MNsure, Minnesota’s health insurance marketplace, is a great source of coverage for individuals and families without access to employer-sponsored insurance. If you qualify, you may be able to receive financial assistance and reduce your costs. Small business owners also have access to coverage through MNsure’s Small Business Health Options Program (SHOP). Under the health care law, everyone is required to have health insurance, and the exchange is the most affordable option for many Minnesotans. Through MNsure, you can find a qualified health plan (QHP) from one of your state’s private health insurance companies, gain coverage, and avoid the penalty tax for being uninsured or having an insufficient insurance plan. Qualified health plans meet Affordable Care Act standards, providing at least 60% actuarial value and ten categories of essential health benefits (EHBs), and thus, more coverage than many plans sold prior to the ACA.
As the exchanges are a development of Obamacare, they create an opportunity for more people in Minnesota, and throughout the country, to become insured. Through MNsure, residents of Minnesota have the advantage of using a state-run program, therefore being more personalized. According to Minnesota Public Radio, “The Supporters of Minnesota building its own exchange argued that Minnesota could build a system that benefited from the state’s long history of health care policy innovation and cost containment. They also maintained that Minnesota would wind up with an exchange tailored to the needs of state residents rather than a ‘one-size-fits-all’ federal exchange.”
The marketplace is a setting where insurers can sell qualified health plans, and shoppers can view plans side-by-side to compare plans and find which coverage is right for them. While the state of Minnesota manages plans and is responsible for the program’s operation, federal law dictates the basics of what plans can be sold and what it must include.
The first thing you’ll want to know about MNsure is if you’re eligible for a lower premium, or even reduced cost sharing. Federal subsidies are issued to your insurer by the IRS and applied to your plan for a discounted rate, making coverage more tangible to lower- and middle- income Minnesotans. Subsidies, or tax credits, are calculated by your income, how much the second-cheapest silver plan costs in your area, how many people are in your household, and whether you have access to employer-sponsored insurance. If you have access to job based coverage that pays at least 60% after deductible or you earn over 400% of the federal poverty line, you won’t be able to get a tax credit.
Subsidies can help people who earn 133 and 400% FPL pay for premiums.
Subsidies provide assistance with cost sharing for people who earn 133 to 250% FPL.
You can calculate your subsidy here or with an agent before you purchase an MNsure health plan. Call us at 888 803 5917 for help enrolling in marketplace coverage.
Qualified health plans must meet certain guidelines, but it doesn’t mean your options under MNsure are limited by any means. You have a choice of multiple carriers, plan designs, deductibles and benefits when you shop the exchange. However, each qualified health plan follows a “metallic” coverage structure, meaning the amount your plan pays after deductible is represented by either bronze, silver, gold or platinum. You’ll already figure that platinum is the most valuable and costs the most, while bronze is cheapest and provides the least coverage from your insurer. With various deductibles and companies to choose from, you can find a plan that meets your budget and health care needs.
60% covered after deductible, 40% cost sharing
Lowest premiums in exchange for higher medical costs.
70% covered after deductible, 30% cost sharing
Affordable premiums with slightly less cost sharing.
80% covered after deductible, 20% cost sharing
Smaller share of costs for a higher rate.
90% covered after deductible, 10% cost sharing
Very low cost for covered services paired with the highest premiums.
An additional plan apart from the metallic tiers is the catastrophic policy, available to young Minnesotans up to age 30. These plans help individuals stay healthy for a lower cost than the bronze plan, and with considerably fewer benefits. Catastrophic coverage through MNsure covers 4 doctor’s office visits annually, free preventive care, and emergency care subject to your yearly deductible.
Companies & Provider Networks
Because plans sold through MNsure are eligible for discounted prices, yet contain a wide selection of covered services, insurers had to trim down their provider networks to make plans affordable. Therefore, a key difference in buying a plan on or off the exchange is the amount of choices you have when receiving care. With a QHP on the exchange, you’ll have fewer doctors and hospitals to choose from, but the quality of your care won’t be compromised. Basically, each carrier made a special network specifically for MNsure in order to keep costs reasonable.
Companies participating on the Minnesota exchange include:
Each plan on the exchange is free to offer more than the minimum, but all will include the following ten categories of EHBs. Preventive care is covered in full regardless of the plan you choose, while other types of care may require a copay, coinsurance, or be subject to the deductible.
- Emergency care
- Pediatric care, including dental and vision
- Maternity and newborn care
- Ambulatory patient care
- Laboratory services
- Prescription drugs
- Rehabilitative and habilitative care and supplies
- Preventive and wellness services and chronic disease management
- Mental health and substance abuse disorder services, including behavioral health care
How to Apply
You can apply for coverage under MNsure by visiting a local health care center or other public place in your community where assisters are staffed. These workers will help guide you through the application process if you have any confusion over using the site. You can also apply directly through MNsure’s website, or if you want to speak with a licensed agent, call us at 888 803 5917. Our agents are certified to sell MNsure plans, and we’ll let you know everything about your options, including subsidies and coverage tiers.