Frequently asked questions about health insurance
coverage options in Minnesota
Minnesota’s marketplace enrollment uses a state-run exchange called MNsure.
MNsure is a place where people can purchase individual/family health insurance, and receive premium subsidies and cost-sharing subsidies if eligible. This is a valuable service for people who are not eligible for Medicare or employed by a company that provides group health insurance.
Minnesota residents can also enroll in MinnesotaCare (the state’s Basic Health Program) through MNsure. Medicaid enrollment can also be done through MNsure, although enrollment in some types of Medicaid (for the elderly, disabled, etc.) is done through the state’s Medicaid office.
In 2017, state lawmakers voted to convert MNSure to a federally run marketplace, but the legislation was vetoed by then-Governor Mark Dayton. This issue came up again in 2021, but the legislation did not advance.
Read more about the history of Minnesota’s health insurance marketplace.
The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Minnesota. Learn more in our comprehensive guide to open enrollment.
Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage. But Native Americans can enroll year-round, as can people who are eligible for Medicaid/CHIP or MinnesotaCare.
Five insurers offer exchange plans in Minnesota for 2023, as was the case in 2022.
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:
- Blue Plus
- Group Health
PreferredOne also offers individual/family coverage in Minnesota, but only outside the exchange (ie, their plans are not available through MNsure).
Average premiums in Minnesota’s individual/family market increased slightly for 2023, by a weighted average of about 1.4%. The following average rate changes were approved for 2023 (enrollment data from SERFF filings):
- Blue Plus: 2.3% decrease (34,600 members)
- Health Partners: 2.1% increase (50,799 members)
- Medica: 2.6% increase (25,029 members)
- UCare: 0.8% increase (51,521 members)
- Quartz: 22.2% increase (1,515 members)
But average rate increases apply to full-price plans. The majority of MNsure enrollees receive premium tax credits (subsidies) that offset some of the cost. And subsidies grow to keep pace with changes in the benchmark plan (second-lowest-cost Silver plan) in each area. The American Rescue Plan has made the subsidies larger and more widely available than they were in the past, and due to the Inflation Reduction Act, that continues to be the case in 2023.
A record high of more than 121,000 people enrolled in private plans through MNsure during the open enrollment period for 2022 health coverage (this was in addition to MinnesotaCare and Medicaid (Medical Assistance) enrollments.
Read more about Minnesota’s health marketplace.
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.
As of early 2022, there were more than 115,000 people with private individual market coverage through MNsure. All of them had coverage for the ACA’s essential health benefits with no lifetime or annual caps on the benefits. And more than 69,000 of them were receiving premium subsidies that make health insurance more affordable.
According to U.S. Census data, Minnesota’s uninsured rate fell from 8.2 percent in 2013 to 4.1% in 2016. But it increased slightly, to 4.4% as of 2018, and increased again, to 4.9%, as of 2019. (That uptick in the uninsured rate was common across the country under the Trump administration.)
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, which has resulted in marketplace insurers sending rebates — often substantial ones — to enrollees when the percentage of collected premiums spent on enrollees’ medical bills is below the allowable minimum.
One of the early, popular provisions of the ACA, MLR requires insurance companies to issue refunds if they spend more than 20% of premiums on administrative items (15% for large-group plans). The MLR rule resulted in $1.1 billion in refunds in 2012, and by the end of 2021, total cumulative refunds had reached nearly $10 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, a partial ACA repeal bill, but his votes on health care reform were a mixed bag over the years. After 15 terms in office, Peterson was replaced in 2021 by GOP Representative Michelle Fischbach, who is opposed to the ACA.
Minnesota’s U.S. House delegation consists of four Republicans and Democrats in 2022.
Minnesota’s former governor, Mark Dayton, had long been a proponent of Obamacare. 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 continues to be occupied by a Democrat.
After Democrats gained control of Minnesota’s 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% of the federal poverty level. Medicaid expansion was a key ACA strategy to reduce the uninsured rate. And as noted above, Minnesota also created a Basic Health Program under the Affordable Care Act, further protecting residents with income a little above the Medicaid eligibility cut-off.
In February 2013, former Governor Mark Dayton signed HF9, a bill that expanded access to Minnesota’s Medicaid program under the ACA. From late 2013 to August 2022, enrollment in Minnesota Medicaid plans (Medical Assistance) and CHIP plans increased by 53%. The enrollment growth was driven by Medicaid expansion, but also largely by the COVID pandemic and the resulting pause on Medicaid disenrollments nationwide.
Minnesota also established a Basic Health Program (BHP) under the ACA, and is one of only two states to do so (New York is the other; Kentucky plans to follow suit as of 2024). Basic Health Programs provide robust, low-premium coverage to people with income between the Medicaid eligibility threshold and 200% of the poverty level, as well as to legally present non-citizens with incomes below 138% FPL who are time-barred from enrolling in Medicaid. 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 also created a BHP as of 2016; to date, New York and Minnesota are the only states that have BHPs, although DC’s Medicaid eligibility extends to 210% of the poverty level, and Kentucky plans to have a BHP as of 2024.)
Premiums and out-of-pocket costs in MinnesotaCare are lower than in plans offered at low incomes in other ACA marketplaces. At various points Minnesota lawmakers have considered extending access to MinnesotaCare to higher income levels or even all income levels, but such plans have not been enacted.
Read more about Minnesota’s Medicaid expansion.
Short-term health insurance plans in Minnesota 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. Buying a new plan entails starting over with a new deductible.
Read more about short-term health insurance coverage in Minnesota.
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. Nationwide, about 46% of Medicare beneficiaries are enrolled in private plans, but in Minnesota, it’s about 55%. Most of these enrollees have Medicare Advantage plans, but some have Medicare Cost plans, a form of commercial Medicare coverage that pre-dates Medicare Advantage. Minnesota has long had the nation’s highest enrollment in Medicare Cost plans, but about 300,000 enrollees had to switch to different coverage (Original Medicare or Medicare Advantage) when their Cost plans were phased out in 2019.
Read more about Medicare in Minnesota, including details related to Medigap plans and Medicare Part D.
- MNsure – the state’s health insurance marketplace, and the only place Minnesota residents can obtain financial assistance with the cost of their individual health insurance premiums.
- Greater Minnesota Healthcare Coalition
- Minnesota Department of Human Services, Health Care Coverage – Medicare Assistance (Medicaid)
- Minnesota State Health Insurance Assistance Program – Information and resources for Minnesota Medicare beneficiaries
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.