minnesota guide to health insurance

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Minnesota health insurance exchange / marketplace

MN penalty payers can still sign up

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Minnesotans who were penalized for not having health insurance in 2014 have another chance to get covered. The special enrollment period runs between March 1 and April 30. Signing up for 2015 coverage won’t change the 2014 penalty, but it will reduce the penalty you may have to pay when 2015 taxes are due.

Individuals who experience a qualifying life event may sign up for health insurance before the next open enrollment period. Anyone else who needs to purchase private coverage will have to wait until November 2015.

Enrollment for Medical Assistance (Medicaid) and MinnesotaCare, a health insurance program for uninsured, working residents, is open year round.

2015 enrollment count

Between Nov. 15, 2014, and Feb. 15, 2015, 60,092 individuals enrolled in qualified health plans (QHPs), 26,891 individuals enrolled in MinnesotaCare, and 72,017 individuals enrolled in Medical Assistance through MNsure.

2015 rates and participating insurers

PreferredOne, which offered the lowest rates in the nation in 2014 and captured a large portion of 2014 enrollees, withdrew from MNsure for 2015. PreferredOne said remaining on the exchange was “not administratively and financially sustainable.” A Star Tribune business writer attributed PreferredOne’s departure as a market dynamics rather than a problem with MNsure.

Consumers who bought a PreferredOne plan through MNsure for 2014 could renew their policies for 2015 by working directly with the insurer. However, PreferredOne rates went up an average of 63 percent, and consumers didn’t qualify for subsidies if they shopped outside the exchange.

Five insurers are offering individual and family policies on MNsure for 2015: Blue Cross Blue Shield of Minnesota, Blue Plus, Health Partners, Medica, and UCare. MNsure will offer 84 plans statewide, up from 78 for 2014. Blue Plus is new to the exchange for 2015.

Minnesota officials announced 2015 premiums increased 4.5 percent on average for the four insurers that returned to MNsure from 2014. MNsure critics characterized the official announcement as misleading as it failed to take into account low-cost 2014 plans from PreferredOne.

2014 enrollment summary

MNsure was quite successful at enrolling residents in 2014 — despite considerable technical problems. A study commissioned by MNsure and conducted by the University of Minnesota showed that the state’s uninsured rate dropped from 8.9 percent in the fall of 2013 to just 4.9 percent over the course of the 2014 open enrollment period — the lowest rate in state history. The study’s author called the drop “unprecedented in Minnesota,” and the state now has one of the lowest uninsured rates in the nation.

According to a MNsure press release, 300,085 people obtained health insurance through the exchange as of Aug. 21: 53,770 people enrolled in private health plans, 65,749 enrolled in MinnesotaCare, and 180,566 enrolled in Medical Assistance (Medicaid).

Fixing MNsure

In April 2014, MNsure hired Deloitte Consulting to audit MNsure’s technology and improve the website to make enrolling in coverage and updating life events easier and more streamlined. Deloitte has been involved in successful state-run marketplaces for Connecticut, Kentucky, Rhode Island and Washington.

Software upgrades were installed in August 2014, and system testing continued right up until the start of open enrollment.

To reduce wait times for consumers and insurance professionals, MNsure increased its call center and support staff and launched a dedicated service line for agents and brokers.

More in-person assisters were available in Minnesota for the 2015 open enrollment period. MNsure encourages residents to utilize the exchange’s assister directory to find local navigators and brokers who can help with the enrollment process.

While these changes improved the experience for individuals shopping for private insurance, the exchange continues to be problematic for county workers who help low-income residents. County officials told the MNsure board that the system remains “woefully inadequate” for verifying eligibility and enrolling people in Medical Assistance, MinnesotaCare, and other social services.

Some of the system issues encountered by social services staff may resolved over time with newly awarded grant money. The federal government awarded MNsure $21 million for IT fixes, and that grant triggered an additional $58.5 million from Medicaid. The money will be used to address a list of 18 priority issues. MNsure’s chief operating officer said the workload of social services staff was heavily weighted in creating the priority list.

MNsure background

Four insurers offered individual policies through the marketplace for 2014: Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, PreferredOne, and UCare. Kaiser Health News reported that Minnesota offered some of the lowest premiums for silver (mid-level) plans in the U.S. Four of Minnesota’s nine regions made Kaiser’s list of the 10 least expensive places to buy health insurance.

While low premiums are good for consumers, they raise financial concerns for the marketplace. As of 2015, MNsure’s operating costs are funded with a 3.5 percent withhold of premiums. Low premiums translate to less money collected through the withhold.

Low enrollment in private health plans compounds the financial problem. While Minnesota far exceeded its 2014 goal of 135,000 signups for overall enrollment, the mix is much different than expected. Enrollment in Medical Assistance was much higher than expected, while enrollment in private health insurance was much lower.

At a December 2014 board meeting, MNsure released lower enrollment targets and a revised budget. MNsure reduced projected enrollment in private health plans from 100,000 to 67,000 for calendar year 2015. The drop reduces projected revenue from private health plan enrollment by $4.7 million for fiscal year 2015.

Changes coming for MNsure?

Given MNsure’s difficult launch, the state conducted a series of audits and reviews.

The first audit reviewed how MNsure spent state and federal money. Auditors concluded that the exchange has generally adequate internal controls and found no fraud or abuse. The review was conducted by the state Office of the Legislative Auditor, and the report was published in October 2014.

Another audit, also conducted by the Office of the Legislative Auditor and released in November 2014, found that the MNsure system in some cases incorrectly determined who qualified for public health benefits. The errors occurred during the first open enrollment period, before a series of system fixes were implemented. The audit did not quantify the total financial impact of the errors. The state Human Services commissioner said a consultant working on technical fixes to MNsure concluded that the eligibility functionality was working correctly as of June 2014.

A third audit, a performance evaluation report released in February, said “MNsure’s failures outweighed its achievements.” Among other criticisms, auditors said MNsure staff withheld information from the board of directors and state officials, the enrollment website was seriously flawed and launched without adequate testing, and the first-year enrollment target was unrealistically low. Auditors recommended that the governor be given authority to appoint MNsure’s chief executive officer and that the state legislature consider an advisory-only role for the MNsure board.

Minnesota legislators are reconsidering MNsure’s governance structure. One bill would double the size the MNsure board of directors (from 7 to 14) and require that at least one seat be held by a representative of the insurance industry. Another bill would dissolve the board and restructure MNsure as a state agency, which would give the governor and legislature more control.

Legislators have also introduced a bill that would allow consumers to receive subsidies even if they shopped off-exchange. The bill would require a federal waiver, and it’s unclear what value federal officials would see from approving such a request.

Minnesota health insurance exchange links

855-3MNSURE (855-366-7873)

State Exchange Profile: Minnesota
The Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.