Minnesota can be a great state to live in, and even to raise a family – but if you can’t find affordable and comprehensive health care coverage to protect you and your loved ones from illness, things can start to look a little less rosy. Believe it or not, you have more options than you think. We’re going to go over some of those options below, and help explain the ins and outs of them so that you can make a good decision about your health care coverage. By the time you finish reading this article, you might even be able to make a decision that saves you a ton of money each year.
Major Medical Insurance in Minnesota
A decade ago, then-President Obama passed what is known as the Patient Protection and Affordable Care Act of 2010. That law set up a series of rules, regulations, and structures which were designed to help millions of Americans find affordable health care coverage and get insured. But the law that passed back then is not the same law that is governing how people find health care coverage today. Knowing the ways in which that law has changed in recent years can help you take a big step forward towards finding affordable coverage.
The biggest change is that the individual mandate – the law that required every tax-paying American to either purchase qualifying health care coverage or pay a tax penalty – was no longer in effect as of the beginning of 2019. This means that, technically, you don’t have to purchase health insurance if you don’t want to. But it’s still a good idea, especially if the insurance isn’t just for you, but for your spouse and/or children. It’s easier to do so than you might think. All you have to do is go to HealthCare.gov, fill out an application, and based on things like your household income, the number of dependents you have, and your current tobacco use status, you can find out whether or not you qualify for coverage and whether or not you qualify for subsidy.
When you compare qualifying major medical coverage through the ACA to the non-compliant coverage options which are available now, there’s almost no contest – major medical coverage is almost always better. The first reason for this is because these policies are guaranteed issue coverage. Even if you are a sick, high-risk individual, you cannot be rejected by an insurance company if you apply for a guaranteed coverage policy. Furthermore, you can’t be charged more for your monthly premiums if you have a pre-existing condition. As a matter of fact, the only legitimate reasons which an insurance company is allowed to charge you more money for your premiums are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Major medical plans for the ACA all come with the same Guaranteed Essential Health and Wellness Benefits as mandated by the ACA legislation. Medical experts agree that putting all of these benefits on an insurance policy can help patients receive cost effective preventative care which lowers the need for and cost of disease management care down the road. Those 10 benefits are listed below:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
With all of those benefits, you might think that these plans are only for people who are wealthy enough to afford them. But that’s where government tax credits come in. The Affordable Care Act sets aside some tax revenue to help make the monthly premiums of these insurance policies more affordable for the average working individual and family. All you have to do is make at least 138% of the federal poverty limit in order to qualify. If you’re not sure whether or not you qualify, all you have to do is take a look at the chart below to find out:
|Household Size||Annual Income (138% of FPL)|
Most people will go to HealthCare.gov first when applying for ACA insurance – but for Minnesotans, it works a little differently. You will want to start by going to MNsure.org, where you can apply for coverage through your state exchange instead of the federal Exchange. Applying for the state Exchange not only gives you quicker and easier access to state-related discounts, but it makes it easier for you to apply for alternative health insurance programs like Medical Assistance or MinnesotaCare if you don’t qualify for an MNsure policy. For more information, you should visit the official MNsure website.
If you can’t qualify for MNsure coverage, there are two alternative, Medicaid-like programs you might qualify for. Medical Assistance is the version of Medicaid that operates within the state of Minnesota, does not require a monthly premium, and the co-pays for some services are between $1 and $3. MinnesotaCare, on the other hand, is similar but does require a monthly premium and a small co-pay. You should visit the section of the MNsure website that discusses the difference between Medical Assistance and MinnesotaCare so that you can more easily decide which program to apply for.
Short Term Health Insurance in Minnesota
Unfortunately, despite the state of Minnesota going above and beyond what most other states do in order to provide major medical coverage for their citizens, some people may not want or may not be able to afford major medical coverage. Under such circumstances, you may be considering short-term health insurance. Before you apply, you should know that in Minnesota, short-term health insurance cannot last longer than 185 days unless you are in the hospital when the plan expires; only then can coverage be extended. If you want to purchase additional short-term coverage, you cannot be insured for longer than 12 months during any 18 month period. Other than that, the basic rules of short-term health insurance apply for Minnesota residents.
Short-term health insurance can be cheaper than an unsubsidized ACA plan – sometimes as much as 33% less in monthly premiums. Unfortunately, most short-term health insurance companies are eager to keep costs down and therefore don’t offer all of the guaranteed Essential Health and Wellness Benefits that the ACA does. They also pass more of your medical costs down to you, either in the form of a $5,000 deductible, annual benefit caps, lifetime benefit caps, or more. But you can add supplemental coverage like fixed indemnity plans, dental, or vision in order to help with your out-of-pocket costs. And unlike some other non-ACA options, you have consumer protections with short-term health insurance. This means that if your provider unjustly denies your medical claim, you can take them to court in order to get them to pay what you are owed.
It should also be noted that one of the most glaring differences between short-term health insurance and major medical coverage is the lack of guaranteed issue status. You will have to undergo medical underwriting with short-term health insurance. And if you have any pre-existing conditions, you will likely get charged more for your monthly premiums – or you could be rejected outright for coverage. If that happens, you’ll have to look into alternative options.
Christian Health Plans/Health Share Plans in Minnesota
To be clear, there is no longer an individual mandate that requires you to purchase health care coverage. But back when the individual mandate was still alive and well, Christian health plans were very popular. They were similarly less expensive than an unsubsidized ACA plan, much like short-term health insurance. But the religious exemption afforded people an escape from the individual mandate so that they could get healthcare coverage – albeit less comprehensive coverage – and not have to pay a tax penalty. But the religious exemption isn’t the only reason why someone might want to consider one of these plans.
People who are shopping for health care coverage often take a look at health share plans because of all the similarities they share with short-term health insurance. Those similarities include:
- No guaranteed issue status
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
But you should familiarize yourself with the differences between these two types of coverage if you want to make the best decision for yourself and your family. For one, there’s no legitimate legal contract between you and a Christian health plan provider; this means that you have fewer legal resources that you are allowed to take advantage of if they decide not to pay out your benefits. Then there are some other, relatively minor differences, like the participation guidelines and the differences in jargon. The participation guidelines will most likely require you to declare a specific faith, usually Christian one, in order to participate in the program. You may also have to give up tobacco use or any other unhealthy habits, and pick up some biblically inspired healthier ones. When it comes to these types of plans, you don’t pay a monthly premium: you pay a “monthly share amount”. Likewise, you don’t pay a deductible, a co-pay, or co-insurance: you pay a “shared responsibility amount” or a “personal responsibility amount” in order to contribute to the pool of funds that the church uses to honor benefits and pay out claims.
Fixed Indemnity Plans in Minnesota
Were you thinking about a fixed indemnity plan in Minnesota? If you’re thinking about purchasing one to replace major medical coverage, that may not be the best idea. Between short-term health insurance, Christian health plans, and fixed Indemnity plans, these plans are the least comprehensive out of the other two ACA alternatives. They include far fewer of the Essential Health and Wellness Benefits, if any, and they pay a much smaller share of your total medical costs compared to ACA coverage, short-term health insurance, and health share plans. They also have lifetime and annual benefit caps, just like short-term health insurance. And you will also have to undergo medical underwriting and subject yourself to higher premiums or rejection based on your health status.
Here’s how fixed Indemnity plans work: you purchase a plan and pay your monthly premiums. Then, if you have a health issue, the indemnity plan pays out benefits based on a per day, per week, per month, per event, or per visit basis. You may be able to find Indemnity plans for hospital insurance, doctor visits, or even dental services if you know where to look. Because fixed indemnity plans pay out the smallest percentage of your total medical costs compared to other forms of insurance, they are best used as a supplement to something like major medical coverage or short-term health insurance instead of a replacement for it. But an indemnity plan could still help lower your medical costs somewhat if you don’t have any other form of coverage. And most indemnity plans won’t restrict you to a narrow medical network, either.
Discount Cards in Minnesota
The first and most important thing you need to know about medical discount cards or “health discount plans” (as they are sometimes called in Minnesota) is that these are not insurance policies. If the individual mandate were still in place, they would not qualify as meeting that mandate. At best, these membership programs offer you an opportunity to get discounts at the register when you purchase prescription drugs, medical supplies, or services from a participating provider. But you don’t file claims, and you won’t have a chance to get reimbursed later. They simply take the edge off of your out-of-pocket medical costs for a monthly or annual membership fee. And you must present your card in order to receive the discounts, because you won’t have the opportunity to do so at a later date.
That’s the best-case scenario. And, indeed, there are decent, honest companies out there that will offer you a discount card that helps you purchase cheaper prescription drugs or get discounts on certain medical services for a good rate. But there are some companies out there that may exaggerate the discount you are eligible for, or lie about the providers who are affiliated with them in order to trick you into purchasing a membership that won’t save you any money. For more information on how medical discount cards work and how to spot scams, you can read about unlicensed health plans on the Minnesota attorney general’s website.