MNsure Guide updated

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Last updated: 18th June 2018. The Minnesota Obamacare system is called MNsure. The MNsure open enrollment period opens on Nov 1, 2017  through Jan 31st, 2018. (you may still quality if you meet certain criterion even outside of open enrollment) Keep in mind that not having coverage may mean you face a tax penalty. If you missed the open enrollment period you are still able to avoid the tax penalty by getingt outside coverage. Click Here to get a free health insurance quote.

Getting Coverage –  You can begin receiving coverage as early as January 1. You can create an account and apply for a plan by visiting the MNsure website. Your identity will be verified, and you can find out if you qualify for financial assistance.

If you qualify for MinnesotaCare or Medical Assistance (MA), your plan options will be mailed to you. Otherwise, you will need to follow the prompts in order to select a plan. Then you will enroll and sign your application. Once you do this, though, you won’t be able to make changes after the fact, so make sure to review all your information carefully before you make a commitment.

Payment– Any financial assistance that you are eligible for will be deducted from your payment. You will not be asked for payment upon enrollment. Instead, you will make the payment for the first month’s premium to the insurance company once you receive an invoice. Keep in mind that your coverage will not be effective until this step is completed. MNsure does not accept or process payments.
If you have any questions, or if there are any changes in your situation that could affect your premiums, you need to notify your insurance provider. To learn more about getting coverage click here.

The Metal Plans

Medical plans are categorized as bronze, silver, gold and platinum. Some of these plans also include dental benefits. Plans are also available that provide just dental coverage.

The difference in the metal levels of the various plans relates to how much you pay for your care, and how much is paid under the plan. The bronze plan covers 60% of expected costs, the silver 70%, the gold 80%, and the platinum 90%. When you’re shopping for a plan, you begin by determining the metal level that you believe will best suit your needs. That means that you need to consider how often you think you’ll need to visit the doctor, the type of prescriptions you expect to need, and how often you’ll need to have those prescriptions refilled. You’ll also want to consider how much you can absorb in terms of out-of-pocket costs, and what you might qualify for in terms of financial assistance.

Make sure to compare plans before making a decision. When you weigh the costs of the premiums against the potential out-of-pocket expenses, and consider the level of financial assistance you’re eligible for, you could actually end up, for example, paying less if you choose a silver plan than if you chose gold or platinum.

Catastrophic plans are also available, but you have to be under 30 years of age, or meet other requirements, in order to qualify. This type of plan also has a high deductible, and the benefit level is even lower than that of a bronze plan.

Helpful Terms –Here are some terms that can help you when you’re considering the best MNsure plan for you and your family:

Cost-Sharing Reduction – These are reductions that are included in certain Silver plans, and they’re only available if you’re determined to be eligible. If you are an American Indian or an Alaskan native, however, you can take advantage of cost-sharing reductions at all plan levels.

Co-Insurance – This is your share of the costs of services that are covered.

Deductible – This is the amount that you have to pay for health services before your insurance plan begins to pay.

Out-of-Pocket – Includes your deductible or co-pay, but not your premium, and not services that aren’t covered under your plan.

Premium – Quarterly or monthly payments to cover the cost of your plan.

MNsure Deadline & Penalties

If you need health insurance coverage in the State of Minnesota, MNsure can help. Of course, as is the case with virtually any kind of insurance coverage, particularly when financial assistance is available, you will need to be aware of the deadlines that you have to meet, and the penalties that could be incurred if those deadlines are not observed. With that in mind, let’s talk about the requirements for enrollment with MNsure, coverage dates, penalties that could apply, and when exemptions can be considered.

MNsure Open Enrollment – MNsure’s open enrollment for 2016 runs from the first of November 2015 to the end of January 2016. There are also special enrollment periods which are effective when you have a major life change like a death, marriage, abandonment by spouse or birth of a child, to name just a few. Additionally, if you are an American Indian in a recognized tribe, or a Native Alaskan, you can enroll during any month of the year.

Coverage – The date on which your coverage begins will depend on the date of your enrollment. If you select your plan between November 1 and December 15, your coverage begins on January 1. If you select your plan between December 16 and January 15, your coverage begins on February 1. Coverage begins on March 1 for plans selected between January 16 and January 31. If you wait beyond January 31, you will be out of luck until the next period of open enrollment, unless, of course, you qualify for special enrollment.  Click Here to get a free health insurance quote.

Medical Assistance and MinnesotaCare

You can find information about Medical Assistance (MA) and MinnesotaCare deadlines by visiting the website of the Department of Human Services.

What Happens if I Don’t Get Coverage? – It is currently the law for most Americans to have health insurance coverage, unless they are exempted. If you don’t qualify for an exemption, and you fail to get health insurance coverage, you can be subjected to a tax penalty, which can increase each and every year that you fail to obtain coverage. The penalty is due when you file your federal income tax.

For the year 2015, the penalty is 2% of your taxable income that goes over your tax filing threshold, or $325 for each adult and $162.50 for each child (to a maximum of $975 per household), whichever is greater.

For 2016, the penalty is 2.5% of your taxable income that goes over your tax filing threshold, or $695 for each adult and $347.50 per child (to a maximum of $2,085 per household), whichever is greater.

After 2016, the penalty will increase annually, based on an adjustment for cost of living.

Exemptions – There are exemptions in certain situations. Needless to say, though, the penalties for violating the laws regarding health insurance can be onerous. And given the financial assistance and tax credits available that enable Minnesotans to purchase health insurance, often at little or even no cost, it doesn’t make sense to violate those laws and risk incurring penalties.

MNsure Financial Assistance

With MNsure, you can compare different insurance plans to find the one that meets your needs. You can also find information concerning your benefits and rights under the Affordable Care Act, and you may even qualify for financial assistance with obtaining insurance coverage for yourself and your family. In fact, most Minnesotans are eligible for some form of financial aid, in the form of cost-sharing reductions or tax credits. Under Minnesota Care of Medical Assistance (MA), you may even qualify for coverage at no cost, or at a significantly reduced cost.

Financial assistance depends on your income, and the size of your household. You need to complete an application in order to determine your eligibility. MNsure provides a useful household income table that will show you what is required in terms of income and household size in order to qualify for assistance. The information is updated at the first of August because MNsure updates their information in the month of July. The table shows the income guidelines from the previous year.

Tax Credits – You are only eligible for the APTC (advanced premium tax credit) when your health insurance is purchased through MNsure. It is based on family size plus combined household income, and can be applied to individual plans with the exception of catastrophic insurance plans.

If you do qualify for the APTC, you can receive it in advance, once your coverage takes effect. This effectively reduces the monthly cost of your health care plan. Alternatively, you can choose to apply for it at the same time that you file your federal tax return.

The credit amount is partly based on the premiums for a standard health insurance plan in your particular area. Keep in mind that the premiums in many counties are already low enough that the APTC will not be applicable.

Cost Sharing Reduction – You could also save money by means of a cost sharing reduction, or CSR. This is an incentive that is provided by the federal government, and it reduces your out-of-pocket costs at the time that you seek medical treatment. This type of reduction is included in certain silver level MNsure plans, and is available only to applicants who are deemed to be eligible for this particular type of subsidy.

Keep in mind that a CSR does not reduce your premiums – only the actual costs that you incur when you seek medical treatment. It works to lower your deductibles, co-pays and co-insurance by capping the amount that you will pay in any given year. For answers to specific questions about CSR plans, you should get in touch with the health insurance provider that offers the plan.

A CSR is limited to households that meet specific income guidelines. Generally speaking, a single person earning no more than $29,425 annually will qualify. If there are four people in the household, the combined earned income cannot exceed $60,625 in any given year.

Having said that, if you are an American Indian or an Alaska native, and a member of a tribe that is federally recognized, the income guidelines are different. CSRs are available at all levels – bronze, silver, gold and platinum.

IRS Tax Form 1095-A

MNsure Tax Forms
MNsure Tax Forms

IRS Form 1095-A, more commonly known as the “Health Insurance Marketplace Statement” is a statement containing valuable information that you will need when you complete your federal tax return. You will need it to reconcile any APTC (advanced premium tax credit payments) that have been made for you, or alternatively to claim the tax credit, assuming that you are eligible. You receive this information from any private health plans in which you may have been enrolled, and the provider will also send a copy to the IRS.

What Information is Contained in the IRS Form 1095A? – Form 1095-A includes information pertaining to you and household members that were enrolled in a MNsure health plan for all or part of the year. It includes the amount of the premium for your health plan, as well as premium amounts for any standalone plans you may have purchased. As an example, you may have a standalone dental plan for your family, and you may also have a child under 19 who used the pediatric component of the benefits. If that is the case, then the premium for the pediatric benefits will be added into the total premium, and if you also bought a standalone pediatric dental plan, then the amount of that premium will also be included.

If you received an APTC (advanced premium tax credit), the form will include the premium amount for the SLCP (second-lowest cost silver plan) that is available to your household for the year. If you did not receive the APTC, but you are eligible, then you will need to determine your premium amount, and the amount of advance payments that may have been made on your behalf to the health insurance provider during the year in order to be able to complete IRS Form 8962. If you did not receive an APTC, this column will be left unfilled.

Why Does Form 1095-A Matter? – If you, or anyone in your household, received an APTC, you need to include Form 8962 with your tax return. You use the information from Form 1095-A to complete Form 8962. Information on how to do this is included on the back of Form 1095-A.

What If the Information on Form 1095-A is Incorrect? – If it appears that the information on Form 1095-A is inaccurate, it is important that you get in touch with MNsure at your earliest convenience. You can reach MNsure toll-free at 1-855-366-7873. You will have to identify exactly what is inaccurate, and explain to the best of your ability why it is incorrect. Then, MNsure will investigate, and get back to you.

What If I Didn’t Get a Form 1095? – If you were enrolled during the past year, and did not get a 1095-A, again, you should contact MNsure right away. You will not receive a 1095-A if you were:

  • Enrolled only in a standalone dental plan or a catastrophic plan.
  • Received an exemption.
  • Were enrolled in a private plan outside of MNsure.
  • Covered by Medicare, Medical Assistance, MinnesotaCare or were covered under a plan provided by your employer.

Help With Issues Related to Form 1095-A – Keep in mind that MNsure will not be able to provide you with advice concerning your income tax return, and they will also be unable to advise you as to how to complete IRS Form 8962. However, you can get the information you need by contacting the IRS for assistance.

MNsure Medical Assistance

If you need help paying for insurance coverage in the State of Minnesota, you may find that MinnesotaCare, Medical Assistance (MA) or even private plans can offer you tax credits that will ease the financial burden. Of course, you may not be sure which programs you can qualify for, and may not even be aware that often you can be covered by more than one program. Accordingly, you need to know your rights and responsibilities under all programs that are available to you.

MNsure coordinates with your health insurance carrier to determine your qualification for various plans and tax credits. Your household’s eligibility for Minnesota Care and MA are managed by Minnesota county agencies, along with the Minnesota Department of Human Services. You have certain rights under these programs, and you also have certain responsibilities.

Reporting Changes – If you have MA, you need to report any changes in your status within ten days of the occurrence of the change. Under MinnesotaCare, changes have to be reported within 30 days. Keep in mind that if you do not report changes, and those changes affect the benefits for which you are eligible, you may need to pay back any benefits that you receive that were not covered. Changes that you have to report include:

  • Any change in income
  • Change in employment (starting a new job, changing jobs, or losing your job)
  • Change of residence
  • Additions to your household (marriage, new baby, etc.)
  • Deletions from your household (death, spousal abandonment, etc.)
  • Change in residency (no longer living in Minnesota)
  • Changes in income tax filing status
  • Changes to citizenship or lawful presence
  • Incarceration
  • Becoming disabled
  • Enrolling in school
  • Leaving school

If your benefits are altered due to a change in status, and you disagree, there are measures that you can take to protect your rights.

Request a Hearing – If you believe that your benefits have been improperly denied, or that your application was improperly processed, you can request a hearing. This entitles you to a fair and full review of your case. You can hire an attorney, represent yourself, or have someone else who is not an attorney represent you. Your case will be evaluated by the federal and/or state office.

The state or federal office may look at your case. They will review the information you gave us and check to make sure we processed your case correctly. They will let you know if they need to ask you questions.

Other Responsibilities – MA may also require you and members of your household to have a health insurance policy. If you fail to provide information regarding your policy, it is possible that you will be denied coverage.

If you are eligible for either Medical Assistance or MinnesotaCare, you will be required to agree, in writing, that your personal information can be shared by health providers, insurance agencies and health plans, employers and landlords, county advocates, utility companies, financial organizations, school districts, your state or county case workers, and any contractors and/or subcontractors that provide services to state or county agencies.

You can withdraw your consent at any time, simply by notifying Minnesota Care or MA. However, as long as you are enrolled, your consent is implied.

When you accept MinnesotaCare or MA, you are assigning the rights to any and all medical payments for you, and for anyone else for whom you apply, to the state. This includes payments from companies and from other persons. You also agree to assist the state in being paid back for any medical expenses that should have been paid for by other persons or companies, unless you can provide a good reason for not doing so.

MNsure Issues

MNsure is your source for health insurance coverage in the State of Minnesota. You can investigate different types of plans, explore the different insurance options that are best suited to you and your family members, and you can even get help qualifying for financial assistance that can help you to get insurance at a reduced cost, or sometimes even at no cost. The MNsure website offers a wealth of information, including details about MinnesotaCare and MA (Medical Assistance), available tax credits, and your rights under the Affordable Care Act.

You’ll find concise, clear descriptions of various private insurance plans, and even a comparison tool that will help you to select the best option. Regardless of your age, income, level of need or ethnicity, you’ll find useful information. Of course, not everyone finds it easy to navigate even the most user-friendly websites, so with that in mind, we’ll provide you with a reference guide that will help you to get all the information you need quickly and easily.

A Great Place to Start – Begin with the MNsure Customer Service Guide. It’s chock-full of all kinds of valuable information, and if what you need isn’t in the guide, you’ll still find out where you have to go to get what you need. This great resource tells you exactly where to get information on the most common topics, so you’ll know just who to contact with your questions or concerns.

If, after looking over the Customer Service Guide, feel that you’d like assistance that’s a little more personalized, you can get one-on-one help with your enrollment by speaking with an assister. Assisters are navigators, agents and brokers in your very own community, and they can provide you with real, face-to-face help. Navigators are members of community organizations who provide free assistance with applications and MNsure enrollment. Agents and brokers are licensed, trained professionals who can also work with you face-to-face to help you select just the right plan.

Help With MinnesotaCare and Medical Assistance

If you need help with Medical Assistance, there is a list of county offices available.

For MinnesotaCare, you can use a number of phone numbers to be put in touch with people who can provide the information you need.

Medicare assistance is available from the Senior Link-Age Line, at 1-800-333-2433.

For information about any Minnesota health care program, contact the Department of Human Services.

Personal MNsure Assistance

The MNsure Contact Center is available Monday to Friday from 8:00 am to 8:00 pm, on Saturday from 8:00 am to 4:30 pm, and on Sunday from 10:00 am to 3:00 pm. They are closed most holidays, but are open on Veterans Day from 8:00 am to 8:00 pm.

All the Information You Need – MNsure is dedicated to helping Minnesotans find affordable health insurance coverage With that in mind, they’ve created a very user-friendly website, and have also endeavored to provide a quality Customer Service Guide. We’ve included just a few of the helpful links that MNsure provides in this article, but you could spend a great deal of time on their site exploring other links that will give you all the in-depth information you need to obtain affordable health insurance for yourself and your family in the State of Minnesota, and also how to deal with any issues that could occur when dealing with MA or MinnesotaCare.

MNsure for Native Americans

As an American Indian, the Affordable Care Act guarantees you special benefits and protections when it comes to health care. However, even if you are receiving services from your IHS (Indian Health Service), there may be things like specialty care or a hospital stay that aren’t fully covered.

MNsure is a place where you can shop for health insurance coverage that meets your needs, compare different plans, and even qualify for financial assistance through Medical Assistance, MinnesotaCare, and tax credits. MNsure can help you to find the information you need about your special rights and benefits under the Affordable Care Act, and assist you with finding just the right insurance coverage for you and your family.

MNSure provides:

  • Clear descriptions of all the private insurance plans that are available to you, along with a side-by-side comparison tool so that you can choose the best option
  • More choices of clinics and doctors
  • Coverage including hospital stays, doctor visits, mental health services, maternity care, emergency room care, dental care, prescriptions, and more
  • Assistance with covering the cost of premiums
  • You can continue to get care from your IHS

Enrollment – To enroll with MNsure, you need to provide either your tribal enrollment card, or a membership document from either your tribe, or the BIA (Bureau of Indian Affairs), on a letterhead. A CDIB (Certificate of Degree of Indian Blood) is also acceptable.

Members of American Indian tribes that are federally recognized can enroll or change plans once a month, outside of the once-yearly open enrollment period. This is so that members of the household who are not also members of the tribe can apply along with the qualifying applicant in order to benefit from a qualified health or dental plan, or to make changes to their plan. They can only do this, though, when the qualifying member is either enrolling or changing their plan.

To determine whether you qualify, you will need to complete an application, and then get in touch with MNsure toll free at 1-855-366-7873 to find out whether you have qualified.

Assistance – Even if you are working, you can still get financial assistance to purchase an insurance plan, depending on your total household income. You can view the income levels required for assistance by visiting https://www.mnsure.org.

Costs can also be reduced through cost sharing plans, as follows:

  • Reduced Cost Sharing – If you are a descendant of a member of a federally-recognized tribe that is below 250% FPL (federal poverty level) that is enrolled in a silver-level health plan through MNsure, you will have reduced deductibles, co-insurance and co-pays when services are delivered from a non-Indian provider.
  • Limited Cost Sharing – If you are an American Indian who is a member of a federally-recognized tribe that is 300+% to -400% FPL, and enrolled in a qualified MNsure health plan, you may have to pay cost-sharing for services obtained outside an I/T/U facility, but Tribal CHS (Contract Health Services) funds may pay for cost-sharing provided CHS rule are followed.
  • Zero Cost Sharing – If you are an American Indian who is a member of a federally recognized tribe that is 200+% to -300% FBP, and enrolled in a qualified MNsure health plan, and enrolled in a qualified MNsure health plan, you will not be co-pays, deductibles and co-insurance, but you will have to pay premiums. This is the case no matter where you receive care.

Finally, of course, if you are an enrolled American Indian, or a descendant who is IHS-eligible, you will not need to pay for services that you obtain from an IHS.

MNsure for Small Business

If you are operating a small business in the State of Minnesota, you usually won’t have to worry about open enrollment periods. You can enroll with MNsure any time, unless you are not able to satisfy the requirements of minimum 75% participation and minimum 50% employer contribution. If that’s the case, you can still enroll, but you’ll have to do it during the special enrollment period which extends from November 15 through to December 15. During that period, the participation and contribution requirements are waived.

New Employer? – If you are a new employer, you will have to follow certain steps in order to begin the process of obtaining coverage. For full details, visit MNsure SHOP’s New Employer Application page.

Renewal? – If you are renewing, MNsure SHOP will get in touch with you 90 days before your renewal date. They will send you an unsecure email including a census template that you need to complete and return within 5 business days. Make sure to complete all fields. Then they will send you a second, secure email that you will use in order to return the census.

Once MNsure Shop receives your completed census, they’ll send you a workbook that you need to complete and return within 14 business days. They will process your workbook, and then send you a Health Coverage Summary which you need to review, and notify them within 2 business days if there are any discrepancies. If they do not hear from you, they will assume that everything is correct, and you will not be able to make any changes to your selections.

If you are renewing automatically, you don’t have to do anything further. Auto-renewal is the preferred course of action if all your plans are the same, or equivalent to a plan in the 2016 Plan Crosswalk (included with your renewal workbook). Keep in mind, though, that an equivalent plan could differ somewhat from your current plan, so make sure that you look over all the details before you complete the workbook. Any new employee that wasn’t previously enrolled will need to complete an employee application.

If you are not renewing automatically, you will receive a letter of instruction that you will need to forward to all your employees. They will use the instructions to compare the various medical and/or dental plans on offer, and they will need to complete a plan selection form.

Once you have collected all the relevant employee documents, make sure that you return them to MNsure SHOP no later than the final day of open enrollment for employees. Upon receipt, MNsure SHOP will process the document, and send you an email letting you know whether you have met the 75% or greater participation rate. Then, around the 5th of the month, you will receive an invoice. Payment will be due no later than the 25th day of the month. Instructions for electronic payment will be included.

Finally, health plan carriers will send ID cards to your employees’ home addresses once the enrollment has been processed. Usually it takes anywhere from 10 to 14 days for the cards to arrive.

Changes in Enrollment – Keep in mind that you are responsible for notifying MNsure SHOP of any changes to enrollment that occur within 30 days of an event (for example, a new hire, termination, cancellation or a significant change – like a birth, marriage or divorce – in an employee’s life). We strongly advise that you do not wait until the waiting period expires before you submit the necessary documentation

To speak to a live agent you can call the phone number below, or  Click Here to get a free health insurance quote.

Speak with a Live representative, call (855) 601-7915

  • Get a Free Health Quote – No Hidden Fees
  • Speak to a Real Human
  • We will answer any other Health questions
  • Learn How to Avoid the Tax Penalty

(Operators available 9am-9pm EST)