Primer: What you need to know about MNsure enrollment
ST. PAUL — The first day of Minnesota's open enrollment period for the individual health care market is Tuesday, Nov. 1.
It's a very unusual time, with the market in crisis. Even people accustomed to buying individual health insurance in recent years will find plenty of differences this time around.
Minnesota's individual market covers about 5 percent of Minnesotans — those who don't have coverage from an employer or a government program. It includes those who buy coverage directly from an insurance carrier and those who go through the state-run MNsure exchange.
For people who need to buy individual insurance, here is what you need to know about this year's open enrollment:
Buy early, really early.
All but one of Minnesota's insurance carriers limit the number of people they will enroll, and experts believe those caps could be reached within days. Only the narrow-network HMO Blue Plus is accepting unlimited customers. So people who want a choice about which insurer they sign up with should buy as soon as possible after open enrollment launches Tuesday.
That's especially true for anyone living outside of the Twin Cities metro. There are fewer providers in most Greater Minnesota counties, so options could narrow more quickly there.
Residents of Stearns, Benton, Morrison, Mille Lacs and Crow Wing counties need to be particularly vigilant: Blue Plus isn't offering plans there, so all the available providers in those counties have enrollment caps. The state Commerce Department has promised that they'll find a way for all residents of those counties to buy an insurance plan but hasn't revealed details of how it will make this happen.
Shop at mnsure.org
There are two ways to buy individual insurance in Minnesota: directly from an insurer (or from an insurer via a broker), or through the state-run insurance exchange, mnsure.org. Until now, a majority of Minnesota's individual market customers haven't used MNsure, in part because of the exchange's technical issues its first few years.
But most Minnesota insurance companies are now referring their customers to MNsure instead of trying to sign them up directly.
That's because only plans bought through MNsure are eligible for federal tax subsidies, and...
Plans could be spendy
Minnesota's individual market will have the nation's 13th-highest health insurance premiums this year. Just a few years ago Minnesota had among the cheapest premiums in the nation, but prices went up by an average of 59 percent this year.
Not everyone will see the full impact of these massive price hikes, though. People who earn less than 400 percent of the federal poverty line will qualify for tax subsidies under the Affordable Care Act to help them buy insurance. The subsidies are available to households earning up to $47,520 for an individual or $97,200 for a family of four.
With premiums running higher than $2,000 a month for some households depending on age and family size, these subsidies can make a big difference. For many people who qualify, the subsidies could blunt or negate altogether this year's big price increases.
But the roughly 124,000 Minnesotans on the individual market who earn more than 400 percent of the poverty line could have to pay the full cost themselves.
Help may be coming
Both Democrats and Republicans in Minnesota's divided government say they want to provide money to pay down insurance costs for people earning above 400 percent of the poverty line. But the two parties disagree on the specifics and are currently consumed by the final week of a bitter election battle in which health insurance is a major issue.
If lawmakers can strike a deal in the next two months, they could direct hundreds of millions of dollars in state subsidies to the individual market. But compromises have been hard to find among Minnesota's political leaders this year.
Even people who do manage to buy insurance and get subsidies may not be happy. In an effort to control costs, Minnesota's insurers have largely narrowed their networks. That means fewer doctors and hospitals will be available for discounted in-market prices.
Lots of shoppers
A big chunk of Minnesota's individual market has been pretty stable in recent years — people renewing their legacy plans each November.
But major insurer Blue Cross Blue Shield of Minnesota pulled out of the individual market this year after suffering huge losses linked to those legacy plans. That means 100,000 Minnesotans will have to find new coverage.
Major market problems
All the turmoil and price hikes reflect the fact that Minnesota's individual insurance market is in deep trouble. Compared with other states, Minnesota's market is a relatively small share of the state's population — just 250,000 people — and has a disproportionately large share of sick people.
That means insurers have paid out more in health costs than they've received in premiums, leading to this year's premium increases, enrollment caps and narrow networks.
Politicians of both parties say Congress and Minnesota's Legislature need to change health insurance law to stabilize the market. A number of long-term fixes are on the table and more will be considered in November.
But what kind of fixes, if any, get passed could depend on the outcome of the Nov. 8 elections.
Both Democrats and Republicans hope to take unified control of the currently divided state Legislature, which would give that party the ability to implement its health reform proposals. If control doesn't change, then Democrats and Republicans will still be forced to find compromise.