BCBS Minnesota Medicare Advantage

Blue Cross and Blue Shield of Minnesota (BCBSMN), a key player in the healthcare sector, offers a diverse array of Medicare Advantage plans for Minnesota residents. These plans, often more comprehensive than Original Medicare coverage, are an attractive option.

When it comes to healthcare, everyone has unique needs and preferences. That’s why BCBSMN strives to offer a variety of Medicare Advantage plans. Whether you prioritize low monthly premiums, extensive coverage, or flexibility in choosing providers, BCBSMN has a plan tailored for you.

What is a Medicare Advantage Plan?

You may be asking, “What is a Medicare Advantage plan exactly?” Simply put, a Medicare Advantage (MA) plan is an alternative to Original Medicare. While Original Medicare is a fee-for-service health plan provided by the federal government, Medicare Advantage plans are provided by private entities.

These private companies, like BCBSMN, contract with Medicare to provide Part A and B benefits, which cover hospital and medical services. Medicare Advantage plans may offer additional benefits not found in Original Medicare, such as prescription drug coverage, dental care, and vision services.

The Role of Blue Cross and Blue Shield in Medicare Advantage

BCBSMN offers Medicare Advantage plans to eligible beneficiaries as an alternative to Original Medicare. These plans offer all the benefits of Original Medicare and more, including possible additional benefits such as vision and dental programs not covered by Original Medicare.

Choosing a BCBSMN Medicare Advantage plan comes with the primary advantage of a broad provider network. This network includes a broad range of healthcare providers, ensuring comprehensive coverage for residents within the service area.

This means you’ll have access to a vast array of specialists, hospitals, and clinics, providing you the freedom to choose the healthcare that best fits your needs.

Comparing BCBSMN Medicare Advantage Plan Options

That’s why BCBSMN offers an array of Medicare Advantage plans, designed to meet the diverse healthcare needs and preferences of Minnesota residents, including those in Big Stone County.

Whether you prefer the predictability of HMOs or the flexibility of PPOs, BCBSMN has one plan that suits your needs among their Medicare Advantage offerings.

As you compare BCBSMN Medicare Advantage plan options, considering your unique healthcare needs is vital. Therefore, taking the time to understand each plan’s offerings can aid in making an informed decision that best fits your medical and financial needs.

HMO Plans

The emphasis on coordinated care makes BCBSMN’s HMO Medicare Advantage plans stand out. Under these plans, members are required to select a primary care physician (PCP) from the plan’s network. This PCP becomes the central figure in managing your healthcare, offering a personalized and coordinated approach to meet your health needs.

One thing to note about HMO plans is that you’ll generally need a referral from your chosen PCP to consult with specialists. The cost-sharing structures for BCBSMN’s HMO plans are designed to encourage the use of in-network services, which can translate into savings for you.

PPO Plans

BCBSMN’s PPO Medicare Advantage plans could be right for you if you value flexibility. Unlike HMO plans, PPO plans offer:

• No requirement to select a primary care physician

• No need to obtain referrals for specialist care

• The ability to see any healthcare provider you prefer, whether they’re in-network or out-of-network.

Receiving care outside the plan’s network typically incurs higher costs compared to in-network care. So, while PPO plans offer more freedom in provider choice, they may also lead to higher out-of-pocket expenses.

Special Needs Plans (SNPs)

BCBSMN caters to individuals with specific healthcare needs by offering Special Needs Plans (SNPs). These plans are tailored to cater to individuals with diseases or health characteristics, providing them with specialized healthcare coverage.

For example, these plans may be suitable for individuals with Medicaid, long-term care requirements, or residents in nursing homes.

Among the SNPs, BCBSMN offers SecureBlueSM (HMO SNP), specifically fashioned for seniors 65 and over who are eligible for both Blue Cross Medicare and Medicaid. This plan simplifies healthcare management for its members by combining Medicare and Medicaid benefits into a single plan.

Prescription Drug Coverage with BCBSMN Medicare Advantage

Prescription drug costs, particularly for seniors needing multiple medications, can significantly impact any budget. That’s why BCBSMN Medicare Advantage plans may integrate Medicare Prescription Drug coverage (Part D), negating the need for standalone prescription drug plans.

This integration means you’ll have a single plan that covers both your medical and prescription drug needs. However, it’s important to note that enrollees may incur various out-of-pocket costs.

Additionally, during the coverage gap, also known as the donut hole, enrollees are responsible for paying for all their prescription drug costs until they reach the annual out-of-pocket spending limit.

Understanding Part D

Offered by private insurance companies like BCBSMN, Medicare Part D plans provide coverage for prescription drug costs. These plans are often integrated into BCBSMN’s Medicare Advantage plans, giving you a one-stop solution for your healthcare needs.

Costs associated with Medicare Part D plans, which include premiums, can change on an annual basis.

However, a low-income subsidy program is featured in Medicare Part D to assist those who qualify based on their income and assets with their medication expenses. This can be a lifeline for those struggling to afford their medication costs.

BCBSMN Formulary and Drug Tiers

BCBSMN employs a formulary system in its Medicare Part D plans. This system is designed to categorize drugs into tiers that influence the member’s cost-sharing responsibilities.

The drug tiers in the BCBSMN formulary range from preferred generic drugs, with the lowest cost-sharing, to non-preferred and specialty medications that incur higher cost-sharing amounts.

Prescriptions must be filled out at a network of approved pharmacies in accordance with the BCBSMN Medicare Part D plan requirements.

Enrollees can review and potentially adjust their formulary drug coverage each year during the Open Enrollment Period. This allows for adjustments as your health needs change, ensuring your plan continues to meet your needs.

Enrolling in a BCBSMN Medicare Advantage Plan

Having decided that a BCBSMN Medicare Advantage plan is the right choice for you, the next step is to understand how to enroll. Well, there are a few eligibility criteria to consider, certain enrollment periods to be aware of, and a specific application process to follow.

Eligibility Criteria

Certain eligibility criteria must be met before enrolling in a BCBSMN Medicare Advantage plan. Firstly, you must have both Medicare Part A and Part B coverage. Additionally, you need to reside within the plan’s service area, which is something to consider if you’re a Minnesota resident who lives part-time in another state.

There’s also the Freedom BlueSM plan, designed specifically for veterans who have credible drug coverage through sources such as the VA or TRICARE.

Enrollment Periods

Having established your eligibility, the next consideration is when to enroll. The initial enrollment period for Medicare Advantage coincides with your initial eligibility for Medicare, which typically starts 3 months before your 65th birthday month and ends 3 months after your birthday month.

If you don’t enroll when you’re first eligible, you may face a late enrollment penalty added to your premium.

There are also other periods during the year when you can enroll in, switch, or drop a Medicare Advantage plan. These include the Annual Election Period from October 15 to December 7 and the Medicare Advantage Open Enrollment Period from January 1 to March 31. In certain situations, like relocating out of the plan’s service area or losing current coverage, you may qualify for a Special Enrollment Period.

How to Apply

After determining your eligibility and the appropriate enrollment period, you can begin the application process. The easiest method is to apply online. However, if you prefer a paper trail, you can download, fill out, and submit paper enrollment forms for plans like Medicare Plus Blue PPO or BCN Advantage HMO-POS.

BCBSMN also provides phone assistance for Medicare Advantage plan enrollment, and you can call customer service for help with the application process. If you’re looking to switch from one Medicare Advantage plan to another, you can utilize plan change forms provided by BCBSMN.

Once you’ve submitted your application, you can check the status online, and processing can take up to 7 business days.

Summary

Choosing the right healthcare plan is an important decision that can greatly impact your health and finances. BCBSMN Medicare Advantage plans offer a comprehensive solution, combining medical coverage, and may include prescription drug coverage, and additional benefits such as dental, vision, and wellness services.

With a variety of plan options including HMO, PPO, and SNPs, you can find the perfect fit for your unique healthcare needs and preferences.

Remember, healthcare is not a one-size-fits-all proposition. It’s about finding the right coverage that suits your individual needs. So, take the time to understand each plan, compare your options, and make an informed decision.

Frequently Asked Questions

What are the most highly rated Medicare Advantage plans?

The most highly rated Medicare Advantage plans are UnitedHealthcare, Aetna, Blue Cross Blue Shield, and Humana, based on factors like network size, extra perks, local support, and low-cost plan availability.

UnitedHealthcare is the largest provider of Medicare Advantage plans, with high star ratings and a broad array of options.

What is the largest Medicare Advantage company?

The largest Medicare Advantage company is UnitedHealth Group, with 7.6 million people in its plans and $257 billion in premium revenues in 2022.

Is Medicare Plus Blue the same as Medicare Advantage?

Yes, Medicare Plus Blue includes both Medicare Advantage and Part D prescription drug benefits as one plan, so they are not the same.

What is a BCBSMN Medicare Advantage plan?

A BCBSMN Medicare Advantage plan is an alternative health insurance plan to Original Medicare offered by Blue Cross and Blue Shield of Minnesota, often including additional benefits like prescription drug coverage.