Minnesota Health Insurance Programs

The State of Minnesota has a vibrant health insurance market with dozens of carriers competing to provide coverage in the individual and workplace-sponsored markets. You can purchase insurance in Minnesota on an individual basis for yourself and your family. You can also obtain it as part of a benefit plan from your employer. If you are poor, indigent, elderly or if you have a young child, you may also be able to qualify for the state Medicaid program.

Types of Plans

• Minnesota recognizes a variety of plan types. You can choose a health maintenance organization, or HMO, for example. These plans contract with selected local care providers, who in turn offer discounts to the HMO for services. HMOs require you to go through a primary care physician, who then refers you to specialists as needed. You give up some flexibility to choose providers, but HMOs can help keep premiums affordable. You can also choose a preferred provider organization or PPO, which is similar to an HMO but does not require you to go through a primary care doctor to see specialists. At the other end of the scale are indemnity plans, which provide broad coverage and which do not confine you to a network of approved providers. You have more flexibility with these plans, but premiums tend to be higher.

Minnesota Medicaid

• Medicaid is a federally subsidized but state-run welfare program that provides basic health care services for the poor, indigent, elderly and children of low-income families. Each state is free to select its own enrollment criteria, within federal guidelines. The Minnesota Medicaid program is called "Medical Assistance." Adults with no children can qualify if incomes are below $677 per month, for a single person, or $911 per month for married couples. However, the income guidelines are much more generous when children are involved.

MinnesotaCare

• MinnesotaCare is another state program providing subsidized health care services and medical insurance to the needy. There are several variants: MinnesotaCare Expanded covers pregnant women and children under age 21. There are no co-pays or coverage limits under this plan. MinnesotaCare Basic Plus One covers single adults with no children. MinnesotaCare Basic Plus Two covers parents. There are limits on income and assets in order to qualify. Co-pays apply. There are also plans for emergency medical assistance.

Individual Coverage

• You can purchase coverage as an individual, or for yourself and your family, by purchasing directly from a health insurance agent. Agents can be captive -- meaning they represent only one company -- or they may be a broker, representing a number of different companies. Ensure the agent you are working with has a valid insurance license from the State of Minnesota. Additionally, make sure the company the agent recommends is also authorized to do business in Minnesota. You can verify this information by contacting the Minnesota Department of Commerce (see Resource section).

Group Coverage

• You may also get coverage from your employer, if your employer offers it. Typically, to qualify, you must work a minimum number of regular hours. Your employer will set the precise criteria. Costs with group insurance are typically split between the employer and the insured. Employers generally pay half or more of the premium. There are no medical underwriting criteria for group health insurance plans. Under Minnesota law, the insurer must issue you a policy if you are a qualified employee. However, if you do not take the coverage when offered, you may have to wait until the next open enrollment period to qualify for coverage.

High-Risk Pool

• Minnesota does maintain a high-risk pool for residents who are unable to obtain coverage through traditional means. The program is administered by the Minnesota Comprehensive Health Association. If you have been turned down for traditional health insurance, you may be able to get a plan through them. Premiums will be higher, generally, for similar coverage. But the MCHA may be able to help you prevent a medical challenge from turning into a financial catastrophe as well. See Resource section for more information.