Member resources

Summary of coverage, cost sharing and limits

This is only a summary. For details about covered services, you can call your worker, health plan or provider. If you are not in a health plan, call Health Care Consumer Support at 651-297-3862 or 800-657-3672. Your provider must get approval for some services before you get them. Services must be medically necessary. The following lists do not include all covered services.

If you have Medicare: Minnesota Health Care Programs cannot pay for any drugs in the Medicare prescription drug benefit. If you have Medicare, you can get Part D drug coverage. Prescriptions under Part D may have different copays.

Health Care Consumer Support Find health plan member services

Medical Assistance

MA covers these services. There is no cost sharing in MA. Some people get their MA services through a health plan.

More about Medical Assistance

Coverage for some long-term care, including nursing home care, may require a separate application to determine whether MA can pay for it. Ask your worker for more information.

  • Acupuncture
  • Child and Teen Checkups (C&TC)
  • Chiropractic care (under 21 only)
  • Community First Services and Supports (CFSS)
  • Dental services
  • Diagnostic services – lab tests and X-rays
  • Doctor and clinic visits
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Services (for children under age 21)
  • Emergency medical services and post- stabilization care
  • Family planning services
  • Hearing aids
  • Home care services, including personal care assistance (PCA) services
  • Hospice care
  • Hospital services (inpatient and outpatient)
  • Immunizations and vaccines
  • Individualized Education Program (IEP) Services
  • Interpreter services
  • Medical equipment and supplies
  • Medical transportation (emergency and nonemergency)
  • Mental and behavioral health services
  • Nursing home care and care in an intermediate care facility for people with developmental disabilities (ICF/DD)
  • Obstetrics and gynecology (OB/GYN) services
  • Optical services
  • Prescriptions and medication therapy management
  • Rehabilitation therapies
  • Substance use disorder services
  • Surgery
  • Telehealth services
  • Urgent care

Emergency Medical Assistance

Emergency Medical Assistance is fee-for-service coverage. There is no cost sharing in EMA. People do not enroll in health plans.

  • EMA pays for a medical emergency treated in an emergency room or hospital. Follow-up care from the same provider is covered if the services were paid for as part of treating the emergency.
  • Your provider must submit an EMA Care Plan Certification Request to get coverage for these services:
    • EMA pays for renal dialysis.
    • EMA pays for kidney transplants for eligible patients who are currently receiving dialysis services.
    • EMA pays for treatment of cancer (if not in remission), including surgery, chemotherapy and radiation.
    • EMA may pay for some nursing home and home health care services for some very limited emergency conditions.
    • EMA may pay for ongoing treatment of a condition to prevent you from having to go to the hospital.

EMA does not cover nonemergency services. Some examples of services that are not covered are these:

  • Alcohol and drug treatment
  • Care of chronic conditions (such as diabetes management)
  • Day training
  • Eyeglasses
  • Family planning services 
  • Organ transplants (Exception: kidney transplants are covered)
  • Most nursing home care or other facility care
  • Lab and X-ray services
  • Preventive or screening appointments and tests
  • Rehabilitative therapy
  • Other nonemergency services
More about Emergency Medical Assistance

MinnesotaCare

If you have questions about your health care program, covered services or cost sharing, you can:

  • call your worker
  • call your health plan member services
  • ask your provider

Your provider must get approval for some health care services before you get them. The services must be medically necessary.

More about MinnesotaCare Contact your local county or Tribal office Health plan member services

Children under 19 and pregnant adults 19 and over

MinnesotaCare covers these things for children under 19 and pregnant adults 19 and over:

  • Acupuncture
  • Child and Teen Checkups (C&TC)
  • Chiropractic care (for children under age 21)
  • Dental services
  • Diagnostic services – lab tests and X-rays
  • Doctor and other health services
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Services (for children under age 21)
  • Emergency medical services and post-stabilization care
  • Family planning services
  • Hearing aids
  • Home care services
  • Hospice
  • Hospital services, inpatient and outpatient
  • Immunizations and vaccines
  • Interpreter services
  • Lab and X-ray services
  • Medical equipment and supplies
  • Medical transportation to and from medical services (covered only for MinnesotaCare members under age 19)
  • Mental health services
  • Obstetrics and gynecology (OB/GYN) services
  • Optical services
  • Prescription drugs
  • Rehabilitation therapies
  • Substance use disorder services
  • Surgery
  • Telemedicine services
  • Urgent care

Parents, caretakers, adults without children, and children who are 19 or 20 years old

Coverage is the same as MinnesotaCare for children under 19 and pregnant adults 19 and over, except these services are limited:

  • Medical transportation (emergency only)

Also, these services are not covered:

  • Care in an intermediate care facility
  • Nursing home care
  • Orthodontic services
  • Personal care assistance (PCA) services
  • Private duty nursing

Cost sharing and limits

There is no cost sharing for the following members:

  • Children younger than 21 years old
  • Pregnant adults
  • American Indians who receive services from an Indian health care provider or through a referral from the Indian Health Services (IHS) Contract Health Services
  • American Indians enrolled in a federally recognized tribe

Some people 21 years old or older pay cost sharing.1 Cost sharing means the amount you pay toward your medical costs. You must pay your copay directly to your provider. Some providers require that you pay the copay when you arrive for medical services. MinnesotaCare enrollees pay no family deductible. Cost sharing is as follows:

  • $100 copay for ER2 visits
  • $28 copay for non-preventive visits; no copay for mental health visits
  • $250 per inpatient hospital admission
  • $0 ambulatory surgery
  • $0 outpatient hospital
  • $10 copay for eyeglasses
  • $10 (generic) or $25 (brand) copay for prescription drugs up to $70 per month; no copay for some mental health drugs
  • $45 per visit for radiology services
  • $0 per visit for dental services
  • $0 copay for durable medical equipment
  • $0 monthly deductible
  • $100 Emergency room visit for toothache or other nontraumatic dental condition

1 American Indians who are members of a federally recognized tribe are exempt from cost sharing. You must pay your copay directly to your provider. Some providers require that you pay the copay when you arrive for medical services.

2 ER copay does not apply for visits that lead to an inpatient admission.