Health Insurance Marketplace in Minnesota
If you live in Minnesota, MNsure is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the MNsure website to apply for coverage, compare plans, and enroll. You can apply as early as October 1, 2013. Visit MNsure now to learn more.
Choosing the Right Health Insurance Plan
There are a number of different tiers of plans available on the Minnesota Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below: NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan. Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you. Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services. Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you. Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the Minnesota insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently. Minnesota health insurers don’t have to offer every tier of plan, but within the Minnesota health insurance exchange, all health insurance companies must offer at least one silver plan and one gold plan to consumers. Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Minnesota will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Minnesota 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
Accountable Care Organizations in Minnesota
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Courage Center MN – Health Care Innovation Award
- Sanford Health MN – Health Care Innovation Award
- Trustees Of Dartmouth College MN – Health Care Innovation Award
- National Council Of Young Men’s Christian Associations Of The United States Of America (YMCA Of The USA) MN – Health Care Innovation Award
- Institute For Clinical Systems Improvement MN – Health Care Innovation Award
- Mayo Clinic MN – Health Care Innovation Award
Models Run at State Level
- Incentives for the Prevention of Chronic Diseases in Medicaid Demonstration
- Multi-payer Advanced Primary Care Program
Health care facilities where Innovation Models are being tested
- Winona Health Services Winona, MN – Advance Payment ACO Model
- Essentia Health St. Mary’s Medical Center Duluth, MN – Advance Payment ACO Model
- Good Samaritan Society – Ambassador New Hope, MN – BCPI Initiative: Model 3
- Good Samaritan Society – Maplewood St Paul, MN – BCPI Initiative: Model 3
- The Metropolitan Area Agency on Aging MN – Community-based Care Transition Program
- Cook Area Health Services, inc.; dba: Scenic Rivers Health Services Bigfork, MN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Jennifer DeCubellis LPC, LPA Minneapolis, MN – Innovation Advisors Program
- Allina Hospitals and Clinics Minneapolis, MN – Pioneer ACO
- Park Nicollet Health Services St. Louis Park, MN – Pioneer ACO
- Fairview Health Services Minneapolis, MN – Pioneer ACO
- Health Foundations Women’s Health & Birth Center St Paul, MN – Strong Start for Mothers and Newborns Initiative
- Morning Star Women’s Health and Birth Center St. Louis Park, MN – Strong Start for Mothers and Newborns Initiative
- Alisha’s Care Center Long Prairie, MN – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Minnesota
On October 31, 2011, Governor Mark Dayton (D) signed Executive Order 11-30 which charged the Minnesota Health CareReform Task Force with recommending strategies to improve overall health care delivery in Minnesota, including advising and overseeing an Exchange Advisory Task Force.1 Building on the work of the Advisory Task Force, on March 20, 2013, Dayton signed into law legislation creating the Minnesota Insurance Marketplace.[MN2013]
The Minnesota Health Insurance Exchange Advisory Task Force formed in October 2011 and continues to meet. The 15 Task Force members include representatives of employers, consumers, organized labor, and tribes, as well as four majority and minority Legislators from the House and Senate. The three ex officio members are the Commissioners of the Department of Commerce, the Department of Human Services, and the Department of Health. The Advisory Task Force established 10 technical workgroups to discuss exchange options and provide technical assistance directly to the Commerce Commissioner and indirectly to the Advisory Task Force. In December 2012, the Health Care Reform Task Force issued recommendation to the Legislature and Governor for implementing the Affordable Care Act, including expanding Medicaid, establishing a state-based health insurance exchange, and providing affordability and coverage support for individuals with income 138-200% of the federal poverty level.3
Structure: The legislation defines Minnesota’s Exchange as a “board” or agency within the Executive Branch.
Governance: The Minnesota Marketplace will be governed by a seven-member board, including one ex officio member (or their designee): the Commissioner of Human Services. The Governor appoints six members with the advice and consent of the Senate and the House of Representatives. The six appointed members must include a representative of consumers eligible for individual coverage; a representative of consumers eligible for public coverage; a small employer; an expert in health administration or finance; an expert in public health, health disparities, public health care programs and the uninsured; and an expert in the individual and small group insurance markets. Appointed Board members will serve staggered four-year terms. The Governor must appoint members by April 30, 2013.
Board members cannot be affiliated with a carrier, institutional health care provider or other entity providing health care, navigator, insurance producer, or other entity in the business of selling items or services to or through the exchange. Board members must recuse themselves from discussion and voting on issues in which there is a conflict of interest.
The Board will establish advisory committees to provide insurance producers, health care providers, the health care industry, consumers and other stakeholders the opportunity to advise the Board.
Contracting with Plans: The legislation specifies that the Exchange will function as a clearinghouse in the first year of operation, accepting all plans that meet the minimum standards. Beginning in 2015, the Exchange may consider issues such as affordability, quality and value, promotion of prevention and wellness, efforts to reduce health disparities, market stability, meaningful choices, and access in deciding which plans to make available.
In Minnesota, the Commissioner of Commerce enforces the state’s insurance laws, while the Commissioner of Health has authority over Health Maintenance Organizations (HMOs). To avoid duplication, existing regulatory structures within the Departments of Commerce and Health will be used to certify qualified health plans (QHPs). The Departments released QHP certification guidance in October 2012.4
Minnesota has also examined accreditation and quality measurements of QHPs. In July 2012, the Department of Commerce issued a Request for Proposals (RFP) for assistance with the development of a quality rating system and enrollee satisfaction survey system for insurance carriers and QHPs.5 This contract is expected to run from September 2012 to June 2013. Also in 2012, the plan certification subgroup released draft recommendation regarding certification requirements for carriers and QHPs and the measurement and reporting workgroup released proposed criteria for selection of a health plan quality rating system.6,7
Dental and Vision Benefits: In November 2012, the plan certification and adverse selection work groups released recommendations for certification criteria of stand-alone qualified dental plans (QDPs).8 The workgroups concluded that QDPs should be meet many of the requirements for dental plans that are already in state law, included those related to licensure, marketing, rating variation, and essential community providers.
Risk Adjustment, Reinsurance, and Risk Corridors: Based on recommendations from the workgroup focused on risk sharing and risk adjustment, Minnesota decided the federal government should operate the state exchange’s reinsurance program and the risk adjustment program for 2014 and 2015.9 The workgroup also recommended that the exchange should pursue obtaining authority to use the state’s existing all payer claims database and develop a risk adjustment methodology that could be implemented in the future.10
Consumer Assistance and Outreach: In August 2012, a subcontractor presented the results of market research findings and recommendations, including that the state should begin outreach, engage brokers as intermediaries because small businesses seek their advice and expertise, and explore naming the exchange with some variation of the terms “marketplace” and or “choices.”11 In January 2013, the state launched a consumer-friendly website for the exchange that includes a subsidy calculator with the branding MNsure. The state also released an RFP for a Public Awareness Marketing/Outreach Campaign to raise awareness of the Exchange and to promote enrollment.12 The campaign is expected to run from June 2013 to March 2014.
The Board of the Exchange is required to develop policies and procedures for Navigator and In-person Assister programs to be implemented in January 2015. Until those policies go into effect, the requirements of the Navigator program will be met by an existing outreach and assistance program operated by the Department of Human Services. In October 2012 the navigators and agents/brokers workgroup released draft training requirements for in-person assistors.13
Small Business Health Options Program (SHOP) Exchange: In November 2012, the small employer workgroup provided a report summarizing the results of market analyses and discussions to date.14 Notably, the workgroup had not yet reached consensus on whether transitioning from a defined benefit model to a defined contribution model would be both feasible and attractive to small employers.
Information Technology (IT): Information Technology (IT): Minnesota plans to develop a single, integrated eligibility determination system that would sort applicants into the appropriate coverage program, including Medicaid, the Children’s Health Insurance Program (CHIP), the Exchange, and potentially the Basic Health Program.15 In June 2011, the Departments of Commerce, Human Services, and Health completed a joint Gap Analysis of the state’s IT infrastructure.16 They concluded that a Minnesota exchange could utilize some existing systems, but most functionality will need to be derived from new elements. Minnesota expects to use flexible and interoperable solutions developed through an IT RFP and to leverage efforts from other states. Also in June 2011, Minnesota published an RFP as a two-stage, proof-of-concept approach to evaluate IT options for an exchange.17 During the first stage, RFP respondents proposed prototypes for either a fully functional exchange technical infrastructure or for specific component modules. Minnesota’s strategy was to allow multiple vendors to propose prototypes for one or more of the eight distinct modules in order to identify the vendors that best met the needs of each particular IT component. In October, the state awarded select respondents with stipends to create the proposals and prototypes within the second stage. The proposals and prototypes were made public in November 2011 and online feedback was collected through January 30, 2012.
In July 2012, Minnesota announced the selection of a prime contractor to lead a team of specialized technology firms with the design and development of the exchange’s technological capabilities and with major technology improvements to the state’s Medicaid systems.18 The exchange and the Department of Human Services created an Exchange/Medicaid Collaboration Steering Committee and an Eligibility and Enrollment Workgroup to streamline decision-making and communicate with the IT vendor.19 The Department of Human Services has also issued an Implementation Advanced Planning Document to coordinate Medicaid and Exchange activities, focusing on determining eligibility for state health programs through a single set of process using a single IT system. To assist in financing the information technology upgrades of the state’s Medicaid eligibility systems, Minnesota applied for and received CMS approval of an Advanced Planning Document for the enhanced federal match.20
Minnesota was asked to participate in an Early Innovator sub-workgroup consisting of multiple states discussing technical topics related to exchange development.21 Minnesota is also one of multiple states participating in the Enroll UX 2014 project, which is a public-private partnership creating design standards for exchanges that all states can use.
Financing: In August 2012, the finance workgroup explored multiple long-term funding options for the exchange and compared different options, including a user fee, an assessment on premiums in the exchange, an assessment on fully-insured products sold by insurers, a broad-based health care tax, an appropriation, or some combination of these options. In October 2012, the workgroup released a report highlighting the results of subcontractors’ projections of budgetary needs and enrollment, and recommendations on financial transparency, accountability, flexibility, and timing.22
Prior to January 1, 2015, the authorizing legislation imposes a 1.5% user fee on individual and small group plans and dental plans sold through the Exchange to fund the Exchange’s operations. Beginning in January 2015, the user fee will increase to 3.5% of premiums.
Basic Health Program (BHP): Minnesota has considered establishing an optional bridge program available through the Affordable Care Act (ACA) that allows states to use federal funding to offer subsidized health insurance to adults with incomes between 139 and 200% of the federal poverty level (FPL) who would otherwise be eligible to purchase subsidized coverage through an exchange. Subcontractors provided Minnesota with an assessment of the impact of a BHP and implementation of other ACA provisions in April 2012.23 In November 2012, the access workgroup of the Health Care Reform Task Force recommended that Minnesota expand Medicaid to 138% FPL and provide affordable, comprehensive coverage for those with incomes 138-200%. The workgroup indicated it will continue to assess the coverage options for this population, including coverage through the exchange without additional subsidies, providing wrap-around benefits and/or subsidies for coverage purchased through the exchange, or creating a BHP.24
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through an exchange, cover certain defined health benefits. In the summer of 2012, the access workgroup of the Health Care Reform Task Force compared multiple benchmark plan options and concluded that all are subject to Minnesota’s current state mandated benefits and therefore are very similar.25 Since Minnesota has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield Major Medical.26
The Minnesota Department of Commerce received a federal Exchange Planning grant of $1 million in February 2011. The state has also received four Level One Establishment grants: $4.2 million in August 2011, $26 million in February 2012, $42.5 million in September 2012, and $39 million in January 2013 to support the development and implementation of the exchange.27
In addition, Minnesota, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.28
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Minnesota is participating in Medicaid expansion.
On December 20, 2012, Minnesota received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange.29 Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future guidance and regulations, and demonstrating legal authority to operate the state-based exchange. Governor Dayton has indicated that key policy decisions would be made during the 2013 legislative session.30
For more information on Minnesota’s health insurance exchange, visit: http://www.mn.gov/hix
1. Executive Order #11-30. “Establishing a Vision for Health Care Reform in Minnesota.”http://mn.gov/governor/images/EO-11-30.pdf
2. Minnesota 2013 Session Laws, Chapter 9 https://www.revisor.mn.gov/laws/?id=9&doctype=Chapter&type=0&year=2013
3. Roadmap to a Healthier Minnesota: Recommendations of the Minnesota Health Care Reform Task Force, December 11, 2012. http://mn.gov/health-reform/images/TaskForce-2012-12-13-RoadmapDraft.pdf
4. Minnesota Health Insurance Exchange Planning Certification Guidance. October 9, 2012.http://mn.gov/commerce/insurance/images/HIX-CA-QHP-CertificationRequirements10-11-12.pdf
5. Minnesota Department of Commerce Request for Proposals. Quality Rating System and Enrollee Satisfaction Survey. May 2012.http://mn.gov/commerce/insurance/images/ExchRFPquality-rating-system.pdf
6. Minnesota Health Insurance Exchange, presentation to the Exchange Advisory Task Force. September 27, 2012. http://mn.gov/commerce/insurance/images/ExchATF-QHPcertPresentation9-27-12.pdf
7. Proposed Criteria for Measure Selection in the Minnesota Health Insurance Exchange Quality Rating System. November 5, 2012.http://mn.gov/commerce/insurance/images/ExchMeasureCriteriaSelection11-5-12.pdf
8. “Recommendations for Certification Criteria for Stand-Alone Dental Plans and Other Exchange Dental Coverage Issues.” November 6, 2012.http://mn.gov/commerce/insurance/images/ExchPlanDentalCertification11-13-12.pdf
9. Minnesota Health Insurance Exchange Blueprint Application. 5.0 Risk Adjustment and Reinsurance. November 2012.http://mn.gov/commerce/insurance/images/5%252E0%2520CoverPage.pdf
10. “Risk Adjustment Recommendations to Minnesota Health Insurance Exchange Advisory Task Force.” October 24, 2012.http://mn.gov/commerce/insurance/images/ExchATFriskRecommendations10-24-12.pdf
11. Salter Mitchell “Minnesota Exchange Communications: Full Market Research Findings.” August 10, 2012. http://mn.gov/commerce/insurance/images/ExchReportPubEducation-Outreach8-12.pdf
12. Minnesota Management and Budget RFP “Health Insurance Exchange Public Awareness Marketing/Outreach Campaign” http://www.mn.gov/hix/images/RFP-MarketingCampaign.pdf
13. Minnesota Health Insurance Exchange, Assistor Training Requirements- Draft. October 14, 2012. http://mn.gov/commerce/insurance/images/ExchNavAssisterRequireDraft10-17-12.pdf
14. Munson-Regala, M. “Small Employer Technical Workgroup Report.” November 20, 2012.http://mn.gov/commerce/insurance/images/ExchATF-SmEmpReport11-20-12.pdf
15. Courtot B, Dorn S, Chen V. “ACA Implementation—Monitoring and Tracking: Minnesota.” Robert Wood Johnson Foundation and Urban Institute. July 2012.http://www.rwjf.org/files/research/6020.400318.minnesotasitevisit.2012.july.pdf
16. Minnesota Level One Grant Application. Funding Opportunity Number IE-HBE-11-004. August 2011. http://mn.gov/commerce/insurance/images/HealthReformLevelOneProjectNarrative.pdf
17. Minnesota’s Request for Proposal. Health Benefit Exchange Technical Infrastructure Prototypeshttp://www.state.mn.us/mn/externalDocs/Commerce/Health_Benefit_Exchange_Technical_Infrastructure_Prototypes_062011101807_MN-ExchangeIT-RFP.pdf
18. Press release from the Minnesota Department of Commerce. “Minnesota Takes Next Step in Health Insurance Exchange.” July 16, 2012.http://mn.gov/commerce/insurance/media/newsdetail.jsp?id=209-44950
19. Minnesota Project Narrative, Level One Establishment Grant Application, August 23, 2012.
20. Heberlein M, et al. “Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012” Kaiser Commission on Medicaid and the Uninsured. (January; #8272).http://www.kff.org/medicaid/upload/8272.pdf
21. Minnesota Project Narrative, Level One Establishment Grant Application, August 23, 2012.
22. Minnesota Health Insurance Exchange. “Navigator, Agent, Broker Work Group” October 24, 2012. http://mn.gov/commerce/insurance/images/ExchATFnavReportServiceLevels10-24-12.pdf
23. Gruber J and Gorman B. “The Impact of the ACA and Exchange on Minnesota.” April 2012.http://mn.gov/commerce/insurance/images/ExchGruberGormanFinalReport4-12.pdf
24. Access Work Group presentation to the Minnesota Health Care Reform Task Force- Draft Recommendations. November 15, 2012. http://mn.gov/health-reform/images/TaskForce-2012-11-16-Access-Recs-PPT-Revised.pdf
25. Minnesota Health Care Reform Task Force, Access Workgroup. “Essential Health Benefits: Basic Facts and Frequently Asked Questions.” August 16, 2012. http://mn.gov/health-reform/images/WG-Access-2012-08-16-EHB-Fact-Sheet-and-FAQs1.pdf
26. Minnesota Health Care Reform Task Force, Access Workgroup. “Essential Benefits Set- Default Scenario.” August 16, 2012. http://mn.gov/health-reform/images/WG-Access-2012-02-09-Essential-Benefit-Set-Default.pdf
27. Minnesota Affordable Insurance Exchange Grants Awards List, Center for Consumer Information and Insurance Oversight, accessed at http://cciio.cms.gov/archive/grants/states-exchanges/mn.html
28. Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011. http://www.rwjf.org/coverage/product.jsp?id=72289
29. Letter from Secretary Sebelius to Governor Dayton. December 20, 2012.http://cciio.cms.gov/resources/files/mn-blueprint-exchange-letter-12-20-2012.pdf
30. Letter from Governor Mark Dayton to Legislature. Re: Follow-up to August 23rd letter. September 18, 2012.
Provided by the Henry J. Kaiser Family Foundation