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Minnesota Health Insurance

Minnesota Medical Insurance Overview

The state of Minnesota is generally a healthy state with regard to its residents and there are many people who have insurance coverage which contribute to the health of the state overall.  While Minnesota has many programs, public and private, available to its citizens, there exists a portion that has no insurance coverage.  Still, it is believed that the residents of Minnesota will enjoy the benefits as a result of the healthcare legislation of recent years.

The Affordable Care Act was passed, laying out a lot of changes to the landscape of healthcare and insurance that will resound through the year 2020.  This legislation has made it easier and more affordable for people to obtain insurance coverage and will offer benefits to an estimated 30 million more benefits by 2020.

Minnesota’s Health Care Issues
Minnesota ranks in fourth place with regard to the health of its residents when compared to the country’s residents overall.  The United Health Foundation explains that the state of Minnesota is in good shape and has more strengths than weaknesses when it comes to its residents.  Despite its strengths overall, there is still a small amount of room for improvement.

Strengths include its low rate of cardiovascular deaths, low uninsured population and few poor physical health days.  Weaknesses include its low per capita health funding, high amounts of excessive drinking and low immunization among adolescent males for HPV.

Understanding Minnesota’s Uninsured Population
In the state of Minnesota, there are seven percent of people who do not have health insurance benefits.  This is a relatively low figure, but 70,000 children in the state lack coverage, which is quite alarming.  Since 2011, the percentage of those without insurance has dropped significantly to seven percent.

Provided below are some statistics with regard to the uninsured population of Minnesota:
Poor adults make up the largest portion of uninsured residents in Minnesota.
53 percent of companies operating in Minnesota don’t offer health benefits packages.
The percentage of children who lack insurance coverage in the state is quite high.

Group Health Plans
Group health insurance benefits are available to workers in companies that offer them to their employees.  Fifty-seven percent of people living in Minnesota have this type of coverage.  Obtaining this type of insurance is typically more advantageous and cost-effective because the insurance company is able to spread out the amount of risk over a larger group of people.  In addition, the employer contributes to the amount of the premiums, making this a great option if you are employed in Michigan.

Health Maintenance Organizations are regulated by the Minnesota Department of Health, while Preferred Provider Organizations are regulated by the Minnesota Department of Commerce.

Signing Up
If you wish to sign up for coverage under your employer’s group plan, you will have to wait until an enrollment period.  To learn more information about when the enrollment period is at your workplace, seek out the Human Resources department.  It isn’t easy finding coverage under a group plan that will be beneficial and cost-effective for your situation, so it is best to do the greatest amount of research possible to make an educated decision.  You should consider the following factors before you enroll for coverage:

  • Is the premium affordable?
  • How many options do you have for coverage?  You should have at least two options under your employer’s group plan with varying levels of coverage.
  • Do you have a spouse or dependents that you want to cover?  If so, ensure that you are able to do so under your employer’s plan.

Pre-Existing Condition Exclusion Periods
If you suffer from a pre-existing condition, your group health insurance cannot be denied to you, but you can be subject to waiting out an exclusion period before your benefits are available for use.  In the state of Minnesota, you may be subject to a pre-existing condition exclusion period of up to a year before you can access your benefits package.  Insurance providers can also look into your medical history for a period of up to six months to determine whether or not you have a pre-existing medical condition.

Affiliation or Waiting Periods
Waiting periods apply to anyone enrolling into a group health benefits package and can last two months long.  For people enrolling late, this period can be three months time before your benefits are available for use.

Individual Health Plans
In the state of Minnesota, seven percent of the population has coverage through an individual insurance policy.  This plan type is usually for people who are self-employed, unemployed or employed by a company that doesn’t offer a benefits plan.

Individual policies are a great deal more expensive than obtaining coverage through group plans because all of the risk is placed on one person.  It is estimated that a healthy young person in Minnesota can get insurance coverage under an individual plan for $70, but he or she will not get comprehensive coverage or a low deductible.

For those who have pre-existing conditions, you can be denied insurance coverage in the state of Minnesota.  This plan type is subject to extensive underwriting on the part of the insurer, making this a less affordable option for Minnesota residents.  Despite the ability to deny you coverage based on the presence of a pre-existing medical condition, you can get coverage through some individual insurance providers.  Under these companies, you may have to wait out an exclusion period of 18 months with the same amount of time dedicated to the look back period.

Continuation Coverage
Continuation coverage is available through the Consolidated Omnibus Budget Reconciliation Act (COBRA) if you have lost your insurance coverage for any reason.  Under COBRA, your benefits can last up to 18 months and you can qualify based on the size of the company that originally issued the benefits package.

There are also conversion plans available that take the provisions covered under the group plan and convert them to an individual policy.  In this manner, you are able to continue your coverage through the same insurance provider.

Minnesota Health Benefit Exchange
In March 2013, the state of Minnesota established its health benefits marketplace called MNsure.  The website was created to provide insurance options to residents in Minnesota so they can obtain information on each plan and buy coverage.  The exchange was part of the mandates created on the state level under the Affordable Care Act which made health insurance marketplaces a necessity for residents of every state.
Minnesota State Insurance Programs
In the state of Minnesota, the percentage of the population that is covered through the use of a state-funded health insurance program is 29 percent.  The programs available to the residents of Minnesota have eligibility requirements that are based on age, gender, health status and level of income.

The state-sponsored programs that are offered to people living in Minnesota are: the MCHA, PCIP, Medical Assistance, the Sage Program, WIC, MinnesotaCare, the Health Minnesota Contribution Program, Medicare, the VA Medical Benefits Package, the Partnership for Prescription Assistance, and the National Association of Mental Illness Helpline.

Below is a brief description of each program:

Minnesota Comprehensive Health Association (MCHA)
This is Minnesota’s high risk pool and while there is no waiting period, it does have a pre-existing condition limitation for six months.  In addition, you will have to pay higher premiums than the PCIP.

Pre-Existing Condition Insurance Plan (PCIP)
For those who have been rejected insurance coverage because of a pre-existing condition can seek coverage through PCIP.  It takes longer to receive approval for this program as opposed to the MCHA and you have to have gone without insurance for a period of six months.  Once approved, you may see premiums between $96 and $414 for a wide range of services.

Medical Assistance
This program is the largest health benefits program in the state of Minnesota and offers benefits to children, families, adults without children, blind people, disabled people and pregnant women.

Sage Program
Sage is a program that is dedicated to screening women for breast and cervical cancer.  Breast and cervical exams are free to eligible women and you can also get diagnostic services in the event that you have been diagnosed with a problem.

Women, Infants, and Children (WIC)
WIC is a state-sponsored program that works to provide nutritional guidance and foods to pregnant women, infants and children up to the age of five-years-old.  Also provided to pregnant women and new mothers is breastfeeding counseling services and infant care and safety resources.

This program covers prescriptions, hospitalizations and doctor’s visits for those who qualify.  In order to qualify, your family must meet certain income guidelines and not be enrolled in any part of the Medicare program or incarcerated.  This program is generally for residents of Minnesota with low incomes.

Healthy Minnesota Contribution Program
This program aids adults who don’t have children and whose incomes fall in a lower bracket in the state of Minnesota.  The program provides contributions to the costs of private health insurance to those who qualify.

Medicare, the Medicare Prescription Drug Program and
Medicare is provided to disabled individuals and seniors over the age of 65.  There are four parts to the Medicare program, each having their own level of benefits.  Guaranteed coverage is offered to those who qualify based on age and whether or not they have worked in a Medicare-covered job for at least ten years. is a counseling service for people who are looking over their Medicare options.

VA Medical Benefits Package
Those who served active duty in any branch of the United States military consecutively for 24 months without being dishonorably discharged can obtain comprehensive medical benefits through this program.

Partnership for Prescription Assistance
This program helps those who lack prescription drug coverage the ability to find assistance through one of the 475 programs it deals with to help pay for medications.

National Association of Mental Illness (NAMI) Helpline
The NAMI Helpline is a nationwide organization that works to provide resources and guidance to the mentally ill through a volunteer-run helpline.

The Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act, more commonly known as “HIPAA,” is a law that was created to provide protections for consumers regarding private insurance companies.  Under HIPAA, insurers offering group coverage cannot decline to cover people suffering from pre-existing conditions.

HIPAA also provides continuation coverage for people who have lost their insurance benefits because of a change in dependent status, job loss or divorce.  HIPAA has made great strides towards offering limitations on private insurance providers, but it has yet to make it mandatory for companies to provide their workers with health benefits.