Minnesota Medicaid (Medical Assistance MN) and MNCare: Ultimate Guide

The Medicaid program in Minnesota is more commonly referred to as the Minnesota Medical Assistance program. Minnesota also has a special program called MinnesotaCare for people who don’t quite meet the eligibility requirements for Minnesota Medicaid but still require assistance paying for medical bills. This guide can help you determine whether or not you are eligible for either program and what services you can have covered.

Click below to learn more about Minnesota Medicaid:

• MN Medicaid Coverage and Costs
• MinnesotaCare Coverage
• How to Apply for Minnesota Medical Assistance and MinnesotaCare
• How to get Both Medicare and Medicaid in Minnesota

MN Medicaid Coverage and Costs

The MN Medicaid program is usually referred to as the Minnesota Medical Assistance program. It’s a very comprehensive program, but keep in mind that in some cases, a doctor will have to prove that your treatment is medically necessary and submit it to Medicaid for approval before you can receive coverage for that treatment.

Costs are very limited for this program. Some adults may need to pay a monthly deductible of less than $3 before receiving full coverage. Copays are usually $0 or $1 and are never more than $3.50. Kids, pregnant women, care facility residents, those in hospice, and those in the breast/cervical cancer program will not owe any copays. Every month, your out-of-pocket maximum will be 5% of your monthly household income.

Coverage includes treatments and services related to:

• Alcohol and substance abuse
• Chiropractic care
• Dental (for kids and pregnant adults only)
• Emergency room visits
• Eyeglasses
• Family planning and birth centers
• Hearing
• Home services
• Hospice
• Hospital (inpatient + outpatient)
• Immunizations/vaccinations
• Labs and x-rays
• Medical equipment
• Medical transportation (emergency and non-emergency when necessary)
• Mental health
• Nursing homes/care facilities
• Surgeries
• Prescriptions
• Rehabilitative therapy
• Urgent care

Mental Health and Addiction Treatment

The Minnesota Medicaid program takes mental health treatment very seriously. It’s often a benefit that is forgotten about because mental illnesses are not always conditions you can “see.” However, treatment for mental health concerns is just as important as physical health treatments. These are some of the care options you can receive through Minnesota Medical Assistance:

• Adult Rehabilitation Facilities (medication, intervention, peer specialists, practice with living and social skills, transitions to community living)
• At-home Assertive Community Treatment (symptom management, employment/housing/finances/education coaching, dental care, substance abuse care, etc.)
• Certified Community Behavioral Health Clinics
• Certified peer specialists
• Crisis response teams
• Day treatment
• Dialectical Behavioral Therapy (therapy, group skills training, coaching, etc.)
• Employment services
• Inpatient and outpatient hospital treatments
• Psychosis treatment (for schizophrenic episodes, etc.)

Minnesota Medicaid Income Limits

To qualify for Minnesota Medicaid, you must legally live in the state of Minnesota and meet the following income limits:

MinnesotaCare Coverage

MinnesotaCare is a program for those who don’t quite meet the eligibility standards for Minnesota Medicaid but still need help paying for medical services. It covers most of the same benefits that the Medicaid program covers, but to a slightly lesser extent. Eligibility is still based on income, but the limits are a bit higher. You also must legally live in the state of Minnesota, must not be incarcerated, and must not be eligible for Medicare. This chart can help you determine whether or not you are eligible for MinnesotaCare based on your income.

MinnesotaCare Payments and Premiums

MinnesotaCare covers most of the same benefits as Minnesota Medical Assistance, but the Care program requires more out-of-pocket spending. There is a $2.95 monthly deductible, and then you’ll pay the following copays:

• $6-$20 for prescriptions with a max out-of-pocket cost of $60 per month (some drugs might have a $0 copay)
• $15 for non-preventative doctor visits, except for mental health
• $25 for eyeglasses
• $25 for radiology
• $25 for outpatient hospital visits
• $50 for ambulatory surgeries and ER visits
• $150 for inpatient hospital stays

How to Apply for Minnesota Medical Assistance and MinnesotaCare

The Minnesota Medical Assistance application and the MinnesotaCare application can be found within MNsure, the health insurance marketplace for the state of Minnesota. If you are denied for Medicaid, you may be referred to MinnesotaCare. You’ll need to start by creating an account with MNsure. Then, select the application that includes financial help. You can also print and mail in the MNsure paper application instead of using the online service, but the online application is faster.

If you are over 65, disabled or blind, only need help with Medicare costs, or receive additional benefits like SSI, you should apply using this physical application instead. If you don’t have a way to print your application, you can call 800-657-3739 to have one mailed to you, or you can go to your local county office.

How to Get Both Medicare and Medicaid in Minnesota

If you meet the eligibility requirements for MN Medicaid and are eligible for Medicare, you can benefit from both programs! In fact, you may be eligible for a Dual-Eligible Special Needs Plan, or DSNP. DSNPs are Medicare Advantage plans designed specifically for people who benefit from both Medicare and Medicaid. Most people with a DSNP won’t pay anything for their Medicare coverage.

For help finding out if you qualify and for help selecting a Dual-Eligible Special Needs Plan, complete this form, and we’ll have one of our licensed  agents reach out to you ASAP.