What is a Qualified Health Plan through MNsure?

Qualified Health Plans (QHPs) are health insurance plans offered through the online MNsure marketplace exchange. QHPs are plans for individuals and families who have an income that makes them ineligible for a public program, such as MinnesotaCare or Medical Assistance. All QHP plans meet the minimum essential benefits requirement, and some consumers can even qualify for tax credits and cost sharing.

Who is eligible for a QHP through MNsure?

Anyone is eligible to apply for a health insurance plan through the MNsure marketplace. However, only certain individuals are eligible for advanced premium tax credits (APTC) and cost-sharing reductions (CSR). Individuals and families that are eligible for these benefits include those who do not have access to employee sponsored insurance, and meet the income guidelines, which can be found here.

 

If you or your family qualify for QHP with advanced premium tax credits, MNsure will reduce the amount you pay each month by giving you a tax credit to be put towards your monthly premium. As an example, if you qualified for $117 in tax credits, then your monthly premium bill each month would be reduced by $117. Some consumers are also eligible for CSRs, which help to pay for out of pocket costs such as copays, and reduce yearly deductible amounts.

 

However, even if you or your family do not qualify for these benefits, you may still be able to enroll in a QHP through MNsure without financial assistance. Unassisted plans through MNsure offer competitive rates, and all of them cover basic services such as preventative visits, generic prescriptions, behavioral health visits, and more. For a comprehensive list of services covered under the Affordable Care Act through MNsure, click here.

How do I apply and enroll in a QHP through MNsure?

All health insurance applications, whether they are a public program or a QHP are done through the MNsure.org site. After filling out an application, you will be given an eligibility determination. If you are eligible for a QHP, you will then be prompted to enroll into a plan. MNsure offers many plans, with a price point for every type of coverage. Plans are sorted by provider and by metal level. Providers in the Twin Cities include Ucare, Health Partners, Medica, and Blue Cross Blue Shield. There are three metal levels: bronze, silver and gold.

Bronze Plans:

Bronze plans are best for individuals who want to make sure they are protected from worst-case medical scenarios, but otherwise don’t use their care very frequently. These plans offer the lowest monthly premium, but out of pocket costs for using care may be high.

Silver Plans:

Silver plans are a good option for individuals and families who are looking to have more coverage from their insurance. The monthly premiums are higher than bronze plans, but deductibles are lower, and more routine care is covered. Silver plans are also the only MNsure plans where consumers can utilize their CSRs.

Gold Plans:

Gold Plans are the best value for individuals who utilize the healthcare system often. With a gold plan, the premiums are higher, but more costs are covered under this type of plan, and the yearly deductible is often low.

When do I need to enroll in a QHP?

If you do not have insurance through an employer, and you think you may qualify for a QHP with MNsure, it is important to keep in mind that there is an enrollment period. In Minnesota, this usually starts on November 1st and ends sometime in January. During this time, Minnesotans are eligible to apply for and enroll in a QHP plan. Outside of these dates, consumers are not eligible to enroll unless they have a qualifying life event (QLE). If a qualifying life event occurs, the consumer must sign up for a QHP within 60 days of the event. To determine if you may have a QLE, click here.

 

Please note Minnesota’s open enrollment period may vary year to year, you can check with MNsure to determine approximate dates. Also, keep in mind that the enrollment period does NOT apply to public programs like MinnesotaCare or Medical Assistance, both of which have year-round enrollment periods.

 

To explore your options, and see what plans MNsure has to offer for you and your family, you can utilize the shop and compare tool by navigating to the MNsure homepage or clicking here. To get assistance from a Certified MNsure Navigator, you can call Briva Health at 1-855-566-7873.

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