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 whether you might qualify for MinnesotaCare. If you do, it is probably your best choice. You can see if you qualify for MinnesotaCare at MNsure.

If you don’t qualify for MinnesotaCare, consider other options, including Medical Assistance (MA) and private health insurance from your employer or through MNsure.

MinnesotaCare Basic Eligibility Requirements

To qualify for MinnesotaCare, you usually must meet several basic requirements:

• Not be able to get Medicare, Medical Assistance (MA), or affordable employer-sponsored coverage
• Be a U.S. citizen or have a legal immigration status, and
• Have income within certain limits.

Not Be Able to Get Medicare, MA, or Employer-Sponsored Coverage

MinnesotaCare is meant for people who do not have other affordable coverage options. That means that if you could get Medicare, Medical Assistance (MA), or affordable employer-sponsored coverage, you cannot get MinnesotaCare. This is especially important for people with disabilities, because people with disabilities are more likely to qualify for MA. If you have a disability, read DB101’s disability-based MA article.

If you do not have one of these other options, keep reading this article.

Citizenship or Legal Immigration Status

You must be a U.S. citizen or have a legal immigration status to get MinnesotaCare.

Note: Some immigrants who do not qualify for MA may qualify to get MinnesotaCare instead.

If you are a citizen or have a legal immigration status, continue reading this article.

Income

MinnesotaCare is for families with income at or below 200% of the Federal Poverty Guidelines (FPG) ($27,180 per year for an individual; $55,500 for a family of four), but above 138% of FPG ($20,120 for an individual; $41,400 for a family of four).

MinnesotaCare counts 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 MinnesotaCare eligibility.

Note: If you are a legal immigrant who cannot get Medical Assistance (MA) because of your immigration status, you may be eligible for MinnesotaCare even if your income is below 138% of FPG.

There are no limits to how much money or other assets you can have for this type of MA.

If you cannot get MinnesotaCare because your income is too high, consider buying an individual plan through MNsure. See DB101’s Buying Health Coverage on MNsure article.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$14,580
	$5,140
	$14,580
	$5,140
	$13,590
	$4,720
Income-based MA, adults (138% FPG)
Income-based MA, children/pregnant women (280% FPG)
MinnesotaCare (200% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

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The bottom line: If you meet the main requirements described here, MinnesotaCare is a great program that you should sign up for. We explain how to sign up later in this article.

If you get MinnesotaCare, it will pay for a broad range of medical services, including all services that the government considers Essential Health Benefits (EHBs).

You get MinnesotaCare through a health plan in your area. If you’re not sure if a particular service is covered by MinnesotaCare, or if it requires prior authorization, ask your health plan.

Here is a list of the main services that MinnesotaCare provides:

• Alcohol and drug treatment
• Chiropractic care
• Dental care (limited for nonpregnant adults)
• Doctor/clinic visits
• Emergency room care (ER)
• Eyeglasses
• Family planning services
• Hearing aids
• Home care
• Hospice care
• Hospital services (inpatient and outpatient)
• Immunizations and vaccines
• Interpreter services
• Lab and X-rays
• Licensed birth center services
• Medical equipment and supplies
• Medical transportation (access, ambulance and special; only in emergencies for adults)
• Mental health care
• Outpatient surgery
• Prescriptions and Medication Therapy Management
• Rehabilitative therapy

MinnesotaCare does not provide some disability-related services, such as Personal Assistance Services. If you have a disability, find out if you qualify for disability-based MA. Contact your local county or tribal human services office for more information.

You may have to pay a monthly premium for MinnesotaCare. The exact amount you pay depends on your family’s income and household size and the most you would have to pay is $28 per family member. Some people don't have to pay a premium, including children, American Indians, and households with income that is below 35% of the Federal Poverty Guidelines (FPG). Check MinnesotaCare’s premium table to see what your premium might be.

Generally, if you are 21 years old or older, you pay copayments for services. Copayment amounts depend on the medical service you get. Here are some examples:

• Nothing for preventive care
• $10 for generic prescription drugs and $35 for brand-name drugs
• $30 for nonpreventive office visits
• $100 for an emergency room visit

View the complete list of copayments for different types of health care. For more information about copayment amounts, call the Minnesota Health Care Programs (MHCP) Help Desk at 1-651-431-2670 or 1-800-657-3739.

Note: American Indians in federally recognized tribes do not pay copayments or deductibles.

Compared to Private Insurance

MinnesotaCare’s premium, deductible, and copayments are lower than the premium and copayments required by most private insurance plans. For example, many private insurance plans charge hundreds of dollars each month in premiums, have annual deductibles that require you to pay thousands of dollars before the plan will cover most services and, even after the deductible is paid, many private insurance plans require $50 or higher copayments for services.

Application

There are two main ways to apply for health coverage:

• Online using MNsure, a one-stop shop where you can learn about your public and private coverage options.
• Filling out a paper application and faxing it in to 1-651-431-7750 or mailing it to the address listed on the form.

No matter how you apply, it is important to know that if you are not eligible for MinnesotaCare, you may be able to get Medical Assistance (MA) or private insurance subsidized by the government.

How Your Application Is Reviewed for Eligibility

1. First, your application will be reviewed to see if you qualify for income-based MA.
   1. If you do qualify, MNsure will let you know and you can sign up.
   2. If you do not qualify, your application will be reviewed to see if you might qualify for disability-based MA. If so, you will be contacted for additional information to complete your application. To learn more about this process, see DB101’s disability-based MA article.
2. If there is no way you can qualify for MA, your application will be reviewed to see if you qualify for MinnesotaCare.
   1. If you do qualify, MNsure will let you know and you can sign up.
   2. If you do not qualify, MNsure will display private insurance plans that the government may help pay for through tax subsidies, depending on your situation. For more information about these, see DB101’s article about Buying Health Coverage on MNsure.

Staying on MinnesotaCare

Usually, once you are approved for MinnesotaCare, you will continue to get it for 12 months. If your income, immigration status, residency, or household size changes, update your information on MNsure or let your county or tribal human services office know. When you report your changes, the eligibility system will tell you whether you will continue getting MinnesotaCare or if you have new health coverage options. There should always be at least one health coverage option for your family.