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Facts and Figures

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State Government Insurance Programs Offered

Minnesota Comprehensive Health Association (MCHA) (Listed under “Pregnant Women, Children & Families”) Nutrition education and services; breastfeeding promotion and education; monthly food prescription of nutritious foods; access to maternal, prenatal and pediatric health-care services. Eligibility: Must live in Michigan and have a nutritional need determined by WIC staff. Must be a child under 5, a new mom, or a pregnant or breastfeeding woman. Income limit is 185% FPL.

Pre-existing Condition Insurance Plan (PCIP)

Run by the U.S. Department of Health and Human Services Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Must have been uninsured for at least 6 months prior to applying. Must prove being a U.S. citizen or legal U.S. resident, a Minnesota resident, and having problems getting insurance due to a pre-existing condition.

Medical Assistance (Medicaid) Clinic and physician, immunizations, ambulance, emergency room services when used for emergency care, inpatient and outpatient hospital care, lab, x-ray, family planning, pregnancy related services, nurse midwife, medical equipment and supplies, hearing aids, physical, occupational, speech, respiratory and rehabilitative therapy, transportation, mental health services, alcohol and drug treatment, prosthetics, nursing facilities, home health services, hospice, and more. Pre-Existing Health Conditions Covered Must be U.S. citizens or qualified aliens and live in Minnesota. Income limits for the following: Pregnant women: 175% FPL. Children ages 0–1: 280% FPL. Children ages 2–18: 150% FPL. Children ages 19–20: 100% FPL. Parents & relative caretakers with children under 19: 100% FPL. Parents, legal guardians, foster parents and relative caretakers with children under 21: 275% FPL. Adults without children: 75% FPL. Aged, blind and disabled: 100% FPL. Medically-needy singles: $677 monthly income with asset limit of $3,000; couples with monthly income of $911 with asset limit of $6,000. Limited assets such as cash, savings, stocks and bonds (except for pregnant women and children). Disabled are allowed to “spend down” for eligibility.

Sage Screening Program (Search: Sage) Breast and cervical exams, Mammogram screenings, Pap smears and diagnostic services. Minnesota women with no insurance or whose insurance does not cover what Sage Screening provides. Income limit: 250% FPL. Must be age 40 or older. If younger than 40 and is determined by a clinician to be at elevated risk for breast cancer, Sage will cover her office visit and mammogram. If further follow-up is needed, the woman could also have a diagnostic mammogram, breast ultrasound, or outpatient breast biopsy.

Women-Infant- Children (WIC) (Search: WIC) Nutrition education and services; breastfeeding promotion and education; monthly food prescription of nutritious foods; access to maternal, prenatal and pediatric health care services. Must live in Minnesota, have a nutritional need as determined by WIC staff, be a child under 5, a new mom, or a pregnant or breastfeeding woman. Income limit of 185% FPL.

MinnesotaCare Dental services, doctor and health clinic visits for preventive and non-preventive care, emergency room visits, inpatient hospital coverage. Must be U.S. citizens or qualified aliens and live in Minnesota. Must have been uninsured in the last 4 months unless the insurance was Medical Assistance or paid for more than 50% of premium of employer-based insurance. Income limits for the following: Adults without children: 250% FPL. Parents of children under 21, pregnant women, and children under 21: 275% FPL.

Medicare - Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. is a Medicare counseling service. Pre-Existing Health Conditions Covered Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age

Health Coverage tax Credit (keyword: HCTC) Inpatient and outpatient care (lab tests, x-rays, etc.), Doctor visits, Preventive and major medical care (surgery, physical therapy, Durable medical equipment, etc.), Mental health and substance abuse care, and Prescription drugs Must be receiving TAA (Trade Adjustment Assistance), or Must be 55 years or older and receiving pension from the Pension Benefit Guaranty Corporation (PBGC). Must not be enrolled in certain state plans, or in prison, or receiving 65% COBRA premium reduction, or be claimed as a dependent in tax returns. Must be enrolled in qualified health plans where you pay more than 50% of the premiums.

Heath Care Reform

Small business tax credits.  94,900 small businesses in Minnesota could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 63,700 Medicare beneficiaries in Minnesota hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Minnesota who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.

Support for health coverage for early retirees. An estimated 65,400 people from Minnesota retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 3.5 million Minnesota residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 356,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Minnesota peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 3.1 million residents of Minnesota with health insurance from their employer, along with anyone who signs up with a new insurance plan in Minnesota.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 11,400 individuals in Minnesota who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $68.2 million federal dollars are available to Minnesota starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 76 Community Health Centers in Minnesota but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 5% of Minnesota’s population who live in an underserved area.

New Medicaid options for states. For the first time, Minnesota has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

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