Is it Right for You?

Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?

This page looks at options you may have, such as getting public health coverage, like Medical Assistance (MA), MinnesotaCare, or Medicare, or getting health insurance through your job. If these options are available to you, they are better choices than getting an individual plan, because they cost less.

Then, we’ll look at why you might choose to get an individual plan. We’ll focus on getting a plan through MNsure, the easiest place for most people to shop for an individual plan and the only place where you can get help from the government to pay for your private insurance (if you qualify).

Other options that are probably better

The best way to figure out if buying an individual health plan is the right option for you is to sign up for MNsure and complete an application. MNsure will tell you what health coverage options are open to you. If you have any of the options below, don’t pay for private insurance through MNsure.

Public health coverage

There are several public health care programs that help people with disabilities, seniors, children, and anybody who has low income. If you or a family member qualifies for these programs, they are usually your best option and you will not be allowed to purchase a government-subsidized individual plan through MNsure.

Medical Assistance (MA)

Medical Assistance is a major government-funded health program that helps people with low income. You may qualify for MA if you are in one of these situations:

Health Coverage Income Limits for Your Family
MA and immigrants
  • Undocumented immigrants do not qualify for full MA coverage, though they may qualify for MA coverage for emergencies.
  • Some non-citizens who have legal immigration status in the United States do not qualify for full MA coverage. However, if their income is at or below 200% of FPG, they can get MinnesotaCare, a different public program. If their income is between 200% and 400% of FPG, they can qualify for government help paying for individual coverage.
  • Immigrants who have been legal residents for 5 years or longer qualify for all of the same programs that citizens can get.

MinnesotaCare

MinnesotaCare is a government-funded health program that helps people with low income who don’t qualify for MA. You may qualify for MinnesotaCare if your family’s income is more than 138% of FPG ($16,753 for an individual in 2019; $34,638 for a family of four) and at or below 200% of FPG ($24,280 for an individual; $50,200 for a family of four).

The big differences with MA are:

  1. MinnesotaCare is for people who earn too much money to get MA.
  2. For MinnesotaCare, you need to pay a monthly premium, while MA has no premium.
  3. Legal immigrants who do not qualify for MA may be able to get MinnesotaCare.
  4. You are not allowed to sign up for MinnesotaCare if your employer offers affordable coverage.
MinnesotaCare is much different than it was before 2014

Before 2014, MinnesotaCare was a lot different. It had an asset limit, different rules for child and adult eligibility, charged higher premiums, didn’t let you sign up if you had been insured recently by another program, and had a limit on the amount it would help you if you had medical expenses. All of those rules have changed.

Really, you can forget the old rules and think of MinnesotaCare after January 1, 2014 as a whole new program designed to help anybody whose family earns between 138% and 200% of FPG.

Medicare

Medicare is a health insurance program run by the federal government that covers seniors (65 years old or older) and people with disabilities. In order to get health coverage through Medicare, you must have worked for a certain number of years and met other eligibility rules, detailed in DB101’s Medicare article.

If you get Medicare, you cannot get government help with paying for an individual health plan. You could still buy an individual plan through MNsure, but you would have to pay the entire premium yourself. Also, if you want more coverage than what Medicare offers, it is probably better for you to look into whether you might also qualify for Medical Assistance (MA) based on having a disability or being elderly, which would help pay your Medicare premiums and other Medicare expenses. Another option is to look at getting a Medicare supplement policy (sometimes called a Medigap policy) or signing up for a Medicare Advantage plan. These options are not available through MNsure.

The bottom line about public health coverage options

If you or members of your family are eligible for a public program, that public program is probably your best option. If you think you might be eligible for a public program, see the other articles in DB101’s Health Care Coverage section.

Group coverage through your employer

To get private health insurance, a monthly payment called a premium must be paid every month. Many employers offer to pay part, or all, of this monthly premium as a job benefit for you as an employee, your children until they turn 26 years old, and your spouse.

If your employer offers you health coverage that would cost you, for your policy alone, less than 9.5% of your income and that coverage meets bronze-level standards, neither you nor your family will qualify for MinnesotaCare or government help through tax subsidies to reduce the premium on an individual plan. That means that if you decide to purchase an individual health plan, you will have to pay the full premium, which will probably be more than you would pay if you used the coverage provided by your employer. To learn more about employer-sponsored health coverage, read DB101’s article about it.

Medical Assistance (MA) and employer-sponsored coverage

If your family makes 138% of the Federal Poverty Guidelines (FPG) or less, you can choose to get income-based MA through MNsure even if your employer offers coverage. MA may even offer to pay your premium for the health insurance your job offers if MA decides that coverage is "cost-effective."

Note: If you work and have been determined disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT), you may be able to get Medical Assistance for Employed Persons with Disabilities (MA-EPD). Chat with a Hub expert to learn more about MA-EPD.

The bottom line about group coverage through your employer

If your employer provides health coverage, you should not get an individual plan for yourself or your family. In most cases, the group coverage will be your best option.

However, if your income is at or below 138% of FPG or if you have a disability, it could be a better choice for you to get Medical Assistance (MA) for your entire family. In some cases it may even make sense to get employer-sponsored coverage for the adults in your family and get MA for the children.

When an Individual Plan is Your Best Option

You should get an individual plan through MNsure if you cannot get health coverage from:

  • Your job
  • Your spouse’s job
  • Your parent’s job
  • Medical Assistance (MA)
  • MinnesotaCare, or
  • Medicare

If you cannot get health coverage from any of the above options and your family’s income is at or below 400% of FPG, $48,560 for an individual ($100,400 for a family of four), the government will help you pay your monthly premium through a tax credit. If your family’s income is at or below 250% of FPG, $30,350 for an individual ($62,750 for a family of four), the government will also help you get a plan that has lower copayments and other expenses.

When MNsure looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

Later, we’ll go into more detail about how much you you’ll have to pay.

Health Coverage Income Limits for Your Family
Example

Clarence and Samuel have two small children and live in a two-bedroom apartment. Clarence is 37 years old and makes $45,000 per year as a freelance writer, while Samuel is 42 years old and makes $30,000 per year running his own small bakery, so their combined income is $75,000 per year. Since both of them are self-employed, they cannot get employer-provided coverage and their combined income is 299% of FPG, meaning that they and their children don’t qualify for Medical Assistance or MinnesotaCare.

They went to MNsure and found a plan that would cover their entire family. Since the government would help pay for their premium, this plan would cost them less than $500 a month. It wasn’t totally free, but it was a pretty good deal and they were satisfied.