FAQ for Individuals and Families

Health Coverage Requirement

  • Does everyone have to purchase health insurance?

    Yes. All U.S. citizens, legal residents and lawfully present individuals are required to obtain health insurance coverage. Many will be covered by an employer plan, some will qualify for health programs and others will purchase it themselves.

  • What happens if I don’t buy coverage?

    You will owe a tax penalty. The penalty will increase over time:

    • In 2014, it will be the greater of $95 per adult or 1% of taxable income (up to a maximum of $285 per family).
    • In 2015, it will be the greater of $325 per adult or 2% of taxable income (up to a maximum of $975 per family).
    • In 2016, it will be the greater of $695 per adult or 2.5% of taxable income (up to a maximum of $2,085).
    • After 2016, the tax penalty increases annually based on a cost-of-living adjustment.
    • A person will only pay one-twelfth of the total annual penalty for each month without coverage.
    • The penalty for a child is half that of an adult.
    • A maximum penalty would be calculated based on premiums for plans offered through MNsure.

    It's important to remember that even if you pay the penalty you still won't have any health insurance coverage, and are responsible for 100% of the cost of your medical care.

  • Are there any exceptions to the individual mandate?

    Yes. Exemptions are available for:

    • Individuals and families below a certain income level
    • Individuals who cannot afford the coverage that is available
    • Individuals who have suffered a hardship, including eviction, bankruptcy or domestic violence
    • Individuals who have been uninsured for less than three months
    • Members of a federally-recognized tribe
    • Members of a religious group that objects to health coverage
    • Members of a recognized health care sharing ministry
    • Individuals who are incarcerated
  • How do I apply for an exemption from the individual mandate?

    See the instructions on how to apply for an exemption from the individual mandate.

  • I am young and healthy. Why should I buy health insurance?

    Accidents or sickness can happen to anybody. The average cost for a broken arm using hospital emergency services in Minnesota is $2,500. Plus, you are required to do so by law.

Cost

  • Can I lower my cost?

    Possibly. You may qualify for a low-cost or free plan. Tax credits are available to individuals making $46,680 or less and a family of four making $95,400 or less. The amount of assistance is based on a sliding scale, so the lower your income, the higher the amount of assistance.

  • How do I find out if I’m eligible for financial help?

    Beginning November 15, consumers who are eligible to purchase insurance from a private, or commercial, health insurer can log on to MNsure.org and create an account to begin the process for the first time. People who are already enrolled in a MNsure plan will receive information about how to renew their coverage through MNsure. If you believe you may be eligible for one of the state’s public programs, MinnesotaCare or Medical Assistance, you can log on and find out if you are eligible at any time. Enrollment for MinnesotaCare and Medical Assistance is open year-round.

  • How is income determined? What income and deductions need to be included on my application?

    MNsure determines qualifications based on the household Modified Adjusted Gross Income (MAGI). For most taxpayers, MAGI is the same as Adjusted Gross Income (AGI) which can be found on Line 4 on a Form 1040EZ, Line 21 on a Form 1040A, or Line 37 on a Form 1040. 

    Taxpayers who receive non-taxable Social Security benefits, earn income living abroad or earn tax-exempt interest should add back that income to AGI to calculate MAGI.

    Medical Assistance eligibility is determined excluding the following types of income: scholarships, awards, or fellowship grants used for education purposes and not for living expenses, and certain American Indian and Alaska Native income derived from distributions, payments, ownership interests, real property usage rights, and student financial assistance.

  • Are assets used to determine eligibility for tax credits or financial assistance?

    No.

  • How is the advanced premium tax credit calculated?

    This is sometimes known as APTC, “advance payments of the premium tax credit” or premium tax credit. You qualify for an APTC depending on your household size and income. These tax credits can be used to lower monthly premium costs. If you qualify, you may choose how much advance credit payment to apply to your premiums each month, up to a maximum amount. Read more information about financial assistance.

  • How can I find out if I qualify for tax credits?

    You must submit an application for financial assistance to see if you are eligible for tax credits and what the amount will be. If you decide to shop without applying for financial assistance, we can only show you the full price of your premium.

  • Say I qualify for a $300 monthly tax credit. Will I get that all in one lump sum when I file my tax return, or will I get it monthly?

    It’s your choice. We anticipate that most people will elect to receive the tax credit monthly. The monthly option works this way: your tax credit is sent to the insurance company; the amount is deducted from your bill; you are charged for the difference--giving you instant monthly savings.

  • I get insurance now through my employer but it is very expensive. Can I drop employer coverage and sign up with MNsure?

    Yes, you can enroll during open enrollment. However, if the cost of a plan your employer offers is less than 9.5% of your household income for the year, or if the coverage meets the "minimum value" standard set by the Affordable Care Act, you will not qualify for a tax credit.

    You cannot drop coverage and choose a MNsure plan outside of open enrollment unless you are eligible for a special enrollment period with a qualifying event.

  • My employer covers my cost of insurance but does not contribute anything toward family coverage. Can I get dependent coverage on MNsure and keep my employer coverage?

    Yes, though tax credits may not be available. if the cost of a plan your employer offers is less than 9.5% of your household income for the year, or if the coverage meets the "minimum value" standard set by the Affordable Care Act, you will not qualify for a tax credit. Children are able to be on their own health insurance policy without a parent or other adult on the same policy.

How MNsure Works

Enrollment Materials

  • I enrolled in a plan between November 15 and December 5. Why doesn’t my insurance company know that I selected them yet? Do I need to fill out another application?

    No, do not fill out another application.

    MNsure began sending enrollment files to health insurance companies in early December. Until health insurance companies receive enrollment files, they do not have information about your 2015 plan selection and cannot confirm your enrollment. If you want to confirm enrollment, you can contact your health insurance company beginning mid-December or you can contact MNsure before then.

    MNsure Contact Center line: 1-855-366-7873.

    Insurance company contact numbers:

    • Blue Cross and Blue Shield of Minnesota: 1-800-531-6685 or 651-662-5030 
    • HealthPartners: 952-883-5900 or 1-855-813-3887 
    • Medica: 1-888-592-8211 
    • UCare: 1-877-903-0070 
    • Delta Dental: 1-800-926-5530 
    • Dentegra: 1-800-471-0284
  • When will I receive my ID card(s) and plan materials? Does MNsure or my health insurance company send that material to me?

    Your health insurance company will send those materials to you. If you enrolled in a plan between November 15 and December 5, please read the answer above as the timing for when you receive these materials may be different from below.

    You will receive initial communication from your insurance company within 10-15 days of when it receives your enrollment information from MNsure. Watch for this mailing, it will give you important information about your benefits, how and when to make payment, and how to access health care. 

    To ensure you have coverage on the coverage effective date, you must pay your first month’s premium by the due date provided on your invoice. If you do not pay your premium in full by the due date, your coverage effective date may be delayed.

  • I have paid for a qualified health plan but haven’t received my ID card(s), what do I do?

    Contact your insurance company. 

    • Blue Cross and Blue Shield of Minnesota: 1-800-531-6685 or 651-662-5030 
    • HealthPartners: 952-883-5900 or 1-855-813-3887 
    • Medica: 1-888-592-8211 
    • UCare: 1-877-903-0070 
    • Delta Dental: 1-800-926-5530 
    • Dentegra: 1-800-471-0284
  • What if I do not have my welcome packet and ID card before my effective date, even though I have paid my first month’s premium?

    If you have paid your premium in full, you are covered. Your clinic, pharmacy, dental office or hospital will be able to verify your enrollment through your insurance company if you need care before your official ID card arrives. You can also check your insurance company's website as some make ID cards available to new members online.

Minnesota Comprehensive Health Association (MCHA)

  • I am currently enrolled in coverage through the Minnesota Comprehensive Health Association (MCHA) and am losing my coverage on December 31, 2014. Can I enroll in a qualified health plan (QHP) through MNsure without a gap in coverage?

    Yes, current MCHA enrollees who are losing their coverage at the end of 2014 should apply online through MNsure for coverage. Applicants can chose whether or not they wish to apply for financial help. Applicants who are eligible for QHP can enroll in coverage that begins January 1, 2015. 

    In order to avoid a gap in coverage, we strongly encourage you to complete your online application through MNsure and select a plan between November 15 and December 15. You do not need to report your 2014 MCHA coverage on your application for 2015 coverage. You must pay your first premium to the carrier by the due date provided on the carrier’s invoice in order to have your coverage go into effect.

  • What if I select a plan through MNsure after December 15?

    If you apply and select a plan between December 16, 2014 and December 31, 2014 you are still eligible for January 1, 2015 coverage, but the system will not show this. You will need to call the MNsure Contact Center (1-855-366-7873) and report your loss of MCHA coverage. The MNsure Contact Center can assist in manual enrollment for January 1, 2015 coverage. Be prepared to provide a copy of your MCHA closure notice to your carrier to confirm that you are eligible for the January 1, 2015 effective date.

    You must pay your first premium to your insurance company by the due date provided on the insurance company's invoice in order to have your coverage go into effect.

  • Will I have a gap in coverage if I wait until after my MCHA coverage ends to select a plan through MNsure?

    Yes. 

    If you select a plan between January 1, 2015 and January 31, 2015, you will be eligible for coverage February 1, 2015. If you select a plan between January 16, 2015 and January 31, 2015, you will need to call the MNsure Contact Center and report loss of MCHA coverage on December 31, 2014. The MNsure Contact Center can assist in manual enrollment for February 1, 2015 coverage. Be prepared to provide a copy of your MCHA closure notice to your carrier to confirm that you are eligible for February 1, 2015 coverage. 

    If you select a plan between February 1, 2015 and February 28, 2015, you will be eligible for coverage March 1, 2015. If you select a plan between February 16 and February 28, you will need to call the MNsure Contact Center and report loss of MCHA coverage on December 31, 2014. The MNsure Contact Center can assist in manual enrollment for March 1, 2015 coverage. Be prepared to provide a copy of your MCHA closure notice to your carrier to confirm that you are eligible for March 1, 2015 coverage. 

    March 1, 2015 is the last day you can select a plan to receive coverage for April 1, 2015. A current MCHA enrollee who does not apply for insurance by March 1, 2015 will not be eligible to enroll in coverage until the 2016 open enrollment period, unless you experience another qualifying life event or you qualify for Medical Assistance or MinnesotaCare.

Special Enrollment