About MNsure Minnesota’s health insurance marketplace Name of event Date of event Presenter name and title

What is MNsure?  A marketplace where Minnesotans can find, compare choose and get quality health care coverage that best fits your needs and budget  The place to see if you qualify for financial assistance or Medical Assistance and MinnesotaCare 2

Who Does MNsure Serve?  Individuals & families  Uninsured  Buy health coverage on their own  Seeking a better option  Qualify for Medical Assistance (MA) or MinnesotaCare  Small employers and employees  In 2014, more than 370,000 Minnesotans enrolled in quality, affordable health insurance coverage through MNsure 3

Your Benefits  Choice: One-stop shopping with a broad range of plans from multiple insurance companies.  Financial help: MNsure is the only place to qualify for low-cost or no-cost coverage, or tax credits to help pay your insurance premium.  Streamlined Application: You only need to fill out one application for you and your family for all coverage options in MNsure.  Individuals can no longer be denied coverage or be charged a higher premium for coverage because of their medical history.  No annual or lifetime benefit limits on coverage.  No exclusions or waiting periods on medical plans for individuals with pre-existing health conditions.  Free in-person assistance across the state. 4

Health Plans with Quality Benefits  Hospitalizations  Outpatient services  Rehabilitative and habilitative services and devices  Emergency services  Prescription drugs  Laboratory services  Maternity and newborn care (pregnancy, childbirth and breast-feeding support)  Pediatric dental and vision care  Mental and behavioral health 5

Preventive Services  No co-pays or co-insurance for:  Screenings for blood pressure, cholesterol and diabetes  Cancer screenings such as mammograms & colonoscopies  Vaccinations and flu shots 6

American Indian Benefits American Indians or those who qualify to use IHS or Tribal Health Services can expect:  Consistent care. Can continue to get care from IHS, Tribal or Urban Indian Healthcare Facility.  No cost-sharing. Won’t pay for any service from an IHS, Tribal or Urban Indian Healthcare Facility. May also qualify for reduced cost-sharing at any doctor/provider depending on income.  Tribal sponsorship. Some Minnesota tribes will pay insurance premiums. American Indians are:  Entitled to change health plans once a month, if desired.  Exempt from the federal mandate requiring all individuals to purchase health insurance.  Exempt from federal tax penalties for not having coverage. 7

Tax Credits  Only through MNsure can you qualify for a tax credit that can lower your monthly premium.  Individuals making up to $47,080  Families of 4 with incomes up to $97,000 8

Cost-sharing Reduction  People within % of the Federal Poverty Level will get support to pay co-pays, deductibles and/or co-insurance  Individuals earning up to $29,425  Families of four earning up to $60,625  Everyone who buys coverage through MNsure will have a cap on their total out-of-pocket spending (includes deductibles, co-pays, co-insurance) for covered services offered by in-network providers  Maximum for individual in 2016 is $6,850  Maximum for family in 2016 is $13,700  Some plans offer lower out-of-pocket maximum costs 9

Medical Assistance (MA) and MinnesotaCare  Find out if you qualify through MNsure – one application determines your eligibility for public programs or tax credits  Costs are either free or minimal  Benefits are comparable to private insurance and include other services (e.g., transportation) 10

Medical Assistance (MA)  Covers many low-income people, especially children and pregnant women  No monthly premium  No asset test  Eligible individuals can enroll at anytime 11

MinnesotaCare  For lower income Minnesotans who don’t have access to affordable employer health care coverage and are not eligible for Medical Assistance (MA).  Maximum premium is up to $80/month per person. Eligible individuals can enroll year-round.  No asset test for parents and caretakers  Individuals who have access to affordable ESI may not be eligible 12

What You Pay  Factors that affect health plan premiums:  If you are an individual or family  Where you live (geographic area)  Your age  Whether you use tobacco 13

What You Pay (cont.) 14

Health Plans Insurance companies with individual/family plans:  Blue Cross Blue Shield  Blue Plus  HealthPartners  Medica  UCare Levels of CoveragePlan Pays on Average Enrollees Pay on Average (in addition to the monthly plan premium) Bronze60 %40 % Silver70 %30 % Gold80 %20 % Platinum90 %10 % 15

Simple Steps to Get Covered Step 1 Browse sample plans Step 2* Create your online account and apply Step 3 Choose a plan Step 4 Enroll in the plan and sign Step 5 Pay first month’s premium (to insurance company) * If you qualify for Medical Assistance or MinnesotaCare, you do not need to go to step 3. The plan options available will be mailed to you. 16

Get Help: Contact Center MNSURE ( ), toll free  Monday – Friday  8:00 AM – 8:00 PM  Saturday – Sunday  Will be open during Open Enrollment  Staff fluent in Spanish, Hmong and Somali  Access to interpreter services for more than 140 languages 17

Get Help: Assister Network Help when you need it  Navigators: trained individuals at trusted community organizations, do not charge for their services, help any individual, cannot recommend plans or carriers but will refer consumers to brokers  Agents/Brokers: licensed by the Minnesota Department of Commerce, compensated by insurance companies, can provide advice as to which insurance plan is best for an individual’s situation  Certified Application Counselors: trained staff at hospitals, community health centers, and clinics  Assister Directory: Go to MNsure.org, keyword: Assister Directory  Trained and certified  Search by type, language, city, county, zip code or agency name 18

Find an Assister 19

Individual Mandate All U.S. citizens and legal residents are required to obtain health insurance coverage. Exceptions  Individuals and families below a certain income  People who cannot afford the coverage that is available  Individuals who have been uninsured for less than 3 months  Members of American Indian tribes  People who do not obtain coverage because of religious objection If you don’t have health insurance, you will pay a tax penalty. The penalty will increase over time.  In 2015, it is the greater of $325 per adult, or 2% of taxable income  In 2016, it will be the greater of $695 per adult, or 2.5% of taxable income  After 2016, the tax penalty increases annually based on a cost-of-living adjustment  The penalty for a child is half that of an adult 20

When to Enroll  Open enrollment for individuals and families in qualified health plans November 1, 2015 – January 31, 2016  Individuals may apply and be eligible for Medical Assistance and MinnesotaCare throughout the year  Members of federally recognized tribes may enroll or change plan designations one time per month 21

Special Enrollment Period  Life events that may qualify for special enrollment include:  Adoption  Foster care  Birth of a child  Marriage, divorce  Gain of citizenship, national or lawfully present status  Loss of health insurance coverage  Newly eligible or ineligible for tax credits or for cost-sharing reductions (for those already enrolled through MNsure)  Permanent address change that provides new choices for qualified health plans  Enrolled member of a federally recognized tribe 22

Questions? mnsure.org Insert your photo here (optional) Remove this box if no photo Presenter name Title address Phone number 23