MinnesotaCare

3.1.2.2 Premiums and Cost Sharing (Archive)

Premiums

Many MinnesotaCare enrollees must pay a monthly premium to establish and maintain coverage. The following enrollees have no premium:

• Households that include one or more military members, enrolled in MinnesotaCare, who have completed a tour of active duty within 24 months of MinnesotaCare eligibility, are exempt from paying MinnesotaCare premiums for up to 12 months

• Households with one or more American Indians or Alaska Natives enrolled in MinnesotaCare

• Households with income below 35% of the Federal Poverty Guidelines (FPG)

• Children younger than 21

American Indian and Alaska Native enrollees are not required to provide proof of status to be exempt from paying MinnesotaCare premiums.

The MinnesotaCare Premium Estimator Table (DHS-4139A) lists estimated premiums. The premium listed on a bill is the official calculation and the amount an enrollee must pay.

People who are required to pay a monthly premium must pay it to keep MinnesotaCare coverage. Ongoing MinnesotaCare premiums are due the 15th of the month. Premiums should be paid on time to avoid a gap in coverage.

Grace Month

MinnesotaCare enrollees who do not pay their premium before the coverage month, have a one-month grace period. An enrollee will remain covered during the grace month, regardless of whether the enrollee pays the premium for that month. Coverage stops at the end of the grace month if they fail to pay their past due premium.

To restart coverage, the person must pay the past-due premium for the grace month and the future month’s premium. Coverage begins the first day of the month after the month in which the person pays both these premiums in full.

The MinnesotaCare grace month applies only to enrollees who are required to pay a MinnesotaCare premium. Household members who are not required to pay premiums, such as children under the age of 21, remain covered, regardless of whether other household members’ premiums are paid.

Cost Sharing

Cost sharing includes those costs a MinnesotaCare enrollee pays towards their health care. MinnesotaCare cost sharing includes deductibles, medical visit and prescription copays.

Adults age 21 or older have a:

• Monthly deductible

• Copays for non-preventative visits

• Copays for nonemergency ER visits

• Copays for eyeglasses

• Copays for prescription drugs

There is no cost sharing for mental health services.

American Indians and Alaska Natives enrolled in a federally recognized tribe are exempt from cost sharing. Verification of membership in a federally recognized tribe is required to be exempt from cost sharing. Acceptable verifications include a data match from an electronic data source or paper documentation. 

Providers must serve MinnesotaCare enrollees who are not able to pay a copay or deductible at the time of the visit, however, that provider does not have to serve an enrollee again if their cost sharing is still not paid.

Legal Citations

Code of Federal Regulations, title 42, section 600.505

Code of Federal Regulations, title 42, section 600.510

Code of Federal Regulations, title 42, section 600.525

Code of Federal Regulations, title 45, section 155.350

Minnesota Statutes, section 256L.03

Minnesota Statutes, section 256L.06

Minnesota Statutes, section 256L.15

Published:  August 1, 2016

Archived:  December 22, 2016