What is MNsure?
The Affordable Care Act (ACA) passed by the federal government in 2010 required each state to start a health insurance marketplace. They could either choose a federal marketplace (HealthCare.Gov) or create their own state marketplace (MNsure.Org). Minnesota chose to have its own health insurance marketplace which is a service that assists people and businesses in shopping, comparing, and enrolling in a health insurance plan that fits their needs.
MNsure IS NOT an insurance company and does not provide public medical programs (that is through a person’s local county or the state of Minnesota). MNsure assisters/navigators and brokers can help through the website, call centers and in-person. Supplement Plan Advisors has multiple MNsure brokers that can help you. With an account through MNsure.org you can input information about where you live, household income and family information. The nice thing about going through MNsure is that your qualification determination is instantaneous. The information put in will place you into one of four categories based on your income. The four categories are:
- Medical Assistance (MA) through the county
- Minnesota Care (MNCare or Minncare) through the state
- A private insurance plan also called a Qualified Health Plan (QHP) with financial assistance (this is an insurance plan at federally subsidized tax credits which is to help make the insurance plan more affordable).
- A private insurance plan (QHP) without financial assistance (this is an insurance plan with no federally subsidized tax credits).
MNsure has two main enrollment periods. The first one is the Open Enrollment Period (OEP) or sometimes called the Annual Enrollment Period (AEP). The second enrollment period is the Special Enrollment Period (SEP).
What is an OEP and SEP? What makes a SEP so special?
Open Enrollment Period (OEP) is the period each year when any person can enroll in a health insurance plan to start January 1st of the following year, even if they never had a health insurance plan in the present year. The OEP is also the time when a person can make a change from their present health insurance plan to a different one. This also goes into effect January 1st of the following year. In Minnesota, the OEP runs for a set number of weeks, generally starting November 1st and running into December. The end date of the OEP can vary from year to year.
Special Enrollment Periods (SEP’s) are triggered by ‘Qualifying Life Events’ that allow a person to enroll in a qualified health insurance plan outside of the OEP. To take advantage of this enrollment period a person needs to have a ‘Qualifying Life Event’. Some examples are listed below (more can be found on the MNsure.org website):
- Having a baby
- Marriage/Divorce/Legal Separation
- Losing other qualified health insurance
- Residential address change out of your county
If a person qualifies for the Special Enrollment Period, they only have 60 days from the time the qualifying life event happened to take advantage of this period to enroll in a plan. If someone misses this enrollment period they will have to wait until the next Open Enrollment Period.
MNsure’s Mission and Vision (taken directly from the MNsure.org website):
- Our mission: To ensure all Minnesotans have the security of health insurance.
- Our vision: To create a statewide resource that provides access to private health insurance and public medical assistance programs.
What is C.O.B.R.A. Insurance (Consolidated Omnibus Budget Reconciliation Act)?
- COBRA is basically a continuation of your group health coverage for up to 18 or 36 months depending on the circumstances. You can choose it if you are the past employee, a qualified dependent or spouse. COBRA is usually expensive because you are paying your entire premium instead of a reduction, like when you were working. You have up to 60 days to choose the coverage, but if you sign up the second month, you will have to pay all the premiums from the date your employer coverage ended. If you are aging into Medicare, you would usually want to enroll in Medicare Part B right away to prevent any Medicare late enrollment penalties.
If I Am Enrolled in Medicare and COBRA, Who Pays First?
- Medicare usually pays their part first, COBRA pays their part second, and you are left with the remaining costs.
How Will I Know If I Qualify for Continuation of Coverage?
- You must have a “qualifying event”. Continuation coverage must be offered to each person who is a “qualified beneficiary.” A qualified beneficiary is someone who will lose coverage under the plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries. Under the plan, qualified beneficiaries who elect continuation coverage must pay for it. You can look at other health care options too, like buying coverage through the health insurance marketplace. In the marketplace, you could be eligible for a tax credit that lowers your monthly premium. You can see what your premium, deductibles, and out-of-pocket costs will be before you decide to enroll with COBRA. Being able to choose COBRA does not limit or exclude your eligibility for a health coverage tax credit through the marketplace. Supplement Plan Advisors agency sells plans in the marketplace and can show you a comparison.
- If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the plan because one of the following qualifying events happen:
- Your hours of employment are reduced.
- Your employment ends for any reason other than your gross misconduct.
- If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your coverage under the plan because any of the following qualifying events happens:
- Your spouse dies.
- Your spouse’s hours of employment are reduced.
- Your spouse’s employment ends for any reason other than his or her gross misconduct.
- You become divorced or legally separated from your spouse.
- Dependent children will become qualified beneficiaries if they will lose coverage under the plan because any of the following qualifying events happens:
- The parent-employee dies.
- The parent-employee’s hours of employment are reduced.
- The parent-employee’s employment ends for any reason other than his or her gross misconduct.
- The child is no longer eligible for coverage under the plan as a “dependent child.” This happens when the child turns 26 years old.
- Sometimes filing a proceeding in bankruptcy under Title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to the State of Minnesota, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee is a qualified beneficiary with respect to the bankruptcy. The retired employee’s spouse, surviving spouse, and dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the plan.
- For other qualifying events (divorce or legal separation of the employee and spouse, or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the plan administrator. The plan requires you to notify the plan administrator within 60 days after the qualifying event occurs. You must send this notice to Minnesota Management & Budget, State Employee Group Insurance Program, Suite 400, 658 Cedar Street, St. Paul, MN, 55155.
Second Qualifying Events
Is There an Extension of the 18-Month Period of Continuation Coverage?
- Yes, there is a continuation of coverage if your family experiences another qualifying event while receiving 18 months of continuation coverage. The spouse and dependent children in your family get additional months of health and dental continuation coverage, up to a combined maximum of 36 months. Notice of the second qualifying event must be properly given to the plan administrator. This extension is available to the spouse and dependent children if the employee or former employee dies, gets divorced or legally separated, or if the dependent child stops being eligible under the plan as a dependent child. This is only true if the event would have caused the spouse or dependent child to lose coverage under the plan, if the first qualifying event had not occurred. In all these cases, you must make sure that the plan administrator is notified of the second qualifying event within 60 days of the second qualifying event. This notice must be sent to Minnesota Management & Budget, State Employee Group Insurance Program, Suite 400, 658 Cedar Street, St. Paul, MN, 55155
COBRA can be very confusing, and we recommend that you contact the Human Resources Team through your/your spouse’s employer for more clarification because each employer can have different guidelines.
The information contained on this web page is provided for educational and informational purposes only. While we have taken every precaution to ensure that the content of this page is current and accurate, errors can occur. Supplement Plan Advisors LLC assumes no responsibility for any errors or omissions in the content of this page. Sources: Medicare.Gov & SSA.Gov