FAQ for Individuals and Families

Health Coverage Requirement

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

  • 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.

    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.

  • 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.

    Use the numbers below to 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 need to receive health care services or fill a prescription but have not received my ID card?

    If you need medical services or to fill a prescription, please contact your insurance company and it will work to provide you with the information you need.

    • 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

    If you have paid your full premium by the deadline provided by the insurance company, you are covered.

    Your clinic, pharmacy, dental office, or hospital may be able to verify your enrollment through your insurance company if you need care before your official ID card arrives.

    If you need care and do not have a card, contact the health plan’s customer service team. If the plan has received your enrollment from MNsure, you may be able to receive your member number or a temporary ID card or online ID card if you need care.

Special Enrollment