Health Insurance in Minnesota

If you have ever wondered about the details of Minnesota health insurance, then you’ve come to the right place. In this article, you’ll find out more about cost sharing, plan tiers, Noncovered services, and how to appeal denials. You’ll also discover what you can expect from your plan.

Cost sharing

Recently, Minnesota’s health insurance program faced concerns over cost sharing, as the funding mechanism for the Basic Health Plan (BHP) remained uncertain. The state relied on a 2% provider tax, which was repealed in 2014 without an alternative financing plan.

To address the impact of COVID-19, the Minnesota Council of Health Plans (MCHP) introduced voluntary cost-sharing waivers, covering COVID-19 patients facing high treatment expenses. Despite rising health insurance costs, Minnesota health plans are working to increase access to care and maintain affordable premiums.

The average cost of health insurance in Minnesota is projected to rise by 6% by 2022, with gold plans experiencing the largest increase. Low-income individuals may find more affordable options on the exchange or consider Medicaid, tailored for low-income households but not available to everyone.

MNsure marketplace offers plans for self-employed individuals without employer coverage. Premiums and deductibles are relatively low, with the insurance provider covering a lower percentage of medical expenses. However, those with substantial medical costs may find higher monthly premiums more cost-effective.

Plan tiers

• Minnesota’s Health Insurance exchange offers three tiers of health insurance plans: Bronze, Silver, and Gold.
• The cost of health insurance plans varies depending on the tier you choose, your location, and your income.
• Gold plans offer the most coverage and have the highest premiums.
• Gold plans have lower out-of-pocket maximums, which can result in significant savings.
• Silver plans offer a good balance of coverage and premiums.
• Silver plans may offer cost-sharing reductions, which can lower your monthly premiums.
• The lowest Silver plan in Hennepin county costs $265 per month.
• Bronze plans offer the least coverage and have the lowest premiums.
• The cost of health insurance can vary greatly, so it’s important to consider your needs and budget when choosing a plan.
• You can compare quotes from different insurance providers to find the best plan for your needs.

Noncovered services

In Minnesota, some health care services are considered “noncovered services” and are not included in insurance plans. These services require approval from a doctor, and in some cases, a spenddown payment may be required before receiving them. Certain health services, like vaccinations and screening tests, are covered at 100 percent but may not always be readily available. Medicaid covers most medical services, but limitations may apply, so it’s important to check with the provider. Visiting a specialist outside the insurance network may require out-of-pocket payment, and it’s crucial to confirm if the facility is in-network to ensure coverage.

Appealing plan denials

• If your health insurance company denies coverage for a medical service, you have the right to appeal the denial.
• You must file an appeal within six months of the decision made by your health insurance company.
• You can appeal the denial through the Minnesota Department of Commerce or the Minnesota Department of Health.
• You may also need to appeal an appeal to an independent third party.
• An independent third party can make a decision in your favor if the internal appeal doesn’t resolve your concerns.
• The rate of denials in Minnesota is much lower than in many other states.
• Minnesota health insurance providers like HealthPartners work closely with subscribers to help them avoid unexpected denials.
• You can bring a family member or friend or an attorney to the hearing.
• You should be prepared to provide documentation and point to contract language that supports your position.

MNsure’s plan comparison tool

MNsure, Minnesota’s health insurance exchange, offers an online plan comparison tool for residents seeking affordable health insurance. The tool allows users to compare costs, financial assistance, and out-of-pocket expenses for different plans based on income, household size, and location. Users can also search for dental and medical plans and find information on consumer protections and covered prescription drugs.

For those losing employer-sponsored coverage, MNsure provides a special enrollment period within 60 days of coverage loss. Individuals with continuation plans can switch to more affordable individual plans through MNsure, especially with government subsidies. However, careful considerations should be made before making this decision.