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Minnesota lawmakers are considering legislation to create state-funded subsidies and a public option via a MinnesotaCare buy-in program
Minnesota’s state-run exchange, MNsure, has five carriers offering plans for 2023. Across the state’s full individual/family market, full-price premiums increased by an average of about 1.4% for 2023, although there was variation from one plan to another.
By December 15, 2022, more than 119,500 people had enrolled in health coverage for 2023 through MNsure. At that point, there was still a month remaining in open enrollment, during which people could sign up for coverage effective February 1, 2023.
The American Rescue Plan’s subsidy enhancements have been extended through 2025, ensuring that coverage continues to be more affordable than it was prior to 2021. And legislation is under consideration in 2023 that would create additional state-funded premium subsidies and cost-sharing reductions as of 2024.
Minnesota is also one of just two states in the country with a Basic Health Program, known as MinnesotaCare. BHP coverage is available to Minnesota residents with income between 139% and 200% of the poverty level.
Legislation (SF49) under consideration in Minnesota in 2023 would create a public option in the state using a MinnesotaCare buy-in program. The bill includes the option for small businesses to buy into the program, and temporary state-funded subsidies to help people enroll in gold-level coverage prior to the availability of the public option.
A similar bill (HF11) was considered in 2022 and did not advance to a vote. But Minnesota’s Senate flipped to a DFL majority as of 2023, creating a DFL trifecta in the state. So the 2023 legislation may have more of a chance than the prior year’s bill.
As discussed below, Minnesota is also considering additional pieces of legislation in 2023 that would add various state-funded subsidies for private plans purchased through MNsure.
MinnesotaCare premiums have been reduced through 2025 as a result of the American Rescue Plan and Inflation Reduction Act; most eligible enrollees pay $0, but some pay up to $28/month (normally, the premiums range as high as $80/month).
Minnesota has a reinsurance program that has been keeping premiums lower than they would otherwise have been. The reinsurance program was extended for another five years in 2022, continuing it through 2027. The reinsurance program once again covers 80% of applicable claim costs as of 2023, after dropping to 60% in 2022. The return to 80% coinsurance helps to keep premiums stable.
Minnesota has a state-run health insurance marketplace/exchange, MNsure.
Residents can enroll in Medicaid, private qualified health plans, and MinnesotaCare (the state’s Basic Health Program) using MNsure. The existence of MinnesotaCare is the reason that a smaller-than-average percentage of MNsure’s private plan enrollees qualify for premium subsidies and cost-sharing reductions; many of the people who would qualify for those benefits in other states are instead eligible for MinnesotaCare if they live in Minnesota.
On May 9, 2017, lawmakers in Minnesota passed SF800, an omnibus health and human services bill. Among many other things, the legislation called for switching from MNsure to the federally-run marketplace (HealthCare.gov) starting in 2019 (see Section 5). But Governor Dayton vetoed it.
The open enrollment period for individual/family coverage runs from November 1 to January 15. To have coverage effective January 1, the application must be submitted by December 15; coverage is effective February 1 if the application is submitted between December 16 and January 15.
Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
Learn more about enrollment opportunities in our comprehensive guides:
There are five insurers that offer exchange plans in Minnesota for 2023.
Most counties in Minnesota have at least three insurers offering exchange plans for 2023. Every county has at least two insurers and at least 24 available plans.
The following insurers offer plans in the Minnesota exchange, with plan availability varying from one location to another:
PreferredOne also offers individual/family coverage in Minnesota, but only outside the exchange (ie, their plans are not available through MNsure).
2014: Five insurers offered individual policies through MNsure for 2014: Blue Cross Blue Shield of Minnesota, HealthPartners/Group Health, 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.
2015: But 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 issue rather than a problem with MNsure.
However, Blue Plus (an affiliate of Blue Cross Blue Shield of MN, offering HMO plans) joined the exchange for 2015, so there were still five insurers offering plans for 2015: Blue Cross Blue Shield of Minnesota, Blue Plus, Health Partners/Group Health, Medica, and UCare. MNsure offered 84 plans statewide, up from 78 for 2014.
2016: BCBSMN, Blue Plus, Health Partners/Group Health, Medica, and UCare offered individual market plans through MNsure for 2016.
2017: All of the MNsure carriers except Blue Plus limited their total enrollment for 2017. By November 11, 2016, less than two weeks into open enrollment for 2017 coverage, Medica had hit their 50,000 member enrollment cap for 2017 (including on and off-exchange enrollments, and also accounting for expected renewals of 2016 Medica plans), and their policies were no longer available in the individual market in Minnesota, on or off-exchange. The only exception was five counties (Benton, Crow Wing, Mille Lacs, Morrison, and Stearns) where Medica agreed not to limit enrollment, as all of the other available carriers in those counties have imposed enrollment caps too. In those five counties, Medica plans continued to be available.
At that point, Medica’s market share in MNsure for 2017 stood at 34.2%. By December 14, Medica’s market share had dropped to 27.7%, as enrollments had continued to climb for the remaining carriers.
On January 31, Medica re-opened enrollment for 2017. This was because a smaller-than-expected number of 2016 Medica enrollees renewed their plans for 2017, meaning that the carrier still had some wiggle room under their 50,000 member cap; at that point, they had room for about 7,000 more enrollees. Medica plans were thus available throughout the duration of the special enrollment period that was added on at the end of open enrollment, and continued to be available for people with qualifying events.
2018: Plans continued to be available from Blue Plus, Health Partners/Group Health (GHI), Medica, UCare. In the months before a decision was reached regarding an extension of the open enrollment window for 2018 plans (the first year that the federal government imposed a shorter, month-and-a-half enrollment window), two of MNsure’s participating insurers had differing positions: UCare believed the exchange should add an additional two-week special enrollment period, while Medica did not want the exchange to have the option to extend the newly-scheduled six-week enrollment window. Notably, Medica capped their enrollment very early during the 2017 open enrollment period, and while UCare also had an enrollment cap, it was set with a target of nearly doubling their 2016 enrollment. But Medica is the only MNsure insurer that didn’t set an enrollment cap for 2018.
As was the case for 2017, enrollment caps were used in the individual market in Minnesota for 2018 by all insurers other than Medica (Medica did have an enrollment cap for 2017, which they hit very early in open enrollment; however, they resumed enrollments at the end of January 2017). Details about the insurers’ enrollment caps are in the plan binders in SERFF. But MNsure confirmed in May 2018 that none of their insurers had hit their enrollment caps for 2018.
2019 and 2020: Blue Plus, Health Partners/Group Health, UCare, and Medica have continued to offer plans through MNsure, and all of them continued to participate in 2020 as well. Blue Plus expanded to once again offer statewide coverage in 2020, for the first time since 2016.
2021: Quartz joined the exchange for 2021, joining the four existing insurers. HealthPartners and UCare both expanded their coverage areas for 2021. All five insurers continued to offer plans for 2022.
Several states have created state-funding subsidies that are available in addition to the ACA’s federal subsidies, making coverage and medical care more affordable than it would otherwise be.
As described below, Minnesota had a temporary state-funded premium rebate program in 2017. But legislation (SF196) is under consideration in 2023 that would allow the state to provide state-funded premium subsidies and cost-sharing reductions starting in 2024.
The premium subsidies would be available to applicants with household income between 200% and 800% of the poverty level, and the cost-sharing reductions would be available to households with income between 200% and 500% of the poverty level, as long as they select a silver plan through MNsure (federal cost-sharing reductions are also only available on silver-level plans, and only extend to 250% of the poverty level).
An additional bill (HF2286) is also under consideration that would provide a much more modest state subsidy: It would add to the existing federal cost-sharing reductions for people with income between 200% and 250% of the poverty level. The result would be silver plans with actuarial values of 87% for these enrollees, rather than the federally-required 73%.
(HF2286 would also make additional changes, including continuous Medicaid coverage for children under age 6.)
Additional legislation (SF49) under consideration in 2023 would create a public option in Minnesota by allowing people with income above 200% of the poverty level, as well as small businesses, to buy into the MinnesotaCare program. The bill also includes temporary state-funded subsidies to help people enroll in gold-level coverage prior to the availability of the public option.
A similar bill for MinnesotaCare buy-in (HF11) was considered in 2022 but did not advance to a vote. However, Minnesota has a DFL trifecta in 2023, whereas the Senate was under Republican control in 2022. So the 2023 bill may have more of a chance than the 2022 version.
Minnesota’s rate increases for 2022 were among the largest in the nation; the national average rate increase that year was about 3.5%, versus 9.5% in Minnesota. A big part of the reason for the larger-than-average rate increases was the change in the state’s reinsurance program for 2022.
The reinsurance program took effect in 2017 and resulted in three consecutive years of average rate decreases. It had initially been scheduled to end at the end of 2021, which would have resulted in substantial rate increases for 2022 (Group Health, for example, had initially proposed an average rate increase of nearly 31%, based largely on the impending termination of the reinsurance program).
But HF33, which was enacted in late June 2021, extended the reinsurance program for one additional year, through the end of 2022. However, it also reduced the coinsurance percentage from 80% to 60%. That meant that once a claim reached $50,000, the reinsurance program would start to cover 60% of it, as opposed to the 80% that was covered in previous years (the cap remained at $250,000).
This resulted in less reinsurance funding for insurers, and thus higher premiums in 2022. But the premium increases are much smaller than they would have been if the reinsurance program had been allowed to expire.
For 2023, however, the reinsurance program once again covers 80% of the cost of claims between $50,000 and $250,000, thanks to S.F.3472, which was enacted in Minnesota in 2022. And the federal government has approved an extension of the program through 2027.
Nationwide, nearly half of exchange enrollees benefit from cost-sharing subsidies. But in Minnesota, only about 8% of exchange enrollees were receiving cost-sharing subsidies as of early 2022. This is because of MinnesotaCare, which covers all enrollees with income up to 200% of the poverty level. That’s the same group that would otherwise benefit the most from cost-sharing subsidies, so the fact that MinnesotaCare is available means that most of the people who would otherwise be enrolled in cost-sharing subsidy plans are instead enrolled in MinnesotaCare.
At first glance, this would appear to have made the uncertainty surrounding cost-sharing subsidy funding in 2017 a little less of a pressing issue in Minnesota than it was in many other states, since private insurers weren’t facing the sort of losses that insurers in other states were facing without federal funding for CSR.
But when the Trump administration eliminated federal funding for CSR in October 2017, HHS took the position that since CSR funding had been eliminated, the CSR portion of the federal funding for the BHPs in New York and Minnesota would be reduced to $0. This was not a cut-and-dried conclusion, however, as explained earlier in 2017 by Michael Kalina.
In January 2018, the Attorneys General for New York and Minnesota filed a lawsuit against the US Department of Health and Human Services, seeking to restore funding for their Basic Health Programs. A judge ruled in favor of the states in May 2018, ensuring that MinnesotaCare would continue to receive at least some CSR-based funding. The amount awarded to the state for the first quarter of 2018 was just over half of what the state had initially expected in CSR-related funding, but a larger chuck of the funding was restored later in 2018. According to the Star Tribune, however, Minnesota still ended up losing $161 million in federal funding for MinnesotaCare due to the CSR funding cuts.
In early 2019, the Trump administration proposed yet another funding cut (a third, after cuts imposed by the reinsurance program and the elimination of CSR funding) as part of a new methodology for calculating BHP funding. This one was much smaller than the other two cuts, but taken together the funding reductions were pushing MinnesotaCare towards a looming budget shortfall.
But in 2021, the Biden administration gave MinnesotaCare $100 million in additional funding, provided by the American Rescue Plan.
Throughout 2016, then-Governor Dayton called for a state-funded premium rebate for people who buy their own insurance but aren’t eligible for the ACA’s premium subsidies (prior to the American Rescue Plan, premium subsidies weren’t available to anyone with a household income of more than four times the poverty level).
Governor Dayton also noted that the government needed to act quickly to stabilize the individual market in Minnesota, and by late November 2016, his patience with lawmakers was wearing thin. In a November 23 press conference, Dayton said that House Republicans needed to “stop dilly-dallying” and decide whether to move forward with Dayton’s rebate proposal.
Dayton had also indicated that he was considering calling a special session of the legislature after election day to address the situation, and that was being negotiated for December 20. But the talks fell through when Dayton and Republican House Speaker Kurt Daudt couldn’t agree on the three bills that would have been addressed in the special session; as a result, there was no special session.
Instead, the issue was taken up by lawmakers as soon as the 2017 legislative session began. On January 5, Minnesota Senators Michelle Benson (R, 31st District) and Gary Dahms (R, 16th District) introduced S.F.1. The bill called for using $300 million in state funding to provide a 25 percent rebate to roughly 125,000 people in Minnesota.
S.F.1 passed the Minnesota Senate by a 35-31 vote on January 12. Only one DFL Senator (Melisa Franzen, from Edina) voted with Republicans in favor of the legislation. It was then sent to the House, where an amendment was added that stripped out the requirement that health plans provide various mandated benefits (see “Journal of the Day” section “Top of page 154” in this version of the bill; under the terms of the amendment, as long as a carrier offered at least one plan with all the mandated benefits, they would have been allowed to offer others without mandated benefits).
The amended bill was sent back to the Senate on January 23; differences between the bills that the two chambers passed had to be reconciled before being sent to Governor Dayton for his signature. By that point, the amendment to allow less-robust plans to be sold had garnered national attention, and public outrage helped to push lawmakers away from the provision. S.F.1 had also called for $150 million to be appropriated for fiscal year 2018 (through June 30, 2019) from the state general fund to a state-based reinsurance program to stabilize the individual market (Alaska did something similar in 2016, preventing a market collapse), but that provision was also removed in the final version (Minnesota did ultimately set up a reinsurance program, effective in 2018, which has served to stabilize the market and reduce premiums).
A Conference Committee in the Senate recommended that the House “recede from its amendments” and the Conference Committee report passed the Senate on a 47-19 vote. The House passed the bill a few hours later, 108-19. It was sent to Governor Dayton, who immediately signed it into law. DFLers did have to compromise on one issue during the process: S.F.1 allowed for-profit HMOs to begin operating in Minnesota’s individual market, which had long been limited to non-profit HMOs.
Consumers were told to expect the premium rebates to show up by April 2017, but they were retroactively effective to January 2017. So a person who had been paying full price for a plan since January 2017 saw a substantial premium reduction on the April or May invoice. Going forward, for the remainder of the year, a 25% rebate was applied each month.
Since S.F.1 was signed into law with only a few days remaining in open enrollment (it ended January 31 that year), Governor Dayton and exchange officials were worried that there wouldn’t be enough time for people to learn about the rebate and apply for coverage before January 31. In December, Dayton had asked HHS to allow MNsure to extend its enrollment deadline to February 28 (instead of January 31) in order to allow lawmakers more time to work out the details of a state-based premium rebate while still allowing people to enroll after the legislative process is complete.
HHS denied the request for a blanket extension, but MNsure used its own authority on January 28 to grant a one-week special enrollment period (February 1 to February 8) due to exceptional circumstances. Although the state-based 25% premium rebate was available on or off the exchange, the one-week extension was only valid through MNsure; health insurers did not have to accept off-exchange enrollments without a qualifying event after January 31.
The 25% premium rebate program in Minnesota was only authorized for one year, so the rebates did not continue into 2018. And although almost 100,000 people received premium relief through the program in 2017, it ended up costing less than the legislature had allocated, and about $100 million was returned to the state’s budget at the end of 2017.
State Exchange Profile: Minnesota
The Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Short-term health plans in Minnesota are nonrenewable and cannot have terms longer than 185 days.
Minnesota expanded Medicaid eligibility under the ACA and enrollment has grown by 50% since 2013.
Minnesota standardizes its own Medigap plans, so plan options aren't the same as in other states.
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The asset limit for a single person for Aged/Blind/Disabled Medicaid is $3,000 in Minnesota, as opposed to $2,000 in most other states.
Learn about adult and pediatric dental insurance options in Minnesota, including stand-alone dental and coverage through MNSure.
Our state guides offer up-to-date information about ACA-compliant individual and family plans and marketplace enrollment; Medicaid expansion status and Medicaid eligibility; short-term health insurance regulations and short-term plan availability; and Medicare plan options.