If you read the Star Tribune article on October 7th, you may have questions or concerns about Medicare Advantage. Given the number of conversations we’ve had with clients over the past week, we thought it deserved an explanation.


First of all, Medicare Advantage plans are not “New” plans. 
Yes, there are many new Advantage plans available in Minnesota, but Advantage plans, in general, are not “New” plans. The reason we have so many new plans is a direct result of federal legislation called MACRA, which effectively terminated over 350,000 Minnesotans’ from their Cost plan. Cost plans are another type of Advantage plan and were extremely popular in Minnesota for 20+ years. However, MACRA limits where a Cost plan can be sold, which means the insurance carriers needed to create “New” Advantage plans so their members could continue their coverage beyond Jan 1st, 2019.

Medicare Advantage plans are similar to Employer-Group Plans:

  1. Medicare Advantage plans don’t require health history underwriting or have any pre-existing condition limitations.
  2. In order to make changes to or to sign up for a Medicare Advantage plan, you need to wait until certain times during the year, such as the Annual Election Period (Oct 15th – Dec 7th), the Medicare Advantage Open Enrollment Period (Jan-March) or if you have a qualifying life event such as you are new to Medicare, moved to a new service area, losing other group health coverage, or similar.
  3. Medicare Advantage plans work with a provider network, similar to how an employer-group plan utilizes a network of providers. Some Advantage plans have a smaller, more restrictive network, while other plans have a broad, open-access provider network. 

All Medicare Advantage plans must follow the same guidelines as it pertains to benefits: 

  1. They must cover ALL Medicare-Approved Part A & Part B benefits.
  2. They must have a maximum out-of-pocket limit for covered services. For 2020, the maximum out of pocket can’t be greater than $6,700.
  3. The Plan benefits must be, on average, as good as Original Medicare. This means, you won’t pay more than you would have to pay had you ONLY had Original Medicare.

This is the #1 reason why your network is so important – because you could pay more if you choose to seek care with a provider that is out of network. Keep in mind that there are many carriers and plan options available that provide coverage for out of network services and even have a maximum out of pocket limit for in-and-out-of-network services.


DID YOU KNOW? Medicare pays providers on average 87% less! In addition, Medicare pays 80% for covered Part B services. This means your 20% responsibility under Original Medicare is of a much lower rate than what you would be charged if you were covered by any other commercial health plan. 

So when choosing your supplemental plan, you aren’t changing what is covered by Original Medicare. You are changing what you spend for those covered services, and most importantly, providing yourself with a maximum out of pocket limit should you require a significant amount of care. With the right Advantage plan in place, you can have coverage for everything Medicare approves as a Part A & Part B service, seek care with every major care system in Minnesota, and while traveling, and have a “worst-case scenario” with the maximum out of pocket limit should things change in your health. You can even find Medicare Advantage plans that provide coverage for vision, hearing, dental, fitness clubs, acupuncture, and more. At Shoreline, we want you to really know and understand how Medicare works and what you have with Original Medicare. Why? If you understand the meat and potatoes, it’s much easier to choose your side dish. We’re here to help you navigate ALL the plan options and choose the plan that best suits your needs. If you have any questions, don’t hesitate to reach out to us. We’re here to help!
Allison & the Shoreline Crew