Common Pitfalls

In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, if you use tobacco products, and whether you have a disability.

If you do not have the option of employer-sponsored coverage, you may be able to get government help through tax credits paying for an individual plan on MNsure. If you cannot afford private individual coverage, your best options will be public programs, like Medical Assistance, MinnesotaCare, or Medicare, if you qualify.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

MNsure will check to see if you might qualify for disability-based MA if you answer "yes" to at least one of these questions when you fill out your MNsure application:

• Are you blind or do you have a physical, mental, or emotional health condition that limits your activities (like bathing, dressing, daily chores, etc.)?
• Do you need help staying in your home or help paying for care in a long-term care facility such as a nursing home?
• Do you want help from Medical Assistance (MA) to pay for medical bills from the last three months?

MNsure will also check for disability-based MA eligibility if you say you're on Medicare.

If you have a disability and don't answer these questions correctly, you might not get the best health coverage for you. If you have any questions about applying, Chat with a Hub expert.

In the past, people feared that if they got a job while on public health coverage, like Medical Assistance (MA) or MinnesotaCare, they’d lose that coverage, because they would no longer have low enough income to qualify.

Now, if you lose one health coverage option, there should be another one you can get. If you lose your current coverage, you should either become eligible for employer-sponsored coverage, another public coverage program, or private individual coverage. And, if you can’t afford the individual coverage, the government may help you pay for it through tax credits.

The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.

It’s not always obvious, but there are times when you should consider having both private coverage and Medical Assistance (MA). For example, there may be services you need that MA covers but your private plan doesn’t.

If you enroll in MA and you also have cost-effective private coverage, the state will pay the premium for your private policy for you.

If you are eligible for Medicare Parts A and B, you have to keep them in order to enroll in disability-based MA. MA covers many services that are not covered by Medicare, and in many cases a Medicare Savings Program will pay your Medicare premium for you. By having both MA and Medicare, you’ll have better health care coverage than you would by enrolling in just one or the other.

You don’t have to participate in Medicare Part D to qualify for disability-based MA, but if you’re eligible for Medicare Part A or B, MA cannot pay for your prescription drugs. This means that if you're on MA and you refuse Part D coverage, you won't have any prescription drug coverage (unless you have your own private drug coverage). Being enrolled in MA and Medicare makes you a dual eligible and automatically qualifies you for the Medicare Part D Low Income Subsidy (LIS). This means you wouldn’t have a Part D premium or any Part D deductibles. All you would pay for your prescription drugs is a copayment of $1.55 – $11.20 per prescription at the pharmacy.

Note: Most people cannot qualify for income-based MA if they are on Medicare.