Health insurance experts have a warning for people looking to buy insurance on the individual market — act quickly.
"You can't procrastinate. You've got to get started," said Michael Pagelkopf, owner of John W. Pagelkopf Agency.
Open enrollment for the individual health insurance market kicks off today. Southeast Minnesota consumers will once again face the highest premiums in the state. On top of that, there will be fewer plans to pick from and — for the first time — a limit on the number of people that can enroll in certain plans. That matters, because only one plan being offered in the region has Olmsted Medical Center in-network.
Step one — go to MNsure
Pagelkopf's first piece of advice to clients is for them to go to the website MNsure.org and figure out if they qualify for a tax credit. Even if someone thinks they won't qualify, he said it is important to make sure because health premium costs have skyrocketed.
"You need to get in there, put those numbers into the system so it tells you yes you do or no you don't. They can't guess about it," he said.
Tax credits are only available through MNsure, the state-run health insurance exchange. People with incomes up to 400 percent of the federal poverty level qualify for tax credits. That means individuals with an income of up to $47,520 and a family of four with an income of up to $97,200 would qualify.
Don't let sticker price scare you
One of the most confusing aspects of the Affordable Care Act is that just because premiums are going up doesn't mean consumers will pay more. In fact, people who qualify for tax subsidies could actually end up paying the same amount as last year — or even less, said Denise Robertson, a senior navigator with Health Access MN.
"We're finding that a big part of our job is education to help people understand that when insurance premium rates go up, tax credits go up also," Robertson said.
According to MNsure, more than 100,000 Minnesotans who were eligible for tax credits in 2016 did not get one because they failed to enroll via MNsure.
Want Olmsted Medical Center coverage?
Only one insurance plan offered by Medica has Olmsted Medical Center in-network. That is Medica Applause. The insurance company is offering a second plan in the region called Medica with Mayo Clinic. That plan includes Mayo Clinic in Rochester and Mayo Health System facilities. It does not have Olmsted Medical Center in network.
The only way to sign up for these Medica plans this year is via MNsure. Blue Cross/Blue Shield's Blue Plus plan being offered in southeast Minnesota includes Mayo Clinic in Rochester and Mayo Health System facilities.
What's this I'm hearing about enrollment caps?
Faced with what Minnesota Department of Commerce Commissioner Mike Rothman called "an emergency situation," regulators agreed to allow all insurers who offer plans in the individual market — except for Blue Plus — to limit enrollment. The move came amid a threat of the collapse of the individual market after all the insurers threatened to leave. In June, Blue Cross and Blue Shield of Minnesota announced it was leaving the market, affecting about 103,000 Minnesotans.
In southeast Minnesota, that means enrollment for Medica plans is capped at 50,000. There are about 43,000 people currently enrolled in Medica plans.
What if I don't qualify for a tax credit?
That is a tough spot to be in and one Gov. Mark Dayton and lawmakers say needs to be fixed. With insurance rates set to increase by 50 percent to 67 percent next year, these consumers are faced with massive increases.
Only about 5 percent of Minnesotans buy health insurance in the individual market. Of those consumers, half are expected to qualify for tax credits. But that provides little comfort for the remaining 2.5 percent of Minnesotans who are stuck with hefty health insurance costs.
Take the case of Michael Tangen of Fountain. He is single and 56 years old. The cost of his Medica plan is slated to jump by 67 percent next year with a monthly premium of nearly $900 a month and an annual deductible of $6,800.
"I'm pretty much stuck between a rock and a hard spot," he said. "As a single person, if I get sick this year, it's $17,564 out of pocket before the insurance pays anything."
Lawmakers on both sides of the aisle say they want a special session to help consumers buy insurance who do not qualify for tax credits. Dayton recently proposed a 25 percent health insurance rebate to help with the high costs. The big question is whether legislative leaders and the governor can reach a deal.
In the meantime, consumers like Tangen are in limbo.
"I really don't know what to do. I'm extremely frustrated. Nobody seems to have an answer," he said.
Experts recommend getting help
Given how complex shopping on the individual exchange has become, experts recommend consumers reach out for help when making decisions about plans.
"I am really encouraging people across the state to get help this year, make sure they are making the right decision," said MNsure CEO Allison O'Toole.
Individuals can find certified navigators and brokers via MNsure that provide free, in-person help. Simply go to MNsure.org and look at the Assister Directory, under the "Get Help" tab of the website.
In Rochester, Health Access MN will have navigators at the Rochester Public Library from 9:30 a.m. to 4 p.m. on Saturdays (except holidays) from now until the end of January. Individuals can also call 589-8649 for an appointment. Somali and Spanish interpreters are available to assist consumers. Individuals can also call the MNsure Contact Center for help at 1-855-366-7873. The center is open Monday through Friday from 8 a.m. to 6 p.m. and Saturdays from 8 a.m. to noon.
When does open enrollment end?
Open enrollment in the individual market ends Jan. 31. Consumers who want coverage to start Jan. 1 must enroll in a plan by Dec. 15.