A quick guide on the state’s insurance market set up under the new U.S. health care act.
Q: What is MNsure?
A: It is Minnesota’s version of a new marketplace, called for in the federal health law, to help consumers more easily comparison shop among health insurance plans. Minnesota is one of 16 states plus the District of Columbia building its own exchange. People in other states will use an exchange being set up by the federal government or a hybrid state-federal version.
Q: Who will use it?
A: Everyone who qualifies for Medical Assistance and MinnesotaCare, the state’s public health plans. MNsure also will be an option for small businesses with two to 50 full-time employees and for people who don’t get health coverage at work. A key goal is to help the nearly 500,000 uninsured Minnesota residents who will be required to buy coverage in 2014 or pay a fine. If you get coverage from a large company or are a senior on Medicare, MNsure isn’t for you.
Q: Can I still use my broker?
A: Yes. If you qualify for government subsidies to help lower your premium cost, you can’t get the tax credits unless you shop on the MNsure exchange. Your broker can help you access those credits.
Q: Who will qualify for help paying for insurance?
A: It varies, depending on your income and life situation, such whether you are single, have children, or are pregnant. Minnesota is receiving federal funds to cover more people under Medical Assistance, Minnesota’s version of Medicaid. The state also will continue offering MinnesotaCare, a public program for lower-income residents who earn enough to help pay a portion of the premium.
To estimate how much help you might receive, go to www.mnsure.org and click “calculate your cost.” Here are some examples:
• Premium tax credits: Available immediately to individuals with incomes between $22,980 and $45,960 and a family of three earning $39,060 up to $78,120. The higher your income, the lower your discount.
• MinnesotaCare: Covers individuals with income between $15,282 up to $22,980 and a family of three $25,975 to $39,060.
• Medical Assistance: Individuals with income below $15,282 or a family of three under $25,975.
Q: What will change in 2014?
A: Insurers will be required to cover a basic set of conditions for everyone, including maternity care, prescription drugs, mental health care, and dental and eye care for children. They no longer can deny coverage to people with pre-existing conditions, and women can’t be charged more than men. Health plans may still charge higher premiums based on age, tobacco use, and for people in geographic areas where medical costs are higher.
Q: What about out-of-pocket costs?
A: The total out-of-pocket costs (including deductibles and co-pays) are generally capped at $6,350 for individuals and $12,700 for families, though guidelines are still being developed.
Q: I like my current plan, so I don’t need to think about MNsure, right?
A: Not necessarily. A third of individual policies currently have out-of-pocket caps that exceed new federal limits according to Kaiser Health News & U.S. News and World Report. So even if you’ve had the same plan for years and don’t plan to shop on the exchange, your health plan may no longer comply with the federal law so you could still face new choices at enrollment time.
Q: Do I need to go to the exchange on Oct. 1 or can I wait a few months?
A: Oct. 1 is just the opening day. You have until March 31 to buy coverage or face penalties as part of the individual mandate.
Jackie Crosby • 612-673-7335