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 help, including tax credits, Medical Assistance and MinnesotaCare 2

What MNsure is NOT  An insurance company  A health plan  Just a website  Only for those who qualify for a public program or make a certain amount of money 3

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  Since November 1, 2015, more than 415,000 Minnesotans enrolled in quality, affordable health insurance coverage through MNsure 4

What MNsure Offers  Choice: One-stop shopping with a broad range of plans from multiple insurance companies.  Financial help: MNsure is the only place to see if you 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.  Free, local in-person enrollment help across the state. 5

Consumer Protections  Individuals can no longer be denied coverage or be charged a higher premium for coverage because of their medical history.  There are no annual or lifetime benefit limits on coverage.  There are no exclusions or waiting periods on medical plans for individuals with pre-existing health conditions. 6

Essential Health Benefits All plans cover:  Hospitalizations  Outpatient services and doctor’s office visits  Rehabilitative and habilitative services and devices  Emergency services  Prescription drugs  Laboratory services  Maternity and newborn care  Children’s dental and vision care  Mental and behavioral health services 7

Preventive Services  No co-pays or co-insurance for:  Screenings such as blood pressure, cholesterol and diabetes  Cancer screenings such as mammograms & colonoscopies  Vaccinations and flu shots 8

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. 9

Tax Credits  Only through MNsure can you qualify for a tax credit that can lower your monthly premium.  Individuals making up to $47,520 (in 2017)  Families of four making up to $97,200 (in 2017) 10

Cost-Sharing Reductions  People within % of the federal poverty level will get support to pay co-pays, deductibles and/or co-insurance  Individuals earning up to $29,700 (in 2017)  Families of four earning up to $60,750 (in 2017)  Everyone who buys coverage through MNsure has 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 coverage in 2017 is $7,150 (in 2017)  Maximum for family coverage in 2017 is $14,300 (in 2017)  Some plans offer lower out-of-pocket maximum costs 11

Medical Assistance (MA) and MinnesotaCare  Find out if you qualify through MNsure  One application determines your eligibility for public programs or tax credits  Income-based eligibility  Depending on income, coverage is either no-cost or low-cost  Benefits are comparable to private insurance and include other services (such as transportation) 12

Medical Assistance (MA)  Minnesota’s Medicaid program  Covers many people with low incomes, especially children and pregnant women  No monthly premium; low co-pays for some services  No asset test  Eligible individuals can enroll at anytime 13

MinnesotaCare  For Minnesotans with lower incomes who don’t have access to affordable employer health care coverage and are not eligible for Medical Assistance (MA)  Individuals who have access to affordable employer- sponsored insurance may not be eligible  Maximum premium is up to $80/month per person  No asset test  Eligible individuals can enroll year-round  No premiums for American Indians and Alaska Natives and their household members 14

What You Pay  Factors that affect health plan premiums:  If you are an individual or family  Where you live  Your age  Whether you use tobacco 15

What You Pay (cont.) The financial help you may qualify for depends on household size and annual income People in Household Medical Assistance for adults over age 18 Annual income (up to) Medical Assistance for children Annual income (up to) (Slightly higher income limits apply for infants under age 2) Medical Assistance for pregnant women Annual income (up to) MinnesotaCare Annual income* (up to) Tax credits for private health plans Annual income* (up to) 1 $15,800$32,670does not apply$23,760$47,520 2 $21,307$44,055$44,536$32,040$64,080 3 $26,813$55,440$56,045$40,320$80,640 4 $32,319$66,825$67,554$48,600$97,200 5 $37,825$78,210$79,063$56,880$113,760 6 $43,331$89,595$90,572$65,160$130,320 7 $48,851$101,008$102,109$73,460$146,920 8 $54,384$112,448$113,674$81,780$163,560 For each additional person, add $5,399 $11,440$11,565$8,320$16,640 16

Health Plans Insurance companies with individual/family plans:  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 % 17

Simple Steps to Get Covered Step 1 Compare 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. ** If you qualify for Medical Assistance, you will not pay a premium. MinnesotaCare premiums are paid through the MN Department of Human Services. 18

Plan Comparison Tool  Easy way to compare and choose the right medical insurance plan to fit needs and budget  Get more complete picture of health costs  Find the plans available compared on total estimated cost (not just premiums or deductibles)  Find out if you can get help paying for coverage 19

Get Help: Contact Center MNSURE ( ), toll free  Hours  Monday–Friday: 8 a.m.–6 p.m. during open enrollment; 8 a.m.-5 p.m. outside of open enrollment  Saturday: Will be open 8 a.m.-noon during open enrollment  Staff fluent in Spanish, Hmong and Somali  Access to interpreter services for more than 140 languages 20

Get Help: In Your Community Free in-person help when you need it  Navigators: trained individuals at trusted community organizations, provide free assistance with filling out an application and enrolling in coverage, can help consumers understand health plan options but cannot recommend plans  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  Search by type, language, city, county, zip code or agency name 21

Find an Assister 22

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, and you don’t qualify for an exception, you will pay a tax penalty. The penalty will increase over time.  In 2016, it is 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 23

When to Enroll  Open enrollment for individuals and families in qualified health plans November 1, 2016 – January 31, 2017  To apply for a qualified health plan outside of open enrollment, they must have a life event that qualifies them for a special enrollment period  Individuals who are eligible for Medical Assistance or MinnesotaCare may enroll throughout the year  Members of federally recognized tribes may enroll or change plan designations one time per month 24

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 25

Questions? mnsure.org Insert your photo here (optional) Remove this box if no photo Presenter name Title address Phone number 26