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FAQ

You have questions. We have answers.

We created this guide to provide answers to the questions we hear most often. Not seeing the answer to your question? We can help. Call us at 952-883-5599 or 877-838-4949 to learn more.

Get help choosing a plan at our Health Insurance Help blog.

Common health insurance terms

Other important things to consider

Shopping for your perfect plan

Common health insurance terms

What is co-insurance?

Co-insurance is the share of the health care costs you’re responsible for paying. It’s listed as a percentage. For example, if you choose a plan with 20 percent co-insurance, you’ll pay 20 percent of the cost of care after you’ve reached your deductible.

What is a copay?

A copay is the amount you pay for medical services. It’s usually a flat amount – such as $40 – for each office visit.

What is a deductible?

A deductible is the amount you and your family pay before your coverage starts. For example, if your deductible is $1,000, that’s what you must pay before the plan will start to pay.

A plan deductible is a great way to help decide which plan you and your family can afford. For example, if you can afford to pay $5,000 in medical expenses, you could choose a plan with a $5,000 or lower deductible.

Plans with lower deductibles will have a higher monthly premium. Plans with a higher deductible will have lower monthly premiums.

What is an embedded deductible?

An embedded deductible means the individual deductible is embedded in the family deductible. This gives you and your family the opportunity to have medical bills covered prior to the family deductible being met.

For example, let’s assume you’re on a Silver plan with your husband and son. Your family deductible is $4,000, and the individual deductible is $2,000. If your husband has $2,000 in medical bills, his deductible is met, even though the family deductible may not have been met yet. HealthPartners will then help pay his future covered expenses.

What is my out-of-pocket maximum?

An out-of-pocket maximum is the amount you have to pay each year for health care before it’s covered 100 percent by your plan.

The out-of-pocket maximum is the most you’ll pay for care during the year. This cost includes your deductible, co-insurance and copays, but not premiums.

What do you mean by premium or rate?

Your premium or rate is what you pay each month for your health coverage. The following factors are considered for you and any dependents on the plan: where you live, your age and whether you use tobacco.

Other important things to consider

What is a formulary?

A formulary is a list of medicines covered by your health plan. You may also hear this referred to as a drug list. You’ll pay a lower copay or co-insurance for medicines that are on the copay. The formulary used for individual health plans is Generics AdvantageRX.

What is my coverage outside of the network?

All of our plans have out-of-network coverage. The amount you pay (deductibles and co-insurance) for using out-of-network providers will be higher than if you receive care in network.

You can search our networks to see whether your doctors, clinics or hospitals are in network.

What do I do for care if I am traveling?

You will always have a choice of doctor when you have an emergency, no matter where you are. The Affordable Care Act requires that emergency services in out-of-network areas are always covered at the in-network benefit level.

You can also use virtuwell – our 24/7 online clinic that treats everyday medical problems. Prescriptions can be sent to any local pharmacy.

What is an HSA or Health Savings Account?

HSA stands for health savings account. Think of an HSA as a special bank account for medical costs. You can put money into your HSA, and save it or spend it on eligible medical expenses. The money in your HSA:

  • Is yours to keep
  • Is tax-exempt
  • Rolls over from year to year

Use this account to pay for things like plan deductible or co-insurance, dental care, braces, and LASIK surgery and more. For a complete list of HSA-eligible expenses, visit irs.gov and search for health savings accounts.

HealthPartners offers several individual plans that are HSA-qualified. Once you’re enrolled in one of those plans, contact your bank or credit union to open your HSA and begin contributing funds. Opening an HSA account is optional.

Am I eligible for a catastrophic plan?

Catastrophic plans are available for those who are 18-29 years of age before the beginning of the plan year, or individuals who have an Affordability or Hardship Certificate of Exemption from MNsure or the Marketplace.

Shopping for your perfect plan

How do I choose the right plan?

Answer a few easy questions to get personal plan recommendations using our online shopping tools.

What is a tax credit and how do I get one?

Tax credits are available to help you pay for your health insurance. The amount of help is based on your family size and household income. Only those who qualify may use a tax credit. If you live in Minnesota, you must apply on MNsure. If you live in Wisconsin, you must apply on healthcare.gov.

What are metal levels?

Metal levels are an easy way for you to compare plans and cost.

  • Gold plans are perfect if:
    • You expect your family to visit the doctor six or more times per person, per year
    • You’re comfortable paying a higher monthly premium and lower costs when you get care
  • Silver plans are perfect if:
    • You expect your family to visit the doctor three or more times per person, per year
    • You’d rather pay a higher premium each month and less when you get care
  • Bronze plans are perfect if:
    • You or your family are healthy and you don’t expect to visit the doctor much. You want protection against major illnesses or accidents
    • You’d rather pay a lower monthly premium and more when you get care

How do I apply?

You have several options for applying for a HealthPartners health plan:

  • Use our plan advisor tool to browse and compare plans
  • Call HealthPartners Individual Sales at 952-883-5599 or 877-838-4949, Monday through Friday, between 8 a.m. and 6 p.m.
  • Contact your broker or agent
  • If you live in Minnesota, visit MNsure to check your eligibility for a tax credit and apply
  • If you live in Wisconsin, visit healthcare.gov to check your eligibility for a tax credit and apply
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