State of Minnesota
More about
Attorney General
Lori Swanson


Minnesota Attorney General's Office

1400 Bremer Tower
445 Minnesota Street
St. Paul, MN 55101

(651) 296-3353
(800) 657-3787

M - F 8 am - 5 pm

TTY:(651) 297-7206
TTY:(800) 366-4812

X: Government Programs/Assistance

In addition to private health insurance, there are government plans that cover some people. Below are descriptions of available plans.

 

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 the date of this publication, for adults without children in the home the income limit is $699 a month or $8,388 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 $2,882 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. (In 2010, Minnesota discontinued the General Assistance Medical Care (GAMC) program for single adults and expanded the MA Program in 2011 to cover low income adults without children, many who previously were covered by GAMC.)

 

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 be: 1) certified disabled; 2) at least 16 but under 65 years old; 3) 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 $35. 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 and asset limits. Children under age 21 and pregnant women are exempt from the asset limit. For example, as of the date of this publication, a family of four needs to meet a monthly gross income limit of $5,284 and have total countable assets of no more than $20,000 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 for as little as $4 per month. These children may also be subject to waiver of the requirement that they do not have access to insurance coverage. Parents can apply for coverage for their children only.

Adults without children may also apply for MinnesotaCare but benefits are limited to a $10,000 yearly cap on inpatient hospitalization costs with a 10 percent co-pay. 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
Elmer L. Andersen Building
540 Cedar Street
St. Paul, MN 55101
651-297-3862 or800-657-3672
www.dhs.state.mn.us/healthcare

 

MEDICARE

Medicare is the federal government’s health insurance program for people 65 years old and older and 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 18 for further information on Part D.

Medicare is the federal government’s health insurance program for people 65 years old and older and 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 18 for further information on Part D.

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

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 entitledMedicare and You. The guide is available free of charge, in print or audio cassette format in English or in Spanish, by calling 800-MEDICARE or 800-633-4227 (TTY 877-486-2048), or online at www.medicare.gov

 

MEDICARE SUPPLEMENT 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”).

QMB pays your Medicare premiums, deductibles, co-insurance and co-payments. To qualify, 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 $887 for a single person, $1,187 for a family of two, or $1,487 for a family of three.

SLMB pays your Medicare Part B premium. To qualify, you: 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 $1,060 for a single person, $1,420 for a family of 2, or $1,780 for a family of three.

QI also pays for Medicare Part B premiums. To qualify, you: 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 $1,190 for a single person, $1,595 for a family of 2, or $2,000 for a family of three.

QWD pays your Medicare Part A premium if you are not eligible for premium free Part A and you meet income and asset limits. Assets may not exceed $4,000 for a single person or $6,000 for two people. Monthly income may not exceed $1,754 for a single person, $2,354 for a family of two, or $2,954 for a family of three. Contact the Senior LinkAge Line at 800-333-2433 or your local county human service agency for more information.

 

MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION (MCHA)

The Minnesota Comprehensive Health Association (“MCHA”) is a legislatively-mandated health plan for people unable to obtain insurance coverage in the private marketplace due to pre-existing health conditions. MCHA may not turn you away because you have a medical problem. Rather, it is designed to provide health care coverage to people with medical problems. MCHA policies exclude coverage for preexisting conditions for the first six months if the condition was diagnosed or treated during the 90 days preceding the effective date of coverage, but there are ways to get this waived. If you are rejected for health insurance in the private marketplace due to a pre-existing condition, you should consider contacting MCHA. MCHA is considered a high-risk pool, and therefore its rates are generally higher than those charged in the private marketplace. You may contact MCHA at the following address for more information and an application form or you may contact your insurance agent:

Minnesota Comprehensive Health Association
Customer Service Mail Route CP555
401 Carlson Parkway
Minnetonka, MN 55305-5387

For deductible plan options:
866-894-8053 or 800-841-6753 (TTY)

For Medicare Supplement plan options call:
800-325-3540 or 800-234-8819 (TTY)
www.mchamn.com

 

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
Elmer L. Andersen Building
540 Cedar Street
P.O. Box 64976
St. Paul, MN 55164-0976
651-431-2500
Senior LinkAge Line 800-333-2433
www.mnaging.org

 

FINDING HEALTH CARE

Since it was enacted in March 2010, the Affordable Care Act has begun phasing-in changes to our health care system over a number of years. One of the biggest changes will be the implementation of insurance exchanges, which will allow people to choose among a greater number of private health plans. Health exchanges are scheduled to be up and running during the fall of 2013. To learn more about the federal law, including a directory to health plans that are currently available, go to www.HealthCare.gov.

 

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 IV: Appeals, Grievances and Complaints 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 Attorney General’s Office, you may do so as follows:

Minnesota Attorney General’s Office
Consumer Division
445 Minnesota Street, Suite 1400
St. Paul, MN 55101
651-296-3353
800-657-3787

Next Page- XI: Glossary of Terms