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Understanding Health
 Insurance

Get Care

If you feel your life is in danger, call 9-1-1 or go to an emergency room now

  • Talk to a nurse any time of the day or night for advice and treatment options.
  • A 24/7 online clinic can treat more than 60 common conditions like pink eye, sinus and bladder infections.
  • Many companies offer health and well-being programs to employees and usually employees don’t pay to participate. Even better, you may be rewarded for taking part.

ERs are the most expensive. Scroll down to find out how places to get care are different.

Planning ahead for treatments, procedures or surgeries? Need a new knee? Start by asking your doctor for specific information about the care you will receive. Ask for:

  • the technical name of the procedure you will be having
  • a list of tests you may need beforehand
  • a list of care you will likely need afterward

Can you return home right after surgery, for example? Do you need time getting therapy and care somewhere else before you return home. Sometimes, the only follow-up care needed is a visit to the doctor. Other times the surgery or procedure is just the start of the care you’ll need.

Talking to your insurer about what care you’re planning can help make sure everything goes smoothly and you get the best care.

Can’t find your card? Call the number below. Or tap on the company name print a card or download an app.

Knowing your cost up front is not always easy. Deciding how much it will cost to “fix” a person will never be like getting an estimate on the cost to fix a car. But your insurer can help you figure out how much of the bill you will have to pay.

The price you pay for care depends on the insurance you have and where you get care.

  • You and your insurer both pay for your care. How much you each pay depends on your specific policy.
  • Where you get care. Health insurance policies have different lists (networks) of doctor, hospitals and other health care experts. Get care in your network and you’ll probably pay less. Get care out of network and you’ll have to pay more. Also, there is a limit on how much you will pay in network. There is no limit for care that’s outside the network.
  • Ask your insurer. Policyholders can log in to get detailed information that isn’t available to others.
  • MNhealthscores, click on Cost of Services and Procedures circle
  • Main Street Medica, is open to all. It is general information. Call your health insurer for specific details.
  • Ask at work. Some employers have price information online or call centers available to their employees. Ask your human resources department for more information.

Call the place where you got the care and ask why it’s different than what you expected. Ask for a detailed bill. Call the number on the back of your insurance card and ask for help.

No health insurance policy will cover everything. Specific questions about what’s covered need to be answered by your insurer. It’s important to know:

  • You will have to pay for any products or services that are not covered by your policy, such as Lasik surgery to improve vision, cosmetic surgery and eyeglasses and contacts. To get price information for these, contact clinic or hospital directly.
  • Care that is not covered does not count toward the out-of-pocket maximum in your policy.

More is not always better—and that’s true when getting care, too. Sometimes it’s better wait to see if a health problem, such as back pain, improves on its own or with medication before deciding to have surgery.

In general, if your doctor recommends surgery, consider visiting another doctor to get a second opinion and consider your alternatives.

Choosing Wisely is information put together by doctors who specialize in treating common conditions such as sleeping problems, ear infections, knee problems, blocked arteries in your legs, prostate cancer, back pain and more. The doctors explain wise treatment choices and give you ideas to help you talk with your doctor and make better decisions about care for pink eye to end-of-life care.

The best advice we’ve heard is to work closely with your doctor to choose care that has been proven to work for patients like you, does not repeat other tests or procedures you have already had, won’t harm you and is truly necessary.

How do I know where to go when I need care? 

ER? Doctor’s Office? Urgent Care? Online?

How can you tell which option is best when you need care? Call a nurse for help. The phone number is on your health insurance card. They are available to help you day and night.

Unless you have a medical emergency, you will want to check which clinics and doctors are on your insurance policy’s network list.

In general, here is the difference among the different places to get care.

 

Fact: The price you pay for care is different across clinics even within your network. MN Community Measurement’s mnhealthscores.org website shows the same care can be three times higher at one clinic than another. Keep in mind the highest price does not equal the best quality and the most expensive treatment does not mean it’s the best care.

Get Insurance

Of course you want your insurer to help pay your medical bills, but what else should you expect for the premiums you pay each month? Help staying healthy.

Your insurer can help you:

  • Get doctor appointments
  • Make sure everyone who is caring for you works together when you have a serious illness or injury
  • Manage stress
  • Get active
  • Eat better
  • Stop smoking and chewing
  • Manage your weight
  • And more. Be sure to ask!

How to shop

  • Are you 65 or have a disability (as defined by the federal government)? If so, shop for Medicare.
  • Minnesotans under 65 can get insurance on their own in three ways: buy it through MNsure or directly from an insurer; or if you qualify, get Medicaid or MinnesotaCare.
  • Do you regularly take any prescription medications?
  • How many times a year do you usually get care? Are you someone who seems to get sick with strep throat or bronchitis or pink eye often?
  • How about something more serious like diabetes, COPD or other chronic conditions? How often to you get care for chronic conditions?
  • How much have your medical bills been in the past?

Would you rather pay more each month and less when you need care? Pay lower premiums each month but pay more of the medical bill when you’re sick or injured?
The answer to this question helps focus your search for policies labeled Gold, Silver or Bronze.

  • With policies that are called “Gold” you’ll pay more each month, but less when you get care.
  • With policies that are “Bronze” you’ll have the lowest monthly premium, but have to pay more when you need care.
  • Policies that are labeled “Silver” fall in between.

Here are topics to compare:

What policies include my doctor, clinic, hospital and pharmacy?
Insurers works with specific group of doctors, clinics, hospitals and others who provide care—it’s called a network. If you already have a doctor, hospital or clinic you want to keep, look for health insurance where its included. Usually, you pay less when you get care in network and more if your care is outside your network.

Does the policy cover me while traveling?
Some policies pay for general care when you’re away from home, others don’t. Care for true emergencies is often paid for wherever the emergency happens.

Does the policy work with a health savings account (HSA)?
This article does a good job explaining HSAs and how they work.

What does the policy include to help you get and stay healthy?

  • a 24-hour nurse line or online care?
  • how do the fitness center discounts work?
  • what kind of help is there to help you manage stress, quit smoking and eat healthy?

Now’s the easy part. Sign up. These days, in Minnesota, you don’t have to worry about an illness you already have or medications you take to stay well. All you have to do is fill out the forms and pay your first monthly premium.

Kinds of insurance

Nearly 94 percent of Minnesotans have some type of health insurance to help them get care and pay medical bills. Learn more about each kind.

Hospital, clinic and prescription medication insurance mostly for people 65 and older. Hospital is called Part A, Medical Part B and Prescription medications Part D.

You can get Medicare several general ways:

  • Medicare Advantage, you get hospital, clinic and medication with one card. You’ll also have help getting appointments and making sure everyone who cares for you works together. And you’ll often get things like a gym membership that isn’t available with Original Medicare.
  • Original Medicare, helps pay for care at hospitals and clinics. You buy help paying for prescription medications separately.
  • Supplement, or Medigap, policies are available from private companies to help you pay for part of your bill for care.

There are a lot of details. Like with any insurance policy, not everything is covered. You can learn more here.

The Minnesota Department of Commerce oversees health insurance Minnesotans buy on their own. Here’s where you can find more information. You can also contact the health insurers directly, they are listed to the right. MNsure is a good resource as well, and it’s where you can get federal help paying your premiums each month, if you qualify.

Most Minnesotans get their health insurance through work. If you have a question about the insurance you get through work, call the member services number on the back of your health insurance card. In addition, your benefits office if you’re in a large company or the person in charge of payroll (usually) can help answer questions as well. If you’re interested in how coverage through work looks like across the country, the Kaiser Family Foundation has understandable information.

Every day, health insurers spot gaps in care, ensure that people get appointments, arrange rides, coordinate medical care and community-based services, and do more to support more than 900,000 Minnesotans who get care through Medicaid and MinnesotaCare. By working with local insurers for the last 30 years, the state gets help solving problems, and makes sure people across Minnesota can get care.

  • Here is where you sign up. The sign up system will put you in the right kind of insurance. It depends on how old you are, where you live and how much money you make each month.
  • Here you can find a map of counties across Minnesota and what companies can help people get the care they need.
  • Here you can find information on each company, such as what state reviews have to say about the work, how satisfied current enrollees are with the care they get and more.

Minnesota’s public insurance options that combine Medicare and Medicaid are the envy of many health policy experts across the country. One kind of insurance, Minnesota Senior Health Options, is for people 65 and older who qualify for both Medicare and Medicaid.

Another kind of insurance, Special Needs BasicCare, is for people who live with disabilities.

Writers at HealthAffairs say that Minnesota’s approach is a model for the rest of the country. A recent evaluation , they said, of Minnesota Senior Health Options program, showed a 48 percent reduction in inpatient hospitalizations and a 26 percent reduction in the total number of hospital stays for patients who were hospitalized during the year. The researchers at Long Term Services and Supports rank Minnesota at #2 in the country on its work so far to improve services for older adults and people with physical disabilities, and their family care partners. Minnesota had been #1 for several years, but Washington took the top spot in the most recent ranking. Minnesota’s scores are worse than the national average on percent of people living in nursing homes who have low needs for care, and the percent of people with home health care who end up needing to be hospitalized.

Minnesota eared recognition for its work to reduce the chances of someone needed to be in a care facilities a long time after they were hospitalized.

Where to get insurance

Need health insurance and can’t get it through work? Here are some options from companies that work with us.

Help!
Free help is available

There are a lot of places online to get free help figuring out what kind of insurance may work best for you. You don’t have to buy from the organizations to use these tools:

Insurance navigators and brokers and help make getting insurance easier. Brokers are listed on health insurer websites and are paid by the insurer. MNsure also works with navigators and brokers.

Understanding Insurance

For most Minnesotans, you or your employer pays a premium each month. The insurance company pays medical bills with that money. If your bills are more than you’ve paid in premiums, your bills still get paid. That monthly payment also funds services highlighted below,

Medicare, Medicaid and MinnesotaCare work the same way. The federal or state government pays the insurer each month and the insurer pays medical bills and provide the help below.

Sometimes, employers pay medical bills with their own money. They hire health insurance companies to do administrative services such as sending out health insurance cards, contracting with doctors and hospitals and answering questions from employees. This kind of insurance is called self-funded.

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For most of us, rules for our health insurance are set in Washington, D.C., not in St. Paul.

While Medicare and Medicaid laws and the Affordable Care Act regulate almost all health insurance, some insurance is governed by state law as well.

Here’s how it works. Minnesota’s lawmakers have direct influence on the way health insurance works for:

  • about 25 percent of Minnesotans who get our health insurance through small “fully insured” employers or buy it on our own.
  • about 17 percent of Minnesotans who get our insurance through Medical Assistance, Minnesota’s name for Medicaid, or MinnesotaCare.

But health insurance for nearly 58 percent of Minnesotans does not have to follow state law. One category of insurance, offered mostly by large corporations, colleges and government, is called self-insured. That means the employer uses its funds, not an insurance company’s, to pay medical expenses. Federal, not state, laws govern this insurance. And of course the federal government sets the rules for Medicare, national health insurance.

How do you tell if your insurance through work is governed by Minnesota law? One clue is the insurance company’s name will be on your card, but probably not your employers. As always, call the number on the back of your card and ask questions.

Although your health insurer pays on average $792 for medical bills ever second, it does a lot more working behind the scenes to make care as affordable as possible, including:

  • Reducing our medical expenses by negotiating discounted rates with doctors, hospitals, and other providers of care; by preventing fraud and abuse; and by finding new ways to minimize paperwork and increase access to information
  • Protecting us from financial ruin if we are badly injured or become very ill
  • Providing information that helps us live healthier lives, manage our health troubles, and pursue our own wellbeing
  • Helping us stay well with preventive services, routine check-ups and incentives like health-club discounts
  • Helping us navigate health care choices with advice and support from caring nurses, pharmacists and other medical professionals
  • Improving the care we get by making sure it meets quality standards—and by creating new models of payment that pay people who provide care not for the quantity of service, but for the quality of our health
  • Keeping our communities well by working together with community organizations and activists to make social and environmental conditions healthier
  • Enabling businesses to keep their employees healthy, happy and productive

We need health insurance because we can’t pay for medical care alone. It’s impossible to predict when we’ll need expensive care. Insurance is there so if it does happen, you will get help paying medical bills.