Types of Health Coverage

With a disability, a top priority is to make sure you have health coverage. Your financial situation and employment status determine what types of coverage you can get. These are the main options:

• Private health coverage, including employer-sponsored coverage and MNsure, the Health Insurance Marketplace for the State of Minnesota

• Minnesota public health programs, including Medical Assistance (MA), Medical Assistance for Employed Persons with a Disability (MA-EPD), and MinnesotaCare

• Medicare

These programs will be introduced briefly here. For more detailed information about them, see DB101’s Health Care Coverage section.

Private Health Care Coverage

Private health care coverage is the most common type of health coverage.

What It Provides

It pays for some of your medical costs when you see a doctor, go to the hospital, get medical exams, or get prescription medicine. You may need to pay copayments, premiums, or deductibles for these services. Depending on your coverage plan, it may pay for almost the entire cost of your medical expenses, or it may pay only a portion of those expenses. If you have low income and get private coverage through MNsure the government may help pay your premium.

How You Get It

The most common way of getting private health coverage is through your job or your spouse’s job. Many, but not all, jobs offer health care benefits. If you are still working and get health coverage through your job, your employer will continue to pay most of the expenses for your health insurance. Your spouse or parent (if you’re under 26) may also have a job that will provide health insurance for you.

You can also buy your insurance directly from a private insurance company, through an insurance broker, or on MNsure. You can buy private coverage for yourself and for your entire family. Insurance companies cannot reject your application or charge you more because you have a health condition. MNsure is the only place where people who have lower incomes can get government help paying for their individual coverage plan.

When It’s a Good Option

Private health coverage is best when you or your spouse (or parent) has a job where the employer will pay for it. Or, depending on your income and your plan, the government may help pay for your premium. To get government help paying your premium, you must buy a plan through MNsure. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

It’s important to also note that private health coverage doesn’t always cover everything – you may get private coverage and also be able to get public health coverage to cover whatever the private insurance doesn’t pay for.

Read more in DB101’s Individual Coverage article.

Minnesota Health Care Programs

Minnesota has several different public health coverage programs that you may qualify for. Three of the most important for Minnesotans with disabilities are:

• Medical Assistance (MA)
• MinnesotaCare
• Medical Assistance for Employed Persons with Disabilities (MA-EPD)

What They Provide

MA, MinnesotaCare, and MA-EPD help pay medical expenses for people with disabilities, older adults, children, pregnant women, and people with low income.

If you qualify, these programs will help pay for your visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. You may need to pay copayments, premiums, or deductibles for these services.

There are a couple of differences between these programs:

1. They have different income and asset limits. Depending on your situation, it may be easier for you to qualify for one of these programs or the other.

2. You have to pay a monthly premium to get MinnesotaCare or MA-EPD, while MA has no premium.

How You Get Them

You can apply for Minnesota public health programs online at MNsure, or you can get help applying at your county or tribal human services office.

Note: The only way you can apply for MA-EPD is by filling out the Minnesota Health Care Programs Application for Certain Populations and taking it or mailing it to your local county or tribal human services office. You cannot sign up online.

When They’re a Good Option

If you or your spouse (or your parents, if you’re under 26) don’t have jobs where the employer will provide you with private health coverage, the public health care options listed here are your best bet. If you have low income, you may qualify for MA. If your income is a bit higher, you may still qualify for MinnesotaCare. If you are working and have a disability, you will likely qualify for MA-EPD. They can also help if your private health coverage doesn’t cover some of your medical expenses.

Read more about MA, MA-EPD, and MinnesotaCare in DB101’s section on Health Care Coverage.

Medicare

Medicare is another public health program, but it is run by the federal government, not by the state. While you work, some of the money you earn automatically comes out of your paycheck and goes into a Medicare fund. If you become disabled and start getting Social Security Disability Insurance (SSDI), you will start getting Medicare 2 years after your SSDI benefit begins.

What It Provides

Medicare has different “parts” that each help pay for your medical care.

• Medicare Part A helps pay for medical care you get while you’re in a hospital.
• Medicare Part B helps pay for medical care you get outside of a hospital, like when you go to the doctor.
• Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and sometimes Part D coverage through private companies.
• Medicare Part D helps pay for prescription drugs.

Each Medicare part has different rules for how you sign up, how much you have to pay in premiums or copayments, which medical costs it helps with, and how much of the costs it will help pay for.

How You Get It

People with disabilities get Medicare after being on Social Security Disability Insurance (SSDI) for 24 months. SSDI provides income for people have worked and earned enough work credits to qualify, but who can no longer work because of a disability. Once you’ve been getting SSDI for 2 years, you automatically qualify to get Medicare and will begin to get coverage without having to fill out an application.

In the two years before you qualify for Medicare, you’ll need to get coverage through one of the other health coverage options introduced in this article.

When It’s a Good Option

Medicare is always a good option if you qualify. Often it can also be combined with other programs, such as Medical Assistance (MA), so that your share of expenses is lower.

Read more about Medicare in DB101’s Medicare article.