Premium: What you pay monthly for your insurance
Deductible: The amount you pay before insurance starts to cover services
Out-of-Pocket Max: The most you’ll pay in a year before insurance pays 100%
Copay: A fixed amount (e.g., $30) for certain services
Coinsurance: The percentage you pay for services after your deductible (e.g., 20%)

Q: Who should I include in my household income estimate?

A: You should include all members of your taxable household—those you include on your tax return. This includes:

• Yourself
• Your spouse (if you file jointly)
• Dependents (even if they are not applying for coverage)

Do not include roommates or anyone you live with who is not part of your tax filing.

Q: What’s the difference between a small and large network?

A:

• Smaller networks usually have fewer providers and lower premiums.
• Larger networks offer more provider access but often have higher monthly premiums

Q: Will my plan cover Mayo Clinic services?

A: In most cases, Mayo Clinic is out-of-network and does not accept private market coverage.

Q: Am I covered if I travel or live part-time out of state?

A: Yes, but only for emergencies — you are covered until you are stable at in-network rates.
For non-emergency services, most plans offer limited or no out-of-network coverage.

Out-of-Network Examples:

• UCare: $15,000 OON deductible, 50% coinsurance, no max out-of-pocket
• BCBS/HP: $20,000 OON deductible, 50% coinsurance, no max out-of-pocket
• Medica: Emergency-only out-of-state coverage

Q: What’s the difference between enrolling on-exchange and off-exchange?

A:

• On-Exchange (via MNsure): May qualify for financial help (APTC)
• Off-Exchange (direct with insurer): Same plan options, but no financial assistance

MNsure offers tools to compare plans and apply for subsidies.

Q: Should I consider COBRA?

A: Yes, if you:

• Want access to Mayo Clinic
• Travel frequently or need national coverage
• Value comprehensive benefits similar to your employer plan

Check with your benefits coordinator to confirm COBRA eligibility

Q: What are the metal tiers in health plans?

A:

• Catastrophic: Under age 30; very high deductibles, lowest premium
• Bronze: Low premium, high out-of-pocket
• Silver: Moderate premium and out-of-pocket costs
• Gold: High premium, low out-of-pocket

Q: Can I contribute to an HSA?

A: Only if your plan is HSA-compatible.

• You can use HSA funds for deductibles, copays, and medical services
• You cannot use HSA funds for your monthly premium

Q: Can I use HRA funds for premiums?

A: Yes, but if you use an HRA to pay premiums, you will not be eligible for a tax credit through MNsure. You can only use one type of financial help.

Q: How do I know if I qualify for premium help?

A: MNsure compares your estimated Modified Adjusted Gross Income (MAGI) to the average cost of a Silver plan.

If your premiums exceed 8.5% of your income, you may qualify for a tax credit.

Q: Can I get a tax credit if I have employer coverage?

A: Only if your employer plan is considered unaffordable.

Use this tool to check:

Q: Can I apply outside of Open Enrollment?

A: Yes, but only if you have a Qualifying Life Event (QLE), like:

• Loss of job-based coverage
• Divorce
• Birth/adoption of a child

Also, a new SEP is available if you’ve already filed taxes.

Q: Where can I get help with small business health plans?

A: Contact Slate Small Business Solutions:

612-354-2917
support@slatesbs.com
https://www.slatesbs.com/
Hours: Monday – Friday, 9 am – 4 pm

Q: Do I qualify for free or low-cost coverage through the state?

A: You may qualify based on income for:

• Medical Assistance (MA)
• MinnesotaCare (MNCare)

Apply through MNsure with financial assistance or directly contact your county.