Of the more than 300,000 Minnesota residents who are losing their Medicare health plans next year, many are finding that alternative coverage options may require a larger or larger copayment during the visit. ;doctor.

The differences are particularly evident for consumers who lose their Medicare Cost plans while being referred to Medicare Advantage plans, which typically charge higher fees for X-ray ambulance trips.

Insurers say that the highest co-payments in general are offset by lower monthly premiums with Advantage plans. Consumers can avoid the complexity of co-payments by switching to the original Medicare plus a Medigap supplement, but they will likely find higher premiums as a result.

"There will always be compromises to make," said Kelli Jo Greiner, health policy analyst at the Minnesota Board on Aging. "That's what makes things so complicated."

Co-payment is one of the many problems that Minnesota faces when it decides to replace the Medicare Cost plans sold by the state's largest nonprofit health insurers.

A federal law eliminates cost plans in 66 countries in 2019, leaving consumers with the choice between the initial Medicare plans and the new Medicare Advantage plans. Across the country, about two-thirds of Medicare beneficiaries opt for the initial Medicare system, while one-third opt for Advantage plans sold by private health insurance companies.

State officials are concerned that people who lose their costs will not return to the original health insurance without buying Medigap coverage and Part D. This could result in financial hardship for those who accumulate large amounts of medical bills. health care, because in many cases Medicare covered only 80% of medical costs and did not cover most drugs.

There are several key differences between the original Medicare plus Medigap and Medicare Advantage coverage routes.

Original Medicare plus a supplement usually offers broader access to doctors and hospitals. Medicare supplements, called Medigap plans, may be associated with Part D plans from more than two dozen companies that sell drug coverage, while plans under the Advantage plan are limited to the benefits offered by their medical insurer. The benefits of Medigap plans are standardized, while the details of Advantage plans can change from year to year. And Medigap plans do not use rules such as "pre-authorization" that control costs, but can frustrate patients.

Medicare Advantage plans, on the other hand, often sell for a much lower monthly premium, including some zero-premium options. Low premiums create a savings opportunity for people who do not use a lot of care. In addition, plans often include additional benefits going beyond the original health insurance, such as preventive care coverage and discounts on dental services, vision and health care. 39; audition. Some decision-makers have highlighted Advantage plans as they expose health insurance companies to a quality risk while giving them a degree of quality – which they believe is an incentive to manage quality care effectively.

Another difference is the share, which can be structured as a lump sum per service or as a percentage of the cost of the service. The Medicare Advantage plans cap the total annual value of these direct costs at between $ 3,000 and $ 6,700 for networked services (and more for off-grid care).

"That's part of the math," said David Lipschutz, general counsel for policy at the Center for Medicare Advocacy. "Do I want to pay more in monthly bonus with more insurance than I will not pay more when I generate health expenses? Or do I want to use a lower monthly premium knowing What if I want to use health care services that I could be on the hook? "

72-year-old Tommy Stiles of Henning has chosen the Medigap route, although the premium will be higher.

Stiles had been very pleased with the coverage of the most comprehensive Medicare cost insurance plan from Blue Cross and Blue Shield of Minnesota. Among other things, the plan required him to pay $ 0 for ambulance trips, doctor visits, outpatient surgeries and X-rays.

Thus, Stiles said that he was alarmed this fall when Blue Cross directed him to a Medicare Advantage program that would require him to pay between 5 and 20 US dollars for a doctor visit, USD 50 per ambulance, USD 150 per outpatient surgery and 10% x-ray costs. . Instead, he opted for a Medigap plan in which the premium is about 10% higher.

"There are no surprises," Stiles said of the Medigap-style cover.

Stiles is part of the cost group sub-group that includes prescription benefits and is therefore eligible for a process called "presumption" in which their current insurer automatically enrolls them in a new Medicare Advantage plan. The federal government asserts that the presumption can only take place if the total cost to the recipient with the new coverage does not exceed the average cost of the former health care plan of more than $ 36 per member per month.

Stiles is skeptical about the decisive process because he says it seems that Blue Cross is directing him to a plan in which he could pay a lot more in co-payments and co-insurance. For several years, Stiles has been visiting the Mayo Clinic for prostate cancer treatment. During this period, he had to face less than $ 5 in overhead costs.

The Advantage plan included a comparable premium and an annual cap slightly lower than the cost plan in terms of costs to be borne, but it offered many other ways to support these costs. "My budget does not leave surprises of $ 3,000 or $ 4,000," Stiles said.

Blue Cross defended the presumption process, claiming that the calculation took into account not only the share, but also the premiums that are often lower than the value of the additional benefits. The insurer acknowledges that it recognizes that Medigap is better suited to certain people and encourages consumers to consider their options.

"For some of those members who have potentially high costs, it might be better to participate in a Medigap plan because it would allow you to budget more simply knowing that you are going to pay a premium. said Joel Stich, senior director of government contracts at Blue Cross.

Minnesota who lose Medicare Cost plans have a unique right to enroll in a Medigap policy without answering questions about their medical history, which could block their registration at a later date.

At the Minnesota Board on Aging, officials said the presumption process provided a public benefit by ensuring that consumers do not unwittingly return to Medicare without additional coverage, which can protect them from large medical bills. At the same time, the board encourages people to actively evaluate whether the plan in which they were considered is the best choice.

On the Medigap side, consumer advisers say the search for the best offer requires shopping with the many insurers selling Medicare Supplement policies and studying the differences between Part D drug plans.

The complexity of the decision that faces so many Medicare beneficiaries this fall explains why average waiting times are longer on the state's LinkAge line, which provides free advice on Medicare options . The average wait time this year is greater than 21 minutes, compared to more than 8 minutes in 2017.

"People are not happy to have to make these changes," said Greiner of the state's governing board on aging. "People were really happy with what they had."