The MNsure Application for Health Coverage and Help Paying Costs application (DHS-6696) (PDF) has been updated for November 2020. People use this application to apply for Medical Assistance (MA), MinnesotaCare and affordable private health insurance (qualified health plans) with premium tax credits and cost-sharing reductions.

We made the following changes:

• Cover page: We updated the dollar amount for a family of four to qualify for a free or low-cost program according to the 2020 federal poverty guidelines (FPG). This figure reflects 400 percent of the FPG, which is the income limit for a family of four to qualify for enrollment in a qualified health plan with insurance assistance.
• Step 2, Person 1, Questions 38, 39, 40, 41 and 43: Wages and Tips (These changes were also made to Person 2, 3 and 4, Questions 22, 23, 24, 25 and 27.) We changed the abbreviation for Employer Identification Number to EIN. We added instructions to write the total wages for the next 12 months if a person’s work hours and wages vary.
• Step 2, Person 1, Question 45: Adjustments to Income (This change was also made to Person 2, 3 and 4, Question 29.) We deleted Tuition and Fees. This adjustment is not permitted after December 31, 2020.
• Step 2, Person 1, Question 46: Projected Annual Income (This change was also made for Person 2, 3 and 4, Question 30.) We updated the question to ask for projected annual income for 2021.

Printed copies of the 11-20 version of the application will be available for ordering soon. Destroy older versions. Processing entities will continue to accept any completed older versions of the application that applicants provide. You can order printed copies of the 11-20 application.