What to know about enrollment caps on Minnesota health insurance plans

Oct. 20--To avoid being locked out of the health plan they want, Minnesotans buying insurance on the individual market will need to shop early next month.

That's because all but one of the plans selling insurance on Minnesota's individual market have set enrollment caps -- and could fill up in a matter of weeks.

"The choices are going to be so incredibly limited," said Heidi Mathson, past president of the Minnesota Association of Health Underwriters, which represents insurance agents and brokers. "I think those caps are going to be met very quickly."

This means options for health insurance could narrow to one or two choices soon after the open enrollment period begins Nov. 1. In Greater Minnesota this is particularly likely because many counties outside of the Twin Cities metro have fewer options to begin with.

Here is what you need to know about how these enrollment caps will affect open enrollment:

WHO'S AFFECTED

The enrollment caps apply to Minnesota's individual market, which currently covers about 5 percent of the state's residents. It doesn't apply to people who get insurance from their employer or from a government program such as Medicare, MinnesotaCare or Medical Assistance.

The caps apply on a statewide level for each plan, not on a county-by-county basis. They affect people whether they buy insurance directly from an insurer or through the state-run MNsure exchange at mnsure.org.

WHAT ARE THE CAPS?

UCare is capping its enrollees at 30,000, which is 14,000 more than its 2016 enrollment of around 16,000.

Medica's cap is 50,000, which is 7,000 above its 2016 enrollment of 43,000.

HealthPartners will accept up to 72,000 people, 6,100 above its current enrollment of 65,900.

Altogether the four plans will accept 152,000 total enrollees, which is 27,100 above their 2016 enrollment.

These caps can't be lowered, but plans can decide during the open enrollment process to increase their caps above what they've already agreed to.

One plan, the narrow-network HMO Blue Plus, is not capping its enrollment.

WHAT IF I ALREADY HAVE INSURANCE?

Current customers of an insurance plan on the individual market have priority under the caps AND will be able to renew their current plan regardless of how many new people sign up.

These current customers can also switch insurers. If they do, then their spot under their current plan's enrollment cap will be opened up for new customers.

HOW IT WORKS WHEN A PLAN HITS ITS CAP

Customers won't be in a situation where they sign up for a plan but are then told that plan is actually not available because it hit a cap.

Instead, plans that have hit their cap will be removed from MNsure overnight once the exchange has been notified that the plan is no longer available. People who sign up for insurance after the plan has reached its cap but before it's been removed will still get their insurance. This means plans will likely slightly exceed the caps before being removed.

WHAT HAPPENS AS OPTIONS NARROW

In almost every Minnesota county, the uncapped Blue Plus program will have plans available even after all other insurers reach their caps -- though Blue Plus may have fewer or different provider options than other insurers in the market.

Blue Plus isn't available in five Central Minnesota counties: Stearns, Benton, Morrison, Mille Lacs and Crow Wing. That means those counties only have plans with caps available.

Assistant Commerce Commissioner Peter Brickwedde said Wednesday that the department doesn't expect people in those five counties to be shut out of insurance by the caps, but promised that if this does happen, Commerce would "work with carriers to make sure everyone in those counties... has an opportunity to find coverage in 2017."

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