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Managing Your Health Care

Government Programs and Assistance

Medical Assistance (“MA”)

MA, Minnesota’s Medicaid program, is the largest of the public health care assistance programs in Minnesota. It provides medical assistance to low income citizens, children and families, and people with disabilities. MA may also help pay premiums for other health insurance, including insurance through an employer or Medicare. To qualify you must meet eligibility guidelines such as income and asset limits which depend on family size and composition. For example, as of July 1, 2017, for adults without children in the home the income limit is $1,336 a month or $16,039 a year for one person. For children ages 2-18 living in a family of four to be eligible, the family must meet an income limit of $5,637 per month. Contact your county’s human services agency for more information about eligibility requirements. You may also call the MA Help Desk at (651) 431-2670 or (800) 657-3739.

Medical Assistance for Employed Persons with Disabilities (MA-EPD)

MA-EPD allows working people with disabilities to qualify for MA under higher income and asset limits.

To qualify, Minnesotans need to:

  1. Be certified disabled;
  2. Be at least 16 but under 65 years old;
  3. Be employed in a position earning more than $65 per month and paying applicable federal and state taxes;
  4. Have no more than $20,000 in countable assets (this asset limit does not apply to pregnant women and children ages 16-21); and
  5. Pay a monthly premium based on income and household size.

If you are married, your spouse’s assets and income do not count toward the asset limitation and premium calculation. The minimum monthly premium is $65. There is no maximum income limit or premium amount. Individuals with unearned income, such as Social Security Disability and/ or Supplemental Security Income, are required to pay a small percentage of their unearned income in addition to the monthly premium. Contact your county human service agency or the Disability Linkage Line at (866) 333-2466 for more information. You may also call the MA Help Desk at (651) 431-2670 or (800) 657-3739.

MinnesotaCare

MinnesotaCare is a health care program for Minnesotans who do not have access to other health care insurance. There are no health condition restrictions, but applicants must meet eligibility guidelines, including income limits. For example, as of January 1, 2017, a family of four must not exceed a monthly gross income limit of $4,050 to qualify for MinnesotaCare. Enrollees pay a monthly premium based on income and family size and parents have co-pays for certain services. Some children may be covered without paying a premium. Adult enrollees have co-pays ranging from $3 to $25 for physician services, prescription drugs, outpatient services, and eyeglasses.

Contact your county’s human services agency for more information about MinnesotaCare eligibility requirements. You may also contact the Minnesota Department of Human Services, which administers MinnesotaCare, at:

MinnesotaCare
540 Cedar Street, St. Paul, MN 55101
(651) 297-3862 or (800) 657-3672
www.mn.gov/dhsexternal link icon

Medicare

Medicare is the federal government’s health insurance program for people 65 years old and older as well as certain younger people with disabilities. Medicare Part A covers hospital and nursing home services. Part B covers physician and other professional services. Part C includes Medicare Advantage plans run by private companies approved by Medicare that encompass Part A, Part B, and usually other coverage including prescription drugs. Part D covers outpatient prescription drugs. People who are entitled to Social Security benefits pay no premium to receive Part A coverage, but must pay Part A’s annual deductible and co-insurance requirements. Both Part B and Part D have monthly premiums in addition to annual deductibles and coinsurance requirements. See page 19 for further information on Part D.

In addition, if you have original Medicare coverage (not a Medicare Advantage plan), Medicare supplement insurance is available to fill in the gaps in Part A and Part B coverage. You can purchase supplemental insurance to pay for items that original Medicare generally does not cover.

If you have questions about Medicare eligibility or want to apply for Medicare benefits, contact the Social Security Administration toll-free at (800) 772-1213 (TTY (800) 325-0778), or visit www.medicare.gov.external link icon

The U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services offers a comprehensive guide to health insurance for people with Medicare entitled Medicare and You. The guide is available free of charge, in print or electronic format in English or in Spanish, by calling (800) MEDICARE or (800) 633-4227 (TTY (877) 486-2048), or online at www.medicare.gov.external link icon

Medicare Supplemental Programs

DHS administers several programs for Medicare enrollees that can help with Medicare costs: Qualified Medicare Beneficiary (QMB), Service Limited Medicare Beneficiary (SLMB), Qualified Individuals (QI) and Qualified Working Disabled (QWD). Please note that the dollar amounts, below, are effective from July 1, 2017 through June 30, 2018. The numbers change each year because they are based on the federal poverty guidelines. (The changes are usually small increases.) To get up-to-date dollar amounts after June 30, 2018, please contact the Senior LinkAge Line at (800) 333-2433, your local county human services agency, or the Minnesota Department of Human Services at (651) 431-2000.

Qualified Medicare Beneficiary (QMB)
QMB pays your Medicare premiums, deductibles, co-insurance, and co-payments. To qualify, effective July 1, 2017, you must:

  1. Be enrolled in or eligible to enroll in Medicare;
  2. Have no more than $10,000 total countable assets for a single person or $18,000 for two people; and
  3. Have monthly income of no more than $1,025 for a single person or $1,374 for a family of two.

Service Limited Medicare Beneficiary (SLMB)
SLMB pays your Medicare Part B premium. To qualify, effective July 1, 2017, you must:

  1. Be enrolled in or eligible to enroll in Medicare;
  2. Have no more than $10,000 total countable assets for a single person or $18,000 for two people; and
  3. Have monthly income of no more than $1,226 for a single person or $1,644 for a family of two.

Qualified Individuals (QI)
QI also pays for Medicare Part B premiums. To qualify, effective July 1, 2017, you must:

  1. Must be enrolled in or eligible to enroll in Medicare;
  2. Have no more than $10,000 total countable assets for a single person or $18,000 for two people; and
  3. Have monthly income of no more than $1,377 for a single person or $1,848 for a family of two.

Qualified Working Disabled (QWD)
QWD pays your Medicare Part A premium if you are not eligible for premium-free Part A and you meet income and asset limits. To qualify, effective July 1, 2017, your:

  1. Assets may not exceed $4,000 for a single person or $6,000 for two people; and
  2. Monthly income may not exceed $2,030 for a single person or $2,727 for a family of two.

Minnesota Board on Aging

The Board on Aging contains a network of local area agencies on aging that provide several services to older Minnesotans, including health insurance counseling, prescription drug information and more. If you would like to contact the Board on Aging or its local area agencies, they can be reached through the Senior LinkAge Line or otherwise as follows:

Minnesota Board on Aging
540 Cedar Street, P.O. Box 64976
St. Paul, MN 55164-0976
(651) 431-2500 or Toll-free: (800) 882-6262
Senior LinkAge Line: (800) 333-2433
www.mnaging.netexternal link icon

Making a Complaint to a Government Agency

As you can see from this booklet, it isn’t necessarily easy to identify which government agency you should contact regarding a complaint or concern. You need to identify what type of plan you have (i.e., self-insured, fully-insured, etc.). Then, refer to page 14 of this booklet that identifies the different government agencies responsible for regulating the health care industry. If you have any questions or want to make a complaint to the Minnesota Attorney General’s Office, you may do so as follows:

Office of Minnesota Attorney General Lori Swanson
445 Minnesota Street, Suite 1400
St. Paul, MN 55101
(651) 296-3353 (Twin Cities Calling Area)
(800) 657-3787 (Outside the Twin Cities)
TTY: (651) 297-7206 or TTY: (800) 366-4812