The political rhetoric has been much more substantial than changes coming to Minnesotans' 2018 health plans.

The federal Affordable Care Act, known to most Americans as Obamacare, remains the law of the land. Although Minnesota officials have made some changes they say will help their constituents, most people probably will not notice a huge health insurance change.

Most of the Minnesota tweaks came during the 2017 state legislative session, with the Republican-controlled Legislature passing them and Democratic Gov. Mark Dayton agreeing to many of the changes.

Individual health insurance policies for 2018 go on sale at 8 a.m. Wednesday, Nov. 1, with state and federal money being used to keep premiums in check.

Here is a look at where health insurance stands in Minnesota:

Individual policies

By far the most attention is focused on the 4 percent of Minnesotans who buy their own insurance policies.

Nearly everyone else is served by employer-provided insurance or government-funded programs, such as MinnesotaCare and Medical Assistance (the Minnesota version of Medicaid).

Like in the past few years, individual 2018 policies may be purchased starting Wednesday from private insurance agents or state-operated MNsure.

For many in the individual market, 2018 prices will be close to what they pay this year. Some actually will see lower rates after massive increases hit them a year ago.

The Legislature and governor agreed early this year to provide 25 percent rebates to individual insurance policy customers who did not receive federal subsidies. Those end at year's end, but a new financing mechanism is in place to reduce premiums 20 percent from what they otherwise would have been.

Beyond reinsurance, many Minnesotans can qualify for federal aid to reduce premiums, but only if they insurance buy from MNsure. For instance, individuals who earn up to $48,240 annually and families of four earning up to $98,400 qualify.

Residents of most Minnesota counties will have at least two insurers providing policies, although only Medica will sell in Kittson, Roseau, Lake of the Woods, Todd and Meeker counties.

One of the big concerns in 2017 was that some plans greatly limited in-network health provides. A new law requires every plan to include more than one provider system, an effort to make sure patients can have access to a nearby doctor or have a choice.

Many people who opt for MNsure enroll via its website, but others prefer to deal with face-to-face with person. For that, people may go to the MNsure website or call to find "navigators" who provide free assistance.

For more information on buying individual policies, Minnesotans may contact their private insurance agents or online or call (855) 366-7873 or (651) 539-2099. MNsure telephone hours are 8 a.m. to 6 p.m. weekdays and 10 a.m. to 2 p.m. Saturdays.

While most states end enrollment in mid-December, Minnesota enrollment continues through Jan. 14. However, for new policies to begin Jan. 1, MNsure says patients must be enrolled by Dec. 20.

Agriculture cooperatives

Two organizations are taking advantage of a new law that allows cooperatives to provide insurance to farmers.

A group formed just to provide insurance, 40 Square, has held meetings throughout the state in recent weeks, and organizer Jeff Nielsen said they give him confidence that at least 500 policies will be issued, the number needed to make the project financially feasible. Many times that are possible, he added.

Any farmer may join 40 Square for $100, and be eligible to buy health insurance beginning Wednesday. Members must have tax documentation proving they are farmers and each must employ at least one person, perhaps a spouse. Nielsen said accountants say there should be little trouble getting tax and employee documentation for most farmers.

While 40 Square is open to any Minnesota farmer, the Land O' Lakes dairy cooperative is launching its own insurance program for members.

Farmers long have said they have difficulty getting health insurance, which has forced many farmers to get a job in town so they can be insured.

Government programs

Health coverage provided by governments is little affected by new laws.

The MinnesotaCare state insurance program for low-income workers lost millions of dollars in expected federal funding, which could put it in danger for 2019. But the Dayton administration says it has enough state money to cover the shortfall in 2018.

MinnCare and Medical Assistance (what Minnesota calls Medicaid) remain basically the same as this year.

The federal Medicare program, generally for people 65 and older, is not affected by new state laws.

Other issues

• An insurance program for small businesses run through MNsure is experiencing a relatively mild premium increase for 2018.

• A new state law removed some barriers for small businesses self-insuring.

• The country's largest health insurance company, Minnesota-based United Healthcare, has said it plans to take advantage of a new state law and begin offering policies through Minnesota employers. While state officials say United is not yet licensed in the state, it would break a long-standing ban on for-profit health maintenance organizations operating in the state.

• A new Minnesota law is designed to protect patients from surprise bills. State officials say they have heard stories that a patient may be scheduled for a procedure by a provider in an insurance policy's network, but an anesthesiologist or other provider is used who is from another network and whose costs are not well covered by the policy. The law requires patients to be notified of potential out-of-network charges.