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Minnesota Medicaid receives funding from the state and federal governments with the goal of providing healthcare for low-income families. MinnesotaCare provides coverage to those with higher incomes but no access to affordable plans from their employers. Both programs fall under the category of a Basic Health Plan and form the majority of the Minnesota Health Care Programs. According to healthinsurance.org, as of 2023, 1,395,209 Minnesotans were enrolled in the Minnesota Medicaid program.
Depending on eligibility factors, Minnesota residents of all ages can apply for one of the programs. This article discusses how to apply for the Minnesota health insurance programs, its eligibility requirements, coverage policies, common procedures, and more.
Minnesota Medicaid offers quality healthcare with accessible premiums. This guide discusses everything you need to know about the program, including eligibility requirements, coverage options, benefits, and the application process.
These federally and state-funded programs help extend coverage to low-income families or individuals over the age of 65 or who have disabilities. If you want access to quality healthcare without risking your financial future with high medical bills, consider using this information to compare Medical Assistance and MinnesotaCare with other private or third-party options.To prevent shouldering the debt of unexpected medical expenses, many Minnesotans extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
An MHCP card functions as an ID proving you’re a member of one of the state’s healthcare plans and providing you with a group number. You use your number to access benefits at any approved healthcare provider and pharmacy. Always keep your member ID card with you in case you need emergency medical services.
You can apply for Medical Assistance through the MNsure.org website, at your local tribal or county office, or at the state’s Department of Human Services office. State law mandates that informational materials are available to all community healthcare providers and local service agencies.
You can also print online applications.
Who is eligible for a Minnesota Health Care Program? Minnesota residents must prove their residency, U.S. citizenship, or qualification as a noncitizen and provide a Social Security number for each person covered under the plan. They must also meet the income limit, which depends on your age, family size, and disability or pregnancy status.
The Department of Human Services provides the following guidelines concerning income limitations:
Parents and children (including pregnant women), qualifying individual adults, individuals over the age of 65, or people who are blind or have disabilities are all encouraged to apply for Minnesota Health Care Programs membership. If you are an employed person with a disability, you may qualify for coverage if you’re certified disabled, earn more than $65 per month at your job, have no more than $20,000 in countable assets, and pay a monthly premium of $65.
All applicants accepted into the Medical Assistance program automatically receive a card through the mail once the state processes their application. If you need healthcare before you receive your card, your provider can use the PMI number shown on your acceptance letter. New member information can be reviewed here in order to gain access to the member help desk, what to show your doctor or your pharmacist and more frequently asked questions.
To replace a lost or damaged card, log in to your account on the Medicaid Management Information System and follow the instructions. In most cases, you won’t pay to replace your card, which remains valid as long as you continue receiving coverage. The card doesn’t require renewal, even though you must prove your eligibility every year.
Are you wondering what MinnesotaCare covers compared to what Medical Assistance covers? Both policies provide for generally the same services. The plans pay for any procedure deemed:
Minnesota Health Care Programs cover medically necessary dental procedures for eligible MinnesotaCare members. Most people covered through Medical Assistance can receive the following services:
The program does not cover services commonly provided through other procedures or those deemed unnecessary, such as cosmetic treatments. Always ask your dentist whether they accept Medicaid to ensure you’re covered. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Minnesota is advisable.
While the federal government dictates most of the program’s drug coverage, the state discusses its policies in the Pharmacy Service Limitations section of the manual.
The state offers the following supplement prescription drug programs:
Medical Assistance generally covers pharmacist-administered immunizations and vaccines, physician-prescribed or administered drugs for outpatient treatment, and pharmacist-prescribed over-the-counter medications. The program does not cover medications for things such as erectile dysfunction, homeopathic remedies, and medical cannabis, among others. For more information, consult the Drug Categories with Limited Coverage and Preferred Drug List resources.
Minnesota Medicaid and MinnesotaCare provide several options for extended healthcare for individuals with special needs, including:
While the extended health care benefits available through Minnesota medicaid are comprehensive, they are certain limitations in terms of coverage. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Minnesota Health Care Programs cover both emergency and nonemergency medical transportation within the state, including mileage reimbursement for personal vehicles or a public transportation pass, provided you notify them within five days before requiring transportation.
The MHCP covers emergency medical coverage outside the state with the following eligibility requirements:
If you are traveling outside of Minnesota for leisure, it is highly recommended to invest in proper travelers insurance.
While Minnesota Medicaid doesn’t explicitly cover students, any individual under 21 whose parents receive coverage can also enroll under the same policy. Individuals over the age of 65 are also eligible, provided they meet the asset limit.
A senior who, after screening, requires a long-term nursing facility level of care can have their expenditures covered by the MHCP. When Medical Assistance covers room and board at a certified facility, it includes aid for things like laundry, dietary service, nursing, personal hygiene items, and over-the-counter medications like ibuprofen, cough syrup, and antacids.
Seniors who require long-term help but not at the level required of a nursing facility can utilize the Essential Community Supports service.
The Minnesota Health Care Programs offer no special coverage for subgroups such as indigenous people or those who’ve served in the military outside their coverage under the Department for Veterans Affairs. The primary indicators of whether you qualify for Medical Assistance are your age and income, regardless of other demographics. However, under the Tribal and Federal Indian Health Services, specific tribal-based health providers can apply for a special designation as Federal Indian Health Services to have their facilities included within the MHCP network.
You can better understand the question “What is MinnesotaCare coverage?” by knowing what the plan doesn’t cover. The following services are explicitly not covered under any of the Minnesota Health Care Programs:
Funerals are not covered by Minnesota medicaid. In fact, “Minnesota law prioritizes payment of the decedent’s “reasonable funeral expenses” before MA claims. In probate, reasonable funeral expenses are paid from the estate before you can recover MA payments from the estate” For this reason and considering the rising cost of burial and funeral related fees, ensure that your family is secured with comprehensive funeral insurance.
For more details on covered services and their limitations and requirements, read the Minnesota Department of Human Services Provider Manual.
With so much technical language and a large amount of information, many people feel confused when seeking coverage information. What follows is a breakdown of the most common medical procedures and to what extent Medical Assistance covers them.
| Dental | |
|---|---|
| Exams | Yes, concerning dental care, MHCP covers one periodic exam per calendar year, one limited exam per day (to treat a specific, medically necessary oral health problem), and a comprehensive exam every five years. To qualify for coverage, the exams cannot occur on the same day. |
| X-Rays |
Yes, Medical Assistance covers the following X-rays and diagnostic imaging:
|
| Extractions | Yes |
| Tooth Root Removal | Yes |
| Wisdom Teeth | Yes, but for impacted wisdom teeth, your dentist must seek authorization for coverage |
| Vision | Minnesota’s Medical Assistance program covers several optical services. |
|---|---|
| Eye Exams | Yes, the policy covers comprehensive and intermediate vision examinations, provided they’re medically necessary and meet the coverage criteria. |
| Glasses |
You are not required to seek prior approval for eyeglass coverage, and the program pays for them, along with their related supplies, if they meet the following requirements:
|
| Contacts | MHCP also covers contact lenses when they’re prescribed for medically necessary conditions such as aphakia, keratoconus, or aniseikonia. Your provider can seek authorization for additional coverage if you need contact lenses for other reasons. |
| Laser Eye Surgery | The Provider Manual makes no mention of laser eye surgery, and most insurances don’t cover it. However, if you require a medically necessary procedure that doesn’t qualify as experimental or investigative, your provider could make a case to include it within coverage. |
| Surgery | Two common surgical procedures are rhinoplasty and breast reduction. However, the Minnesota Department of Human Services Provider Manual doesn’t mention either of these specifically. |
|---|---|
| Rhinoplasty | The program might cover a rhinoplasty when deemed medically necessary, such as to repair a deviated septum that obstructs breathing or causes sleep issues. It does not cover cosmetic rhinoplasty. |
| Breast Reduction | While MHCP doesn’t cover breast reductions for aesthetic purposes, it may provide coverage when deemed medically necessary after a gender dysphoria diagnosis or to correct or prevent skeletal or muscular complications due to large breasts. |
| Hospital | |
|---|---|
| Hospital stays | When you require a hospital stay for a medically necessary procedure, the MHCP covers inpatient (greater than a 24-hour stay) and outpatient (less than a 24-hour stay) options, including room, board, and other necessary professional services. |
| Ambulance transportation | The program covers ambulance transportation in response to a 911 emergency call, police or fire department call, or an emergency call from your healthcare provider. It may also cover the transportation of an infant from a NICU ward to another hospital or when a hospital discharges a patient because they lack the necessary level of care to treat the patient. |
| Giving birth | A newborn whose parent(s) enrolled in MHCP prior to their birth receives retroactive enrollment within the same month, with some exclusions. Providers must submit separate claims for the mother and the newborn to receive full coverage. |
Minnesota Medicaid covers several necessary mental health services, including:
This list is far from exhaustive, so check the mental health section of the provider manual for more details.
| Sexual Health | |
|---|---|
| Gynecologist visits | MHCP provides for all medically necessary gynecological procedures, including breast and cervical cancer screenings, annual wellness checks, and routine doctor’s visits during pregnancy. |
| Erectile Dysfunction | MHCP does not cover treatment or medication for erectile dysfunction. |
| Birth Control | Medical Assistance covers several forms of family planning and birth control products, including diaphragms and IUDs, contraceptive injections, emergency contraception (Plan B), condoms, and voluntary sterilization. |
| Fertility Treatment | The program limits its fertility treatment coverage to the diagnosis and treatment of infertility causes (such as an ovarian tumor or testicular mass) but doesn’t cover any form of artificial insemination, fertility drugs, or the reversal of voluntary sterilization. |
| Specialist Services | |
|---|---|
| Dermatology | MHCP provides coverage for medically necessary dermatology appointments, such as a diagnostic biopsy for skin cancer or certain acne treatments. |
| Physiotherapy | Physical therapists cannot enroll in MHCP. However, the program reimburses certain physiotherapy expenses when medically necessary and provided by a qualified physical therapist. Talk to your provider before receiving treatment. |
| Massage Therapy | MHCP groups massage therapy under its acupuncture coverage. It covers the service to treat certain conditions, such as acute and chronic pain, mental health disorders, menstrual disorders, and insomnia. It does not cover elective acupuncture therapy that treats conditions such as weight loss, acne, high blood pressure, or fatigue. |
| Podiatry and Foot Care | MHCP covers certain podiatry services, including removing infected toenails, evacuation of subungual hematomas, excision of a nail and the nail bed, reconstructing the nail bed, and other non-routine foot care. The program does not cover routine care, such as foot hygiene, treatment for flat feet, or orthopedic shoes not attached to a leg brace. |
| Allergy Testing | The Medical Assistance program covers several forms of allergy testing, including physician-ordered allergen immunotherapy services, allergy testing resulting from clinically significant symptoms when conservative therapy has failed, and pharmaceutical inhalants. It does not cover investigative tests and treatments, including a P-K Test, Rebuck skin window test, or IV vitamin C therapy. |
| Sleep Physician Services and CPAP Machines | The Minnesota Health Care Programs cover sleep testing conducted in a laboratory and attended by a qualified sleep specialist. Home sleep tests are not covered except in cases where the patient cannot attend a sleep lab. The program covers CPAP devices when prescribed by a qualified medical professional for an eligible condition. |
At Insurdinary, we know that finding the best medical coverage feels overwhelming. You can expand your healthcare coverage by pairing Medical Assistance with other third-party or private insurance policies in a practice called “coordination of benefits.” Examples include no-fault car insurance, workers’ compensation, and Medicare.You can use private insurance providers to fill the gaps in your AHCA Florida Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
Do you want to find the highest-quality healthcare insurance with the best premiums and lowest out-of-pocket expenses? Insurdinary is here to help.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
