En español | Most Minnesotans are eligible to buy health insurance through MNsure, the state’s Affordable Care Act (ACA) marketplace, with open enrollment running through Jan. 15. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill.
Most people already enrolled in ACA marketplace plans have seen their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help it afford health insurance. Prior to the new law, such tax credits were available only to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
- Minnesota residents, including legal immigrants, are eligible to buy insurance through MNsure, regardless of whether they are currently insured, but they'll have to wait until open enrollment begins in November. More information about who can enroll, along with details about eligibility, is on the MNsure website.
- You may also qualify for Medical Assistance, the state’s Medicaid plan, which has no monthly premium. Or for MinnesotaCare, which offers low-cost coverage to Minnesotans with lower incomes. Both plans allow for year-round enrollment. When you apply for coverage through MNsure, you'll find out if you qualify for one of these no- or low-cost insurance options. You can also see what you might qualify for by looking at the state's income level guidelines.
When can I enroll?
- MNsure open enrollment began on Nov. 1 and runs through Jan. 15.
- You can enroll outside of open enrollment if you experience a qualifying life event, but in most situations you only have 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
- Year-round enrollment is open to Minnesotans who qualify for Medical Assistance or MinnesotaCare, and to members of a federally recognized American Indian tribe.
How do I sign up?
You apply for coverage and choose your plan at the same time. As soon as you submit an application with MNsure, you'll learn what coverage you're eligible for. If you qualify for private coverage, you can shop for plans and continue the enrollment process immediately. If you're eligible for a public plan, Medical Assistance or MinnesotaCare, information about next steps will come from the Minnesota Department of Human Services, your county or your tribal agency.
If you enroll in a private plan or for MinnesotaCare, your coverage will not begin until you've paid your first monthly premium. There is no monthly premium for Medical Assistance.
To apply and enroll:
- Online: Go to MNsure's website to apply and enroll.
- By phone: You can call MNsure's contact center at 651-539-2099 (855-366-7873 outside the Twin Cities) between 8 a.m. and 4 p.m., Monday through Friday.
- In person: You can find someone to assist you or visit a broker enrollment center for help. Or, you may want to check out one of the enrollment events in your area.
Certified brokers, for private plans, and navigators, for public plans, offer free help exploring plans and answering questions and are available virtually, by phone or in person. MNsure's website makes it easy to find help near you.
What is covered, and how much will it cost?
All MNsure health coverage plans cover basic dental services for children, but adults who want dental insurance must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
Coverage and cost depend on where you live, the type of plan you choose, your household income, use of tobacco and the age and disability status of you and your members of your family.
If you qualify for Medical Assistance or MinnesotaCare, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All MNsure plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management
- Pediatric care, including dental and vision
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums.
For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for a $0/month premium health coverage option, thanks to the American Rescue Plan. Minnesotans who received unemployment in 2021 may qualify for a new 60-day special enrollment period to shop for coverage through MNsure and take advantage of these new low-cost options. If you’re already enrolled in a plan through MNsure this subsidy will show up on your August invoice for the first time if your account is up to date. You may even be able to change plans to access benefits that greatly reduce out-of-pocket costs for in-network services.
If you’ve already received unemployment benefits this year while enrolled in a marketplace plan, you’ll be able to claim the additional subsidies for the months prior to August when you file your 2021 tax returns. The extra financial help for those who have received unemployment income will expire at the end of 2021. The marketplace’s website provides further information about unemployment income benefits through MNsure and the American Rescue Plan.
What plans are available?
Most MNsure plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover about 70 percent of care costs and potentially much more, if you come from a lower-income household and qualify for cost-sharing reductions -- a subsidy only available through silver plans.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
Minnesotans under 30, and others who qualify for a hardship exemption, can also apply for a catastrophic health plan which offers a low monthly premium and a very high deductible and exists to protect customers in worst-case scenarios.
MNsure’s Shop and Compare tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to MNsure. But you may need to wait until open enrollment, and you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours before Oct. 1, you may be able to save money by switching to a MNsure plan during a 60-day special enrollment window. Be sure to apply and select your plan through MNsure before your COBRA coverage ends to make sure there’s no gap in coverage. If you're not sure if this switch makes sense for you, you can ask for free advice from a certified insurance broker.
If you already have a marketplace plan and want to adjust your coverage, you’ll need to wait until the renewal period opens this fall. If you don’t take action during the renewal period, you’ll automatically be reenrolled in your existing plan if it’s still available. And if it’s not available through MNsure but is available outside MNsure, you’ll be enrolled but will not receive financial help. For this reason, you should be sure to shop and compare MNsure plans during open enrollment to secure the best option and savings for you and your family.
Will I need to get a new doctor?
That depends. Major insurance providers — including BlueCross BlueShield Minnesota, Health Partners, Medica, Quarts and UCare — offer MNsure plans, but not all doctors accept them. Before you select a plan, you may want to check to see if your doctor is in the insurance company's network or contact the insurance company to learn more about in-network vs. out-of-network providers and what that means for you and your costs.
Will my family members qualify for the same health plan that I do?
Most families can enroll in the same plan. But in some cases, the needs of family members may vary — and so might their access to subsidies. If you're not sure what makes the most sense for your family, MNsure encourages you to contact a broker for guidance.
This guide, originally published on May 25, was updated on Nov. 1 to include information about open enrollment.