Health insurance in Minnesota
- Minnesota has a state-run health insurance exchange: MNsure.
- Open enrollment in MN ended on January 13, 2019, but residents will be able to enroll in ACA-compliant coverage if they have a qualifying event.
- Enrollments until Dec. 15 will have a Jan. 1 effective date. Enrollment between Dec. 16 and Jan. 13 will have a Feb. 1 effective date.
- Five carriers offer 2019 coverage in the state’s individual market; four of them offer plans in the exchange.
- Average premiums for 2019 decreased by 12.37 percent.
- About 116,000 enrolled in 2018 coverage through the Minnesota exchange.
- Minnesota adopted the ACA’s Medicaid expansion in 2013.
- In Minnesota, short-term plan durations are limited to 185 days.
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 began on November 1, 2018, but and ended on January 13, 2019, giving Minnesota residents nearly a full additional month to sign up for 2019 coverage.
- Enrollments until Dec. 15 will have a Jan. 1 effective date.
- Enrollment between Dec. 16 and Jan. 13 will have a Feb. 1 effective date.
Five insurers – Blue Plus, Group Health, Medica, UCare and PreferredOne – are offering 2019 coverage in Minnesota. PreferredOne offers only off-exchange coverage.
All five insurers in Minnesota’s individual health insurance market have implemented 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. The decrease would have been more significant though, if the individual mandate penalty wasn’t being eliminated, and if the Trump Administration hadn’t issued new rules that expand access to short-term plans and association health plans. All of those factors serve to reduce the number of healthy people in the ACA-compliant risk pool, which ultimately results in higher premiums.
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. As of the fall of 2018, total enrollment in Minnesota’s individual market stood at about 155,000 people, including on- and off-exchange enrollees. That’s about 3 percent of the state’s population.
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
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.
Franken resigned in 2017, and Minnesota’s Lieutenant Governor, Tina Smith, was appointed to fill his spot in the Senate. Smith then won the special election for the seat in 2018. Klobuchar also won her re-election bid in 2018, so both of Minnesota’s Senators continue to be Democrats.
Minnesota’s eight representatives split their votes on the ACA in 2009/2010, 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, and he continues to represent the rural, fairly conservative 7th District, winning his 15th term in 2018.
Minnesota’s House delegation consists of three Republicans and five Democrats in 2018, and that will continue to be the case in 2019. Four districts (1st, 2nd, 3rd, and 8th) flipped in the 2018 election, but two flipped to the Democrats and two flipped to the Republicans.
Minnesota’s outgoing Governor, Mark Dayton, has long been a proponent of the Affordable Care Act. Dayton chose not to run for a third term in 2018, but Tim Walz, the DFL (Democratic-Farmer-Labor) candidate, won the election, so the governor’s seat will continue to be occupied by a Democrat.
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. But it increased slightly, to 4.4 percent in 2017. That slight uptick in the uninsured rate was common across the country after the Trump Administration took effect. It was due in part to new federal policies that undercut the ACA, but also to rising health insurance premiums that made coverage less affordable for people who don’t qualify for premium subsidies.
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.
In October 2018, there were 997,380 people enrolled in Medicare in Minnesota. That’s a little less than 18 percent of its total population, which is roughly in line with the percentage of the overall U.S. population enrolled in Medicare.
About 87 percent of Minnesotans qualify for Medicare based on age alone. Remaining Minnesota Medicare enrollees are eligible as the result of a disability.
According to 2016 data, Medicare paid about $8,452 per enrollee in Minnesota (for those with Original Medicare, although more than half of Minnesota Medicare beneficiaries have private coverage instead of Original Medicare). That puts per-enrollee Medicare costs in Minnesota about 11 percent lower than the national average, which was more than $9,500 in 2016.
Minnesotans can choose Medicare Advantage plans instead of Original Medicare if they wish to obtain additional benefits and don’t mind the restrictions (including network restrictions) that go along with having a private plan. 56 percent of all Minnesota Medicare recipients chose a Medicare Advantage plan in 2017. That’s the highest percentage in the nation; about 33 percent of Medicare recipients nationwide select a Medicare Advantage plan.
In total, 58 percent of Minnesota Medicare enrollees are in private plans, but that includes Medicare Cost plans. Minnesota has two-thirds of all the Medicare Cost plan enrollees in the nation.
Minnesota health insurance resources
State-based health reform legislation
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).
Scroll to the bottom of this page to see a summary of recent Minnesota health reform legislation.
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.