A quick guide on the state's insurance market set up under the new U.S. health care act.
Q: What will change in 2014?
A: The most sweeping elements of the federal health law, sometimes called Obamacare, come into play. 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. The Minnesota Council on Health Plans offers an interactive quiz to help understand how insurance choices will change in 2014. And, the Kaiser video below explains how it will work:
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. MNsure launches Oct. 1 for coverage that begins Jan. 1. For more information, go to:www.mnsure.org
Q: Who will use the MNsure exchange?
A: A key goal is to help the nearly 500,000 uninsured Minnesota residents get coverage. MNsure will also be an option for individuals who don’t get health coverage at work, for those currently on the state’s high-risk health plan and for small businesses that employ from two to 50 full-time workers. About two-thirds of citizens expected to use MNsure will qualify for public health plans, such as Medical Assistance and MinnesotaCare.
Q: Who will NOT use it?
A: Seniors covered by Medicare and those who get insurance through their employers.
Q: Can I still use my broker?
A: Yes. Insurance agents can help you buy coverage on MNsure or on the open market. Some agents will be certified by the state as official “navigators” who can help eligible families and individuals use the exchange to access tax credits to lower their premiums.
Q: How much will I pay?
A: It depends. Health insurance companies may still charge higher premiums based on age, tobacco use, and for people in geographic areas where medical costs are higher. Government-subsidized health plans have been expanded to cover more Minnesotans, and many moderate-income households will qualify for federal tax credits to reduce the monthly cost.
Q: Who qualifies tax credits and other assistance?
A: The level of assistance depends on your income and other life situations, such whether you are single, have children or are pregnant. Minnesota is receiving additional federal money to cover more people under Medical Assistance, the state’s version of Medicaid. 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 from $39,060 up to $78,120. The higher your income, the lower your discount.
• MinnesotaCare: A government-subsidized program where enrollees pay a small portion of the premiums. It covers individuals with income between $15,282 up to $22,980 and a family of three earning between $25,975 to $39,060.
• Medical Assistance: Individuals with income below $15,282 or a family of three under $25,975.
Q: What are the medals of coverage?
A: They are guides to different levels of coverage and different levels of out-of-pocket costs. A bronze plan covers 60 percent of the medical costs; silver covers 70 percent; gold covers about 80 percent, and platinum costs 90 percent of benefits. The category plan you choose will affect how much you will spend on insurance. Consumers will need to balance costs with their health care needs. If you go to the doctor a lot, you might be better off with gold or platinum.
Q: What about out-of-pocket costs?
A: The total out-of-pocket costs (including deductibles and copays) are generally capped at $6,350 for individuals and $12,700 for families, although 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 might 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.
Q: What are the penalties?
A: In 2014, penalties are $95, or 1 percent of household income, whichever is greater. They rise to $395 or 2 percent of income in 2015 and $695, or 2.5 percent, in 2016. The personal mandate has many exemptions, including financial hardship. Here are more details about how the individual mandate will work.
Jackie Crosby • 612-673-7335