If you can’t afford health insurance … three ways to get help

Health insurance costs a lot — family coverage costs more than $1300 per month. Most people can’t afford that. In other countries, the government provides health insurance. Not here. So what can you do to get help paying for health insurance?

In Minnesota, three programs help pay for health insurance. First, Medicaid is a federal program for very low-income people. Second, MinnesotaCare is a state program for people with somewhat higher incomes who still don’t make enough money to pay for health insurance. Finally, the Affordable Care Act (ACA or Obamacare) gives federal tax credits to help pay for private insurance premiums.

Definitions:

Premiums: The amount that you (or your employer) pay each month for health insurance.

Low-income: Each program defines low-income differently. Click here to see what the federal government says are poverty level incomes in 2014.

Health care subsidy: If you buy health care through MNSure, you may qualify for a tax credit that pays part of your premium each month.

Medicaid (also called MA or Medical Assistance)

Medicaid (also called MA or Medical Assistance) is a federal program for very low-income people. The exact amount you can earn and still qualify for Medicaid varies. For example, a mom with a one-year-old child qualifies if her income is less than $3,709 per month. A single person with no children qualifies if her income is less than $1,293 per month. You can find a table with all the numbers here.

If you are on Medical Assistance, you will not pay any premiums. More than 700,000 Minnesotans are covered by Medicaid. If you get Medicaid, your doctor or health care provider bills the state directly. You do not pay for medical care.

This is the one of a series of articles on understanding health insurance. Click here for all of the articles. This series covers basics — exceptions and complications go beyond the basics.

Minnesota has a full Medicaid system. That means the state program covers the maximum number of people. Some other states restrict Medicaid to fewer people. That leaves many low-income people with no way to get health insurance. Congress could act to change this — but they have not done so.

MinnesotaCare

MinnesotaCare is a state program for low-income people. If you make too much money to qualify for Medicaid, you might still qualify for MinnesotaCare. The income limit for a single person for Medicaid is $1,293 per month, which is $15,516 per year. The income limit for a single person for MinnesotaCare is $22,980 per year, which is $1,915 per month.

If you qualify for MinnesotaCare, you may pay premiums, but they will be much lower than regular health insurance premiums. MinnesotaCare premiums vary, depending on your income. For example, a single person earning $9,336 per year would pay a monthly premium of $6. A single person earning $22,173 per year would pay a monthly premium of $43.

Affordable Care Act subsidies for premiums

If you have a low enough income to qualify for Medicaid, then you cannot get subsidies for private insurance premiums. If your income is too high to qualify for Medicaid, you might qualify for help paying premiums. To get this help, you must sign up for health insurance through the MNSure exchange.

Want to know if you qualify? If your income falls within the ranges on the chart below, you’ll generally qualify for a premium tax credit. That’s money that goes directly to help pay your premium. Here’s the official chart of incomes qualifying for subsidies:

• $11,670 to $46,680 for individuals
• $15,730 to $62,920 for a family of 2
• $19,790 to $79,160 for a family of 3
• $23,850 to $95,400 for a family of 4
• $27,910 to $111,640 for a family of 5
• $31,970 to $127,880 for a family of 6
• $36,030 to $144,120 for a family of 7
• $40,090 to $160,360 for a family of 8

What if you have a low income AND your employer provides health insurance? Generally, you are out of luck. You cannot get a subsidy to help pay for insurance you get through your employer.

HOWEVER — you might be able to get help through MinnesotaCare. According to the MinnesotaCare website:

You may qualify for MinnesotaCare if the insurance offered by your employer is not affordable. Employer insurance is not affordable if:

• It covers less than 60% of medical costs, or

• You pay more than 9.5% of your income towards the premium.

This is another area that gets very complicated, very quickly. For more information or help in figuring out whether you could get MinnesotaCare help, call 651-431-2670 (Twin Cities metro area) or 800-657-3739 (outside Twin Cities metro area).

Complications

When it comes to insurance, nothing is simple. This series covers basics — exceptions and complications go beyond the basics. Here are a few of the complications in Medicaid, MinnesotaCare and tax credits or subsidies.

Spend-downs – If your income is higher than the Medicaid limits, you might still be able to get coverage. A “spenddown” is like a deductible. With a “spenddown,” you pay for part of your medical expenses, and then Medicaid starts paying. Click here for more information.
Medicaid and MinnesotaCare have very complicated rules about who qualifies and what income levels qualify. For more information, click here, or click on the link for each group below:

• Pregnant women
• Families and children
• 19 and 20 year olds
• Children with a disability
• Adults without children
• Adults with a disability
• Employed persons with a disability (MA-EPD program)
• People 65 or older
• People who need nursing home care
• People who need home care
• Noncitizens
• People who want family planning coverage only
• Women who have breast or cervical cancer and have been screened by the SAGE program

This list doesn’t cover everybody who might be eligible for help. To find out if you qualify, you must apply.

Health insurance does not need to be so complicated. One way to uncomplicate it is called “Medicare for all.” The very successful Medicare program covers people who are 65 or older. “Medicare for all” would extend this coverage to everybody.

“Medicare for all” is one way to get to a single-payer system. Most European countries and Canada have single-payer systems. That means everyone can choose their own doctor, dentist, hospital, etc., but all the bills go to a single payer — the government health program.

The decision to keep health insurance complicated was made by Congress. This decision makes sense for the insurance industry, but not for the rest of us.

Articles in this series:

• Trouble ahead? Three health insurance alerts
• Open enrollment time: Should you renew or change your health insurance?
• Beyond the premium: What will you really pay for health care?
• Putting together the puzzle: Deductibles, copayments, co-insurance, out-of-pocket limit
• What you need to know about health insurance bills, networks and tiers
• What does health insurance cover?
• If you can’t afford health insurance … three ways to get help 
• Key questions: Choosing your family’s health insurance