Minnesota’s MCHA program has insured individuals who have otherwise been unable to obtain coverage since 1976. The MCHA is not a state-funded program, but rather a nonprofit formed by state legislature. As the federal health care law has changed the landscape for health insurance underwriting, the program will still be needed even though people with health problems can purchase coverage from private insurers.
26,000 Minnesotans are presently insured by MCHA, many of which have exhausted their COBRA coverage, are in a workplace that does not offer health insurance, or are 65 or older and ineligible for Medicare. There are many reasons why Minnesotans may be unable to receive health benefits other than their medical history, which is important to MCHA enrollment. This risk pool is different than many, including the temporary federal high-risk pool, PCIP, which covered only those who had been rejected for a pre-existing condition, while MCHA accepts more individuals who can prove their inability to obtain coverage.
There are five groups of eligibility for MCHA, all of which require documentation and different qualifications depending on the specific category.
1. Loss of Group Coverage
Those who are Minnesota residents on the day they have applied for MCHA coverage and have lost their employer health benefits may qualify. They must also be defined as HIPAA eligible, which includes having used and run out of COBRA or other continuation coverage; having a coverage gap of no more than 63 days; not eligible for Medicare or Medicaid or have access to any other source of coverage; had 18 months of continuous coverage; and not losing benefits due to fraud or nonpayment of premiums.
2. Health Coverage Tax Credit (HCTC) Program
Those who meet the income guidelines for the HCTC program and are residents of Minnesota on the day they enroll for MCHA may qualify. It is required to be Department of Labor certified to receive assistance with premiums from the IRS tax credit, and receive benefits through Trade-Adjustment Assistance (TAA), Alternative Trade Adjustment Assistance (ATAA) or Pension Benefit Guaranty Corporation (PBGC).
3. Do Not Qualify for Medicare
If a Minnesota resident of at least six months is age 65 or older and is not eligible for Medicare, they can be apply for MCHA. Provide a letter from Social Security in order to prove your ineligibility.
4. Health Based Coverage Decline
Minnesota residents of at least six months who have been rejected by an insurer in the past six months because of a health condition may also apply for MCHA. Provide your letter of rejection from an insurer or have your insurance agent fill out the “Agent Certification of Health Related Rejection.”
5. Presumptive Conditions
If you have been a Minnesota resident for the past six months from the date of your MCHA application and have received treatment within the past three years for a medical condition on the MCHA’s presumptive condition list, you also qualify for coverage. These conditions include the following, and must be supported by a physician’s statement acknowledging the presence of one of these illnesses.
MCHA Plans & Benefits
All MCHA plans are provided through Medica, whether you choose a standard PPO, a high-deductible, or a Medicare Supplemental plan. MCHA coverage is similar to a private plan, offering comprehensive coverage at 80 percent after deductible for the majority of in-network services. Each plan has a $3000 out-of-pocket maximum before the plan covers 100 percent of your service costs, with the exception of the $5000 and $10,000 plans whose deductibles serve as the out-of-pocket limit. Deductible plans cover non-formulary and formulary medications, with a separate deductible for pharmacy benefits.
The $3000 deductible plan makes it possible for the policyholder to open a health savings account to use with their plan. This plan covers 100 percent after deductible for all qualified medical costs, including pharmacy services though it will only cover formulary drugs. Until you reach the deductible, all of your services will be at full cost with the exception of preventive care.
- $500 deductible plan option
- $1,000 deductible plan option
- $2,000 deductible plan option
- $3,000 federally qualified high deductible health plan option
- $5,000 deductible plan option
- $10,000 deductible plan option
MCHA plans include but are not limited to the following services:
- Emergency care
- Physician care
- Prescription medications (including mail order)
- Inpatient and outpatient hospital care
- Home health care
- Mental health and substance abuse services
- Durable medical equipment
- TMJ disorder treatment
- Skilled nursing
- Outpatient rehabilitation
- Medical-related dental services
- Transplant services
- Reconstructive and restorative surgery
- Hospice services
Basic Medicare Supplement Plan
MCHA covers the 20 percent of the service cost not covered by Medicare up to the allowed amount, if the care is Medicare eligible and the member has met their Medicare deductibles. These plans do not provide prescription coverage, though optional riders are available.
How to Apply
Download and print a form from the MCHA website in order to choose a plan, find out what documentation to include, and complete an application. Deductible plans and Medicare plans have separate application forms. Select your application and view benefit summaries here.
Deductible plans: 866-894-8053
Medicare Supplement: 800-325-3540
Mail Route CP555
401 Carlson Parkway
Minnetonka, Minnesota 55305
1. MCHA. “About MCHA.” http://mchamn.com/about/about-mcha/.
2. MCHA. “Eligibility.” http://mchamn.com/eligibility/.
3. MCHA. “Benefit Plans.” http://mchamn.com/benefit-plans/.