Mary Krueger visits with 10-12 seniors each day in her office at the Douglas County Senior Services center. Her next available appointment is more than two weeks away.

Why is she so busy? Krueger, the county's senior coordinator, is trying help those with Medicare work their way through the changes that are taking place for 2019.

She explained that in 2003 a federal law was passed that created a "competition" requirement for Medicare Cost plans. It stipulated that plans could not be offered in areas where there was significant competition with Medicare Advantage plans. Congress delayed the requirements several times and, according to Krueger, Minnesota was one of the states that received a waiver to avoid implementing the changes.

However, in 2015, a new law passed calling for the rule to take effect in 2019, and nearly every county in Minnesota will be making those changes.

Not everyone with a Medicare Advantage plan is affected by the changes. According to Dancing Sky, an area agency on aging that serves Douglas County, "If you did not receive a letter from your insurance company or from the Centers for Medicare and Medicaid Services, you can proceed during the open enrollment period as you have in the past." Open enrollment started Oct. 15 and run throughs Dec. 7.

Beginning in 2019, Centers for Medicare and Medicaid Services won't allow Medicare Cost Plans in counties where there were at least two competing Medicare Advantage plans available the previous year and the plans had a minimum number of members enrolled during the entire previous year.

Krueger said 10 Medicare Advantage plans are available in Douglas County so it is not one of the counties that is exempt. Cost plans will still be available in 21 counties where only a small number of Medicare plan types are available, she said.

The best thing Douglas County seniors can do, Krueger said, is to look at the available plans.

"Get all the information and look at all the companies out there," she advised. "Competition is huge. If there are sessions available for the different companies, like Humana for example, go to all the sessions. Get as much information as possible. Mull it over and don't make a hasty decision."

Kruger also suggested that senior citizens talk to their children or grandchildren for help. Seniors have a little over a month to gather information before they have to enroll, she said.

Scott Soderholm of Soderholm Insurance in Alexandria highly suggests that seniors not wait to the last minute, however. He also said that because everyone has their own unique circumstances, it's best to contact someone who has experience in the insurance business and to "not listen to your neighbor."

"Not all plans fit all situations," he said. "(Prescription) drug usage could determine what plan is best."

Because there are "huge differences" with drug plans starting in 2019, Soderholm said that seniors need to check their plan to make sure it covers what needs to be covered or "they could be in for a shock."

In Douglas County, Soderholm said there are 28 different stand-alone drug plans, 10 Medicare Advantage plans that have drug plans and three Medicare Advantage plans that do not have drug plans. There are no supplement plans that have prescription drug coverage. He said people need to be aware what their plans cover and don’t cover.

Medicare cost plans

According to Dancing Sky, Cost Plans have been a popular option for seniors around the state. They allow seniors to keep traditional Medicare benefits while hanging onto out-of-network health care providers. Put simply, enrollees are not restricted to a network of providers.

The Cost Plan option was popular for "snowbirds," those who move to warmer climates in the winter, because they could leave Minnesota and their cost plan would revert to original Medicare Parts A and B, which allows them to be covered while living outside Minnesota.

More information about Medicare and the changes taking place can be found at or