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How to Get Affordable Health Care in
Minneapolis/St. Paul

Funded through the generous support of Leveraging Investments in Creativity (LINC)/Ford Foundation.

Why do I need health insurance?

»»Access: Access to quality health care is directly tied to having health insurance. Without health insurance or unlimited funds, you will have little or no say in the care you receive or in the choice of providers of that care.

»» Cost: The cost of care is so great that a surgery, a day or two in the hospital, treatment for a chronic condition, a prescription for ongoing drug therapy, or even several hours in a hospital emergency room can throw you into considerable, even ruinous, debt if you are uninsured.

»» Better outcomes: People without health insurance frequently delay care, and are more likely to be sicker when they seek care. Not surprisingly, the mortality rates for cancer and other diseases are higher among the uninsured.

What are my rights and protections?

If you are not insured through your employer, union, or some other type of group, you are currently not guaranteed the right to buy health insurance in Minnesota. Private insurers can refuse to sell you insurance because of your health status or charge you a higher premium based on your age, gender, or pre-existing medical condition. Insurers can count as pre-existing conditions those for which you received medical advice in the 6 months prior to the start of your policy. Coverage for preexisting conditions can be excluded for a maximum of 18 months. However, the amount of time you were covered under your previous insurer may be credited toward your pre-existing condition exclusion period if you have not had a break in coverage of 63 days or more. This credit can cancel out or reduce the length of a pre-existing condition exclusion period. If you are denied insurance, you may have access to Minnesota Comprehensive Health Association plans (see page 3). This program offers insurance to people who are considered uninsurable and unable to buy coverage on their own.

If you are insured through a group health plan, you can’t be charged more or turned away because of your health status. Insurers can count as pre-existing conditions those for which you received medical advice in the 6 months prior to the start of your policy. Coverage for pre-existing conditions can be excluded for a maximum of 12 months. The amount of time you were covered under your previous insurer will be credited toward your pre-existing condition exclusion period if you have not had a break in coverage of 63 days or more. This credit can cancel out or reduce the length of a pre-existing condition exclusion period. If you lose coverage under a fully insured group plan, you may be able to buy a conversion policy. This type of policy cannot impose a pre-existing condition exclusion period, but benefits may be limited.

Please note that in an emergency, federal law protects you from being denied care in a hospital emergency room, regardless of your insurance status and ability to pay. If you do not have health insurance and it’s not an emergency, hospitals are not required to treat you. However, some hospitals will anyway. In addition, some have charity care programs which set fees based on income for those who are uninsured.

For easy-to-understand information on your rights as a consumer, visit www.healthinsuranceinfo.net

How can I get health insurance in Minneapolis and St. Paul?

You have three basic options for obtaining health insurance:

• employment or organization-related coverage
• private, direct-purchase plans
•  government-subsidized programs

What are my employment-related options?

A job or a spouse/domestic partner’s job This is how most people under 65 years old get health insurance. The worker usually pays part of the cost and the employer/union pays the rest. This is called group insurance. Coverage of preexisting conditions may be excluded for a period of time. A waiting period may be imposed before you can sign up for coverage.

A union Entertainment industry unions offer health insurance to eligible members. For performers, eligibility is achieved through the amount of “union work” in which an employer contributes towards the union health benefit. Selected entertainment unions include:

• American Federation of Television and Radio Artists
• Actors’ Equity
• Screen Actors Guild
• American Federation of Musicians Local 30-73
• IATSE Local 16

Small business insurance In Minnesota, small employers (with 2 to 50 fulltime employees) are guaranteed the right to buy group coverage regardless of their employees’ health status. (This is what is referred to as guaranteed-issue insurance). This type of coverage can be an option for those who might otherwise be rejected for individual insurance. For comprehensive information on small business insurance visit the Minnesota Department of Health.

COBRA COBRA is a law that lets you keep the insurance you had through your job if your employer has 20 or more employees. COBRA coverage lasts up to 18 months (sometimes longer) after you’ve left or become ineligible for benefits. You will pay the full premium, i.e. both your share and the amount your employer or union was paying on your behalf. The cost can be high, but is often less expensive than buying insurance on your own. You have 60 days from the date of your notification letter to choose COBRA coverage.

A school Most colleges and universities offer health insurance at greatly reduced cost to full-time (and in some cases part-time) students. If you are considering taking courses, you may want to investigate this option. For example, the University of Minnesota Twin Cities campus offers health insurance to registered students with 6 or more credits. Upon graduation you can choose the Student Conversion Plan, which guarantees you access to several reduced-cost Blue Cross Blue Shield plans for an unlimited period of time between graduation and the time you become eligible for an employer-sponsored plan.

What if I have a pre-existing condition?

If you have a pre-existing medical condition, look for guaranteed-issue insurance. This means you are guaranteed acceptance into a health plan regardless of your medical status. Some options for buying guaranteed-issue health insurance are:

Minnesota Comprehensive Health Association offers insurance to Minnesota residents who have been rejected for coverage by an insurance company within the prior 6 months due to pre-existing health conditions, are 65 or older and ineligible for Medicare, or have a “presumptive condition” as defined by MCHA. Rates are generally higher than on the open market.

HIPAA Plans HIPAA is a law that guarantees you access to insurance coverage if: 1) you had at least 18 months of continuous insurance coverage, the last day of which was under a group plan, 2) you have exhausted any COBRA coverage which was available to you, and 3) you are not eligible for any public or group health plans. Be aware that once you enroll in a HIPAA plan, you cannot change insurers. The premiums for these plans are generally considerably higher than for other plans. Contacting an insurance broker may be the simplest way to compare and choose a HIPAA plan.

Medical Assistance, MinnesotaCare, General Assistance Medical Care, ADAP and Program HH do not exclude pre-existing conditions. See below for more information on these programs.

I’m a freelancer. What’s available to me?

If you are a sole proprietor you do not have the right to guaranteed-issue insurance. However, you may be able to join a professional association which will allow you to purchase health insurance at a reduced rate. Some associations offer discount plans. Be wary of these plans, as they promise discounts on health services and are not comprehensive insurance plans. For a list of associations, see www.ahirc.org.

I can afford to buy private insurance, but I don’t know what type of plan to get.

Private, direct-purchase plans can be divided into 3 types:

• HMO plans, which offer a wide variety of health services but limit coverage of care to doctors within their network.
• PPO plans, which pay for care in or outside a network of providers. If you go to an out-of-network provider, you often pay that doctor’s fees directly and file for reimbursement from the insurance company.
• HSAs (Health Savings Accounts) which combine tax-sheltered funds for health care with qualified high-deductible plans.

Plans vary in services provided. Costs include premiums, co-pays, co-insurance, deductibles and out-of-pocket maximums. High-deductible plans generally have lower premiums, but require you to pay more for medical expenses upfront before your benefits kick in. Health Savings Accounts work best if you are healthy and make limited use of the health care system. Health insurance brokers (listed in the yellow pages) or online brokers (such as www.ehealthinsurance.com) can help you weigh your options. Online brokers make it easy to compare plans, but list only those insurers who have paid to be on their site. Some insurance companies sell short-term insurance, which covers you for a limited period of time. This can be useful if you are between jobs or waiting for another policy to begin. However, you may not be able to renew it.

I will be traveling. Will I be covered if I get sick while I’m on the road?

If you plan to travel outside Minneapolis, speak with your insurer about coverage. PPO plans pay out-of-network claims according to your contract. Generally, HMO plans pay claims for life-threatening emergencies only.

Am I eligible for government-subsidized health care programs?

Eligibility for almost all government health care programs is based on your income, figured as a percentage of the Federal Poverty Level (FPL), as well as other requirements. The 2011 FPL for one person is $10,890 and for a family of four is $22,350. MinnesotaHelp.info is a comprehensive online directory of state services including government-subsidized health care, food, housing, counseling, and services for seniors and the disabled.

Medical Assistance is a public health insurance program. You may be eligible if any of the following categories apply to you and you meet low-income and asset guidelines: you are blind, disabled, 65 years or older, pregnant, a child under 21, or the parent or caregiver of a child under 21. (Adults who do not have children living at home cannot get Medical Assistance unless they are elderly, blind or disabled.) Coverage is comprehensive and includes primary care, hospitalization, prescriptions, and other services. Most enrollees do not have to pay a premium.

General Assistance Medical Care provides health care coverage for low-income adults, ages 21 – 64, who have no dependent children and do not qualify for Medical Assistance. You must have limited income and assets in order to qualify. There are 2 levels of coverage: comprehensive or hospitalization only. There is no cost for comprehensive coverage for those who meet the income limits, but there are copayments for some services. There is a $1,000 co-payment for hospitalization only coverage.

MinnesotaCare is public health insurance for children, families, pregnant women and adults without children. You must have limited income and assets in order to qualify. You cannot get MinnesotaCare if you have had health insurance during the last four months or your job offers insurance. Coverage is comprehensive and includes primary care, hospitalization, prescriptions, and other services. Premiums and co-payments are low.

Medicare is health insurance for people age 65 and older and the disabled. Medicare is divided into different areas of coverage: Part A covers hospitalization, Part B covers outpatient and other medical services, and Part D covers medications. You don’t have to pay a premium for Part A; both Parts B and D require premiums, and all parts require co-insurance or co-pays.

I have a special health condition. Are there public health programs that cover it?

ADAP and Program HH The AIDS Drug Assistance Program (ADAP) and Program HH help HIV+ uninsured or under-insured individuals access medications, treatments, and insurance. ADAP makes medications available to those who do not qualify for Medicaid. Program HH pays medical and dental insurance premiums. Both programs have income and asset limits.

The National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured women access to screening services to detect breast and cervical cancers. Women who are subsequently diagnosed with cancer may be eligible for limited Medicaid. Contact the Sage Screening Program for more information.

I’m not eligible for employment-related coverage or government programs, and I can’t afford private insurance. What should I do?

It is possible to get affordable health care without insurance by taking advantage of sliding-scale programs at community clinics (which set fees based on income). For example, both NorthPoint Health & Wellness Center and Community-University Health Care Center offer primary care, mental health and dental services to the uninsured. For a selected list of community clinics see the last page of this booklet, or visit The Health Center Program, which can direct you to the sliding-scale clinic closest to your home.

Allina operates hospitals, clinics, and urgent care facilities in Minneapolis/St. Paul. It has several programs that help uninsured, low-income patients access discounted services and financial assistance, including Allina Partners Care, the Uninsured Discount Program, and MedCredit. .

Retail clinics like Minute Clinic and NOW Medical Centers offer preventive care and routine treatment at fixed rates for common conditions like strep throat and sinus infections. NOW Medical Centers are located in Cub Foods in the Minneapolis metro area. Minute Clinics are located in CVS pharmacies.

I can’t afford my medications. Can I get them for less, or free?

Minnesota RxConnect provides information about programs to help pay for prescription medications as well as information on accessing lower-cost medicine from Canada. In addition, Minnesota RxPriceCompare  lists local prescription medication prices.

Pharmacy Checker is an independent source of information on online and mail-order pharmacies. It publishes pharmacy ratings, profiles, and drug price comparisons.

The Partnership for Prescription Assistance website has information on over 150 pharmaceutical patient assistance programs which offer low-income, uninsured or underinsured patients free or low-cost medications.

NeedyMeds has information on pharmaceutical patient assistance programs as well as discount drug cards, low-cost clinics, disease-based financial assistance, and government programs.

Some major retailers offer lower-cost medication. Wal-Mart and Target offer over 300 generic medications for $4 for a 30-day supply. Costco also offers discounts via their member prescription program.

I have mental health needs and I don’t have insurance. What should I do?

If you are in crisis and uncertain how to proceed, the Crisis Connection at 612-379- 6363 and the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) are available 24 hours per day, 7 days per week. Staff at both crisis centers can speak with you and refer you to local resources.

The National Mental Health Services Locator offers a comprehensive database of mental health facilities, services, advocacy groups and resources. Substance abuse treatment facilities are also listed.

The Mental Health Association of Minnesota has information on counseling, crisis lines, domestic violence support services, support groups, and other mental health services.

For a selected list of mental health clinics, refer to the end of this guide.

How can I lower the cost of dental services?

Many community clinics in Minneapolis/St. Paul offer low-cost dental care to people with low incomes. For a comprehensive list of dental care resources visit this low-cost dental care directory.

The University of Minnesota School of Dentistry provides a wide range of dental services performed by students under the supervision of dental faculty. Costs are significantly less than they would be at a private practice.

Dental discount plans offer discounts on services at participating dentists for an annual membership fee. They are not insurance. Patients’ experiences with these plans are mixed; they seem to work best when a dentist you already know and trust is participating. Use caution. Links to these plans can be found at www.dentalplans.com.

Resources

Selected Hospitals
Minneapolis
Hennepin County Medical Center, 730 S. 8th St. | 612.873.3000
St. Paul
Regions Hospital, 640 Jackson St. | 651.254.3456

Selected Community Health Care Clinics
Minneapolis
Community-University Health Care Center, 2001 Bloomington Ave. | 612.638.0700
NorthPoint Health & Wellness Center, 1313 Penn Ave. North | 612.543.2522
The People’s Center Medical Clinic, 425 20th Ave. South | 612.332.4973
St. Paul
East Side Family Clinic, 860 Arcade St. | 651.772.9757
Open Cities Health Center, 2 locations:
409 North Dunlap St. | 651.290.9200
135 Manitoba Ave. | 651.489.8021
United Family Medicine Clinic, 1026 West 7th St. | 651.241.1000

Selected Mental Health Clinics
Minneapolis
Lutheran Social Services, 2400 Park Ave. | 612.879.5320
Interprofessional Center for Counseling and Legal Services, 1128 Harmon Place, Suite 100 | 651.962.4960
Walk-In Counseling Center (limited hours, no appointment needed), 2421 Chicago Ave. South | 612.870.0565
Hennepin County Mental Health Center, 1801 Nicollet Ave., 2nd & 3rd Floors | 612.596.943
St. Paul
Hamm Clinic, 408 St. Peter St. Suite 429 | 651.224.0614
Jewish Family Service of St. Paul, 1633 West 7th St. | 651.698.0767
Catholic Charities, 215 Old 6th St. | 651.215.2209

Selected 24-Hour Pharmacies
Minneapolis
Walgreens, 2426 Hennepin Ave. South | 612.377.3308
Walgreens, 4547 Hiawatha Ave. | 612.722.4249
St. Paul
CVS, 810 Maryland Ave. | 651.774.1005
CVS, 499 Snelling Ave. North | 651.917.2001

About The Artists’ Health Resource Center

The Health Insurance Resource Center was created in 1998 by The Actors Fund, with a grant from the National Endowment for the Arts, to help people in entertainment and the arts find affordable health care coverage. With in-person counseling in New York and Los Angeles, national telephone support, an Internet database of resources (www.ahirc.org) with over a half-million visitors each year, and more than a hundred Getting and Keeping Health Insurance workshops offered at arts, cultural and human services organizations throughout the country, HIRC works to reduce the number of uninsured artists and expand access to quality, affordable health care.
For more information, contact us at 212.221.7300 ext.265 or on the web at www.ahirc.org, or visit any of the websites listed in this guide.

About The Actors Fund
The Actors Fund is a national human services organization that helps everyone – performers and those behind the scenes – in performing arts and entertainment. Serving professionals in film, theatre, television, music, opera, radio and dance, The Fund’s essential programs include social services and emergency assistance, health care and health insurance resources, housing, and employment and training services. With offices in New York, Los Angeles and Chicago, The Actors Fund has – for over 125 years – been a safety net for those in need, crisis or transition. Learn more at www.actorsfund.org.

The laws, regulations, rules and policies on which the information in this guide are based are subject to frequent change. The Artist Health Insurance Resource Center makes no representations or warranties, express or implied, as to the accuracy, completeness, or timeliness of the information in this guide. This guide contains references to companies, organizations, services, and health centers. Inclusion of this information is not an endorsement of the products, services, or care provided. Before commencing, terminating or changing coverage you should confirm the information herein with the appropriate company, organization, or government agency. This guide should not be used in place of consultations with qualified legal and/or medical professionals. In no event will AHIRC or The Actors Fund be liable for any decision made or action taken by anyone in reliance upon the information contained in this guide.