Private Health Care Coverage

In order to get private coverage, somebody—you, your employer, your parents, your parents’ employer—must pay for that coverage. In this section, we will introduce you to the basic ways you can get private health care coverage, as well as some of the expenses you may encounter with private coverage.

Coverage Through Work

Many, but not all, jobs offer health care benefits. That’s why private health care coverage through work is the most common way that Americans get their health care coverage.

If you get your health coverage through your job, usually your employer pays most of the expenses. This means that the employer pays hundreds of dollars each month so that you have access to health care. Depending on your job, you will also have to pay a monthly amount in addition to what your employer spends. The total monthly expense paid for the private health care coverage is called the premium.

Cost-Effective Coverage

If your employer provides health coverage, you may be able to get MA or MA-EPD to pay for your portion of the premium if the county determines your private coverage is “cost-effective”. Chat with a Hub expert to learn more.

In addition to the premium you and your employer will be paying, you will have to pay various other expenses out of your own pocket. The most common health care expenses are called “copayments”. A copayment means that every time you have a doctor’s appointment, have a test done, or get a prescription filled you will have to pay some money. With private coverage, copayments generally range from about $10 to $50.

Depending on your health care plan, you may not have to pay anything for certain types of services (testing and vaccinations, for example). But you may have to pay a lot for other types of services. Some plans, for example, may require you to pay for half of all your hospitalization expenses, which can add up to hundreds or even thousands of dollars each day. Other plans simply do not cover certain medical expenses, such as wheelchairs or other durable medical equipment.

All plans have an annual limit on the total amount you have to pay in addition to your monthly premium. This limit is called the out-of-pocket maximum. So, if you have a plan with a $2,000 out-of-pocket maximum, once you’ve paid a total of $2,000 in copayments and other medical expenses, you won’t have to pay any copayments or other expenses for the the rest of the year. Note: You will still have to pay your monthly premium.

Coverage Through Parents

Generally, when people get private health care coverage through their jobs, they are allowed to pay an additional amount to have their family members added to the coverage, including their children

Minnesota law guarantees that your parents can add you to their “employer-sponsored health care plan” (the health care plan they get through work) until you turn 25 (unless you are married). Federal law says that parents who get new health care plans are allowed to add any children under the age of 26 to their plans.

If you have a disability and are dependent on a parent for financial support, you can be covered by your parent’s plan no matter what your age.

Purchasing Coverage

Some people pay a health coverage company directly for their health care coverage instead of getting it through their jobs or parents. This is called individual coverage. With individual coverage, you will usually have to pay a monthly premium, copayments, and a deductible, depending on your plan.

MNsure is the easiest place to apply for individual coverage. It used to be that health insurance companies could deny your application or charge you more if you had a disability, but starting in 2014, that's no longer true. Now, anybody under the age of 65 can go to MNsure and sign up for a private insurance plan.

You should think about getting 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 between 200% and 400% of the Federal Poverty Guidelines (FPG), $49,960 for an individual ($103,000 for a family of four), the government may help you pay your monthly premium via a tax credit. If your family’s income is between 200% and 250% of FPG, $31,225 for an individual ($64,375 for a family of four), the government will also help you get a plan that has lower copayments and other expenses.

Health Coverage Income Limits for Your Family
Catastrophic plans
If you are under 30, you can sign up for a catastrophic plan with a high deductible. You will have to pay the deductible before this type of plan will pay for most Essential Health Benefits, though you will be able to see your primary care provider up to 3 times and get preventive care without paying the deductible. If your income is below 400% of FPG, the government will not help you pay for a catastrophic plan, so it could be more expensive for you than a bronze or silver plan on MNsure.

Read more about how to sign up for individual coverage in DB101's Buying Health Coverage on MNsure article.