Minnesotans are now a just a couple of weeks into the introduction of MNSure open enrollment. Most individual and family health insurance policy owners are just now receiving letters from their insures showing the coverage changes due to the Affordable Care Act accompanied by large premium increases. Below is a step by step approach to navigating the complicated world of health insurance, MNSure, and shopping for new individual/family health insurance plan.
- Step 1 - The first thing that someone should do is see if they are eligible for a advanced premium tax credit (subsidy). Use this easy calculator from the Kaiser Family Foundation. Subsidy Calculator The result of the calculator will put you into one of 4 categories based on your FPL – Federal Poverty Level.
- 0 - 133% FPL : Medical Assistance Eligible
- 134 - 200% FPL: Minnesota Care Eligible
- 201 - 400% FPL: Advanced Premium Tax Credit Eligible
- 400+% FPL: Not eligible for financial assistance.
NO - not eligible for a subsidy. Use this link to get quotes and compare plans: Get Quotes or Contact a Broker . If you are not going to receive a subsidy, you are not required to use MNSure. You can purchase the same plans at the same prices outside of MNSure as you can in. There are also an additional 20+ plans that are only available outside of MNSure. We recommend using a broker to select a plan. The new plans are more complicated than ever and the Prices are the same whether you use a broker or not. To learn more see “Why use a broker”
YES - eligible for a subsidy. Go to the mnsure.org website and create an account. If you would like to use the services of a Broker Assistor, you will need to enter a code near the end of the account creation process. Click here: You will be asked for an “Assister Number”. You will be notified if you are eligible for assistance, what type of assistance (MA, MinnesotaCare, or advanced premium tax credit).
- Step 2 - Compare plans and pricing. A broker can assist you in comparing and selecting a plan. A few things that you will want to consider are:
- The network of doctors that the plan uses. If you do not use an in-network provider you will pay substantially more for non-emergency services if you use an out of network provider.
- The deductible, co-insurance and out-of-pocket limit.
- Prescription drug coverage. Are prescriptions covered with a co-pay or subject to the deductible? You may want to check the plans formulary to be certain your medications are covered by the plan.
- Pediatric dental – does the plan you are considering include the required pediatric dental coverage or will you be required to purchase a separate plan that costs about $23 per child under the age of 19.
- HSA – Are you someone that can take advantage of the tax advantages of a health savings account. See our HSA Coverage Corner for more information.
- Your health – how frequently you go to the doctor.
- Emergency coverage – is there a co-pay for emergency room care or is it subject to the deductible?
- Price – is always a major part of any decision. You need to balance the monthly premium cost with the plan benefits. Take into account not only the deductible, but also consider the upfront benefits (copays for office visits and prescription drugs), the annual out of pocket limit, and any additional costs such as pediatric dental.
- Step 3 – Apply for your health insurance plan. You can either apply online through our website be using the “apply now” button next the plan of your choice (non-MNSure subsidy plans) or Contact a MN Health Insurance Network health plan advisor to assist you in submitting your enrollment.
We will be continually updating this information as more guidance becomes available.
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