*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: November 1, 2012 |
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25.05 - MinnesotaCare Premiums |
Archived: June 1, 2016 (Previous Versions) |
Many MinnesotaCare enrollees must pay a premium to establish and maintain coverage. The MinnesotaCare program pays the remainder of the enrollee's cost of coverage through the Health Care Access Fund.
Exceptions:
n Military members who have completed a tour of active duty within 24 months of being approved for MinnesotaCare coverage are exempt from paying MinnesotaCare premiums for up to 12 months. See Premium Exemption for Military Members and Their Families.
n Children enrolled in MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility are exempt from paying MinnesotaCare premiums through the month of their 21st birthday.
n Households that include one or more American Indian members who have verified their status and who are enrolled in MinnesotaCare are exempt from paying a premium.
Note: Do not exempt the household from MinnesotaCare premiums if no American Indian household members are eligible for MinnesotaCare or if the American Indian household member(s) is enrolled in a different Minnesota Health Care Program. See Premium Exemption for Households With an American Indian Member for more information.
n MinnesotaCare for Volunteer Firefighters and Ambulance Attendants enrollees pay the full monthly capitation rate applicable to MinnesotaCare adults without children.
n Children with household income equal to or less than 200% FPG are exempt from paying monthly premiums.
This section provides information on the types of premiums used to calculate a household's MinnesotaCare premium amount.
Use the MinnesotaCare Premium Table (DHS-4139) or the MinnesotaCare Premium Calculator in MMIS Recipient Miscellaneous Functions (RPRM screen) to estimate a household’s premium. However, the Premium Table and Premium Calculator are only an estimate of the premium amount. The RSLT screen will display the billed premium amount.
Combination of Premium Types in One Household.
There are three types of premiums:
1. Zero premiums. Children with household income equal to or less than 200% FPG and children who qualify for MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility do not pay a monthly premium.
2. Sliding scale premiums. Children with household income over 200% FPG, but equal to or less than 275% FPG and all adult enrollees pay a sliding scale premium based on household size, income, and number of household members covered.
3. Maximum premiums. Children with household income greater than 275% FPG pay the maximum MinnesotaCare premium based on the number of children enrolled. See MinnesotaCare Premium Amounts for maximum premium amounts.
MMIS calculates the MinnesotaCare sliding scale premium based on three factors:
n Household size (up to a maximum of five).
n Income.
n Number of people covered. Sliding scale premiums change depending on whether one, two or three or more people are covered.
Example:
Alan and May apply for MinnesotaCare for their two children. Their income is over 200% FPG.
Action:
The children have a sliding scale premium based on a household size of four with two people covered because the household income is greater than 200% FPG.
Two months later Alan and May request coverage for themselves.
Action:
Using MMIS, calculate the premium based on a household size of four with three or more people covered.
Alan and May have a baby who is added to coverage.
Action:
Using MMIS, calculate the premium based on a household size of five with three or more covered.
Combination of Premium Types in One Household
Households with income at or below 200% FPG, who are applying for adults and minor children in the household, have the premium calculated on the sliding scale.
Example:
Jean and Stuart apply for MinnesotaCare for themselves and their three children. Their income is under 200% FPG.
Action:
The children do not have a monthly premium.
Jean and Stuart's sliding scale premium is based on a household size of five .
The family's total monthly premium is the sliding scale amount for Jean and Stuart.
Jean and Stuart's sliding scale premium is $28. The family's total premium is $28.
Review additional information regarding specific MinnesotaCare premium policy in the following sections:
Initial, Ongoing and Changes to MinnesotaCare Premiums.
MinnesotaCare Premium Payment Options.
MinnesotaCare Premium Credits and Refunds.
Premium Exemption for Military Members and Their Families.
Verification of American Indian status.