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Minnesota health insurance

Five insurers offer 2019 coverage in the state's individual health market. Open enrollment has been extended through January 13.

Health insurance in Minnesota

Minnesota’s health marketplace

Minnesota’s marketplace enrollment is through a state-run exchange: MNsure. In 2017, state lawmakers voted to convert MNSure to a federally run marketplace, but the legislation was vetoed by Gov. Mark Dayton.

For 2019 coverage, a few state-run exchanges – including Minnesota – announced extended enrollment periods. MNsure’s enrollment will begin on November 1, 2018, but it will continue until January 13, 2019, giving Minnesota residents nearly a full additional month to sign up for 2019 coverage.

Five insurers – Blue Plus, Group Health, Medica, UCare and PreferredOne – are offering 2019 coverage in Minnesota. PreferredOne offers only off-exchange coverage.

As of mid-year, the five insurers in Minnesota’s individual health insurance market had proposed rate decreases for 2019 coverage. Charles Gaba at ACAsignups.net reports that ultimately, the average rate change in the state’s individual market was a decrease of 12.37 percent.

When open enrollment for 2018 coverage ended, 116,358 Minnesotans had enrolled — the highest open enrollment total in MNsure’s history, despite a shorter enrollment period.

Read more about Minnesota’s health marketplace.

Medicaid expansion in Minnesota

In February 2013, Governor Mark Dayton signed HF9, a bill that expanded access to Minnesota’s Medicaid program under the ACA. News reports in 2013 reported that Medicaid expansion would provide health coverage for 35,000 newly eligible Minnesota residents. In 2017, Families USA projected that 222,900 people had been enrolled in Medicaid in Minnesota thanks to expansion.

Read more about Minnesota’s Medicaid expansion.

Short-term health insurance in Minnesota

Short-term plans in Minnesota are limited by statute.

The plans cannot last more than 185 days unless the insured is in the hospital on the day that the plan would have terminated and the insurer extends the coverage until the end of the hospital stay.

Short-term plans are nonrenewable in Minnesota, but a person can buy additional plans as long as their total  time with short-term coverage doesn’t exceed 365 days out of any 555-day period – plus any days that a plan is extended to cover an insured who is in the hospital on the day the plan would have ended.

Read more about short-term health insurance in Minnesota.

The Affordable Care Act in the North Star State

In the 2010 passage of the Affordable Care Act, Minnesota’s two Democratic senators – Amy Klobuchar and Al Franken – both voted in support of health reform. Franken is credited for the inclusion of a medical loss ratio (MLR) requirement in the reform bill.

One of the early, popular provisions of the ACA, MLR requires insurance companies to issue refunds if they spend more than 20 percent of premiums on administrative items (15 percent for large-group plans). The MLR rule resulted in $1.1 billion in refunds in 2012, and by early 2016, total cumulative refunds had reached $2.4 billion.

Minnesota’s eight representatives split their votes, with Democrat Collin Peterson joining three Republicans in voting no. Peterson did not support 2017 House Republicans in their efforts to pass the American Health Care Act, but his votes on health care reform have been a mixed bag over the years. Republican Rep. Michelle Bachman (6th District) railed against the ACA and made its repeal a key theme of her failed 2012 presidential campaign. She was replaced in 2015 by fellow Republican Tom Emmer, who supported the American Health Care Act (an ACA repeal effort) in early 2017.

Minnesota Gov. Mark Dayton was a proponent of the Affordable Care Act. After state Democrats gained control of both the state House and Senate in the 2012 election, legislation was passed to implement a state-run health insurance exchange. Minnesota also expanded Medicaid, which it calls Medical Assistance, to residents with household incomes up to 138 percent of the federal poverty level. Medicaid expansion was a key ACA strategy to reduce the uninsured rate.

Minnesota also established a Basic Health Program (BHP) under the AHCA, and is one of only two states to do so (New York is the other). Basic Health Programs provide robust, low-premium coverage to people with income between the Medicaid eligibility threshold and 200 percent of the poverty level. In Minnesota, the Basic Health Program is known as MinnesotaCare, a program that predates the ACA but was revamped to serve as a BHP as of January 2015. New York added their BHP in 2016.

Has Obamacare helped Minnesotans?

Minnesota has enjoyed a low uninsured rate for years due to generous Medicaid eligibility standards and MinnesotaCare, a health insurance program for uninsured, working residents. Under the Affordable Care Act, Minnesota not only expanded Medicaid, it also created a state-based health insurance exchange called MNsure.

According to a study commissioned by MNsure, the state marketplace, and conducted by the University of Minnesota’s State Health Access Data Assistance Center, Minnesota’s uninsured rate was 8.2 percent just before ACA open enrollment began in the fall of 2013.

According to U.S. Census data, Minnesota’s uninsured rate fell from 8.2 percent in 2013 to 4.1 percent in 2016.

Obamacare has helped Minnesotans pay for medical care, and Minnesota hospitals have seen their charity care costs decline by about 17 percent since ACA implementation. The Minnesota Department of Health in October reported uncompensated care fell from $305 million to $268 million in 2015.

Does Minnesota have a high-risk pool?

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Minnesota. As a result, people with pre-existing conditions were often unable to purchase coverage in the private market, or if coverage was available it came with a higher premium or with pre-existing condition exclusion riders.

The Minnesota Comprehensive Health Association (MCHA) was created in 1976 to give people an alternative if they were ineligible to purchase individual health insurance because of their medical history. (Only Connecticut has a risk pool as old as Minnesota.)

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high-risk pools and MCHA stopped enrolling new members as of December 31, 2013. It remained operational for existing members until the end of 2014.

MN Medicare

In 2015, there were 912,285 Minnesota Medicare enrollees, about 17 percent of its total population and the same percentage of the overall U.S. population enrolled in Medicare.

About 86 percent of Minnesotans qualify for Medicare based on age alone. Remaining Minnesota Medicare enrollees are eligible as the result of a disability.

According to 2014 data, Medicare paid about $7,721 annually per enrollee in Minnesota. In 2009, Minnesota ranked 25th in total Medicare spending with $6.9 million.

Minnesotans can choose Medicare Advantage plans instead of Original Medicare if they wish to obtain additional benefits. 55 percent of all Minnesota Medicare recipients chose a Medicare Advantage plan in 2016. That’s the highest percentage in the nation; about 31 percent of Medicare recipients nationwide select a Medicare Advantage plan

Medicare enrollees can also opt for Medicare prescription drug coverage known as Medicare Part D. In Minnesota, 43 percent of Medicare enrollees purchased a Part D plan in 2015.

Minnesota health insurance resources

State-based health reform legislation

Here’s a summary of recent (2017) Minnesota bills related to healthcare reform:

  • S.F.1 created a state-based premium assistance program to make coverage in the individual market more affordable for Minnesota residents (enacted in January 2017).
  • H.F.419 would increase the income limit for MinnesotaCare to 275 percent of the poverty level.
  • H.F.795 would require health insurance plans to cover a 12-month supply of prescription contraceptives rather than requiring quarterly refills.
  • H.F.1129 would make Minnesota a single rating area and would allow enrollees access to out-of-network referral centers.

Other state-based health reform legislation: