insurance.
The Minnesota Department of Health offers information about Medicare plans in Minnesota. The agency serves as a resource for those who need help paying their Medicare premiums and those interested in obtaining prescription drug coverage. The office also offers guidelines for handling complaints about health-care coverage and providers. Information on other types of health-care coverage are also covered by this website, including long-term care insurance. Downloads of publications on specific topics are also available, as well as links to additional resources available through state and federal offices.
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.
Are you about to qualify for Original Medicare or having problems with your current Medicare insurance? The Annual Election period for enrolling in a new Medicare plan will be here soon. Minnesota Advantage plans in Minnesota, also known as Part C plans, can offer you a way to control costs and get access to local medical providers. In most cases, they also include Medicare Part D, so you don’t have to enroll in other prescription drug plans.
Keep in mind that Medigap plans don’t include prescription drug coverage (Part D), so if you want help with your medication costs, you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan. In addition, you can’t use your Medicare Supplement plan to pay for costs you may have with a Medicare Advantage plan. Medigap insurance can only be used to cover costs in Original Medicare.
Medicare penalizes hospitals for readmissions. After making initial payments for hospital stays, Medicare will take back from the hospital these payments, plus a penalty of 4 to 18 times the initial payment, if an above-average number of patients from the hospital are readmitted within 30 days. These readmission penalties apply after some of the most common treatments: pneumonia, heart failure, heart attack, COPD, knee replacement, hip replacement.[31][32] A study of 18 states conducted by the Agency for Healthcare Research and Quality (AHRQ) found that 1.8 million Medicare patients aged 65 and older were readmitted within 30 days of an initial hospital stay in 2011; the conditions with the highest readmission rates were congestive heart failure, septicemia, pneumonia, and chronic obstructive pulmonary disease and bronchiectasis.[33]
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.[74]

Generally, if you already receive Social Security payments, at age 65 you are automatically enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). If you choose not to accept Part B (typically because you are still working and receiving employer insurance), you must proactively opt out of it when you receive your automatic enrollment package. You may delay Part B enrollment with no penalty under some circumstances (e.g. the employment situation noted above), or with penalty under other circumstances. If you do not receive SS when you turn 65 you must proactively join Medicare if you want it (and the penalties may apply if you choose not to based on various factors).
Basic Plan helps cover Medicare's Parts A and B coinsurance, hospice care coinsurance or copayment, skilled nursing facility care coinsurance, the first 3 pints of blood each year, and Wisconsin Mandated Benefits when not covered by Medicare. Basic Plan with Copay covers the same benefits as Basic Plan for Medicare Part A. For Medicare Part B medical expenses, the plan pays generally 20%, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if you are admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. This plan also covers the Wisconsin Mandated Benefits when not covered by Medicare.
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.
Humana is a Fortune 500 company offering several health insurance plans, including Medicare supplement plans. It services over 13 million customers and has won numerous awards from the National Business Group on Health, American Heart Association, Military Times and other organizations for the company’s insurance products and responsible business practices.
If you are enrolled in Medicare Part A and B (Original Medicare), Medigap plans can help fill the coverage gaps in Medicare Part A and Part B. Medigap plans are sold by private insurance companies and are designed to assist you with out-of-pocket costs (e.g. deductibles, copays and coinsurance) not covered by Parts A and B. These plans are available in all 50 states and can vary in premiums and enrollment eligibility. Medigap plans are standardized; however, all of the standardized plans may not be available in your area.
Plan Benefits Plan A Plan B Plan C Plan F2 Plan G Plan K Plan L Plan N Medicare Part A coinsurance and coverage for hospital benefits Included Included Included Included Included Included Included $20 copay for office visits; $50 copay for ER Medicare Part B coinsurance or copayment Included Included Included Included Included 50% 75% Included Blood (first three pints) Included Included Included Included Included 50% 75% Included Hospice Care coinsurance or copayment Included Included Included Included Included 50% 75% Included Skilled Nursing Facility Care coinsurance Included Included Included 50% 75% Included Medicare Part A deductible Included Included Included Included 50% 75% Included Medicare Part B deductible Included Included Medicare Part B excess charges Included Included Foreign Travel Emergency (up to plan limits) Included Included Included Included
In addition, both Minnesota Medigap plans and Medicare plans usually come with a package of membership benefits. These extra benefits may help members save money on such non-Medicare expenses as memberships to fitness clubs, dental care, glasses, and even over-the-counter vitamins and medicine. These membership benefits aren’t insurance, but they may offer the same sort of discounts that people enjoy when they have to pay for in-network services with insurance.

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