Health Insurance in Minnesota

Health insurance is vital for the physical wellness of your family. Although, buying appropriate health insurance coverage for your family can be expensive, you must consider all future risks and its influence on your overall finances. Nevertheless, more than 47 million Americans are uninsured, majority of whom are the working families. The ever-increasing healthcare costs and the lack of proper health coverage render these families, especially children, vulnerable to the awaiting financial disasters. However, for those families who are not covered by their employers’ health group plan, there are low-pricedstate sponsored health insurance programs.

As the 4th healthiest state, Minnesota is a great place to live in and obtain health care services according to United Health Foundation’s 2008 Health Rankings. Although, the state lost its 1st spot in 2006 and 2nd spot in 2007, Minnesota is still going strong in the top five healthy states list. Minnesota, having the population of more than five million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Minnesota who meet specific eligibility requirements.

The Insurance Division of Minnesota Department of Commerce protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 8.8% of the residents remain uninsured as the Minnesota lawmaker attempt to increase the public health funding and lower the percentage of children in poverty. Approximately, 33.8% uninsured Minnesota citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

Health insurance is a crucial component that you cannot afford to live without. When shopping for health coverage, make sure to get in touch with a licensed health insurance agent/broker to avail the suitable health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Minnesota. These regulations apply to all insurance companies offering individual or family health insurance in Minnesota:

Medical Underwriting
Pre-Existing Condition Exclusion Period
18 months
Look Back Period
6 months
Look Back Standard
Mandatory Benefits
Cancer screening for women including screening of breast, ovarian and cervical cancer, reconstructive surgery after mastectomy, direct access to OB/GYNs, eating disorder parity, maternity care
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Minnesota. These regulations apply to all insurance companies offering small group health insurance in Minnesota:

Small Group Size
Employee Qualifications
Owner can count as an employee, proprietor-name on license must draw wages
Guaranteed Issue
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Minnesota. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
18 months
Maximum Premium Increase
State Legislation Reference
Minnesota Continuation Laws
Additional Notes
Premiums may not exceed 102% of group rate
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Minnesota to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Minnesota is summarized in the chart below:

Plan Name
Minnesota Comprehensive Health Association (5MCHA)
Phone Number
HIPPA Eligibility Required?
Available Carriers

Pre-Existing Condition Waiting Period
6 months
Enrollment Periods
Currently Open to New Enrollment
Premium Limits
Between 101% – 125% of standard rates
Lifetime Maximum Benefit
$5 million
Special Notes
To be eligible for the health coverage:
Individuals must have exhausted COBRA benefits.
Individuals must be working for employers who do not offer health insurance.
Individuals must have exceeded lifetime maximum limits, or their previous coverage.
Former employees of bankrupt companies.
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Minnesota provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Phone Number
800-657-3672, 651-297-3862
Apply Online
Age Limits
Under 21
Insurance Carrier
Medica, BlueCross/BlueShield or HealthPartners
Length of Coverage
12 months
Residency Requirements
Minnesota resident and U.S. citizen, non-citizen legal immigrant
Other Eligibility Requirements
Children should not have other health insurance now or have had health insurance (5including Medicare), for at least four months except for Medical Assistance enrollees whose health insurance premium was paid for by Medical Assistance.
Children should not be able to get health insurance through an employer who offers to pay at least half the monthly cost.
Pre-Existing Condition Exclusions
Monthly premium of $4 or more for children

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Minnesota:

Governing Agency
Minnesota Department of Human Services
Phone Number
Residency Requirements
Minnesota resident and U.S. citizen, legal non-citizen
Federal Poverty Line Income Limits
Infants (5ages 0-2): 280% FPL
Pregnant Women: 275% FPL
Children (5ages 2-18): 150% FPL
Elderly, blind and people with disabilities, Parents (5and adults ages 19 and 20): 100% FPL
SSI Recipients: 70% FPL
Medically Needy Individual: 67% FPL, Couple-62%
Disabled are allowed to “spend down” for eligibility
Additional Resources

Minnesota Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Minnesota’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Minnesota: At-A-Glance
Provides exclusive health data of the Minnesota state., a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.