Fee-for-service coverage (often referred to as ‘straight MA’)

We will send you an MA member ID card in the mail. Always carry it with you. Show your member ID card and all other types of health care cards (Medicare, private health insurance through an employer, etc.) to all health care providers.

To request a new ID card, call either:

• The Health Care Consumer Support (HCCS) help desk. For those who speak little or no English, this help desk provides free interpreter services. TTY: Use your preferred relay service. 
• Your local county or tribal office.

Find examples of Member ID Cards.

Review the one-page overview (DHS-8573) (PDF) to understand services you may be able to get.

Covered services

MA covers health care services and items that are medically necessary. Some services and items may require an authorization. You may have to pay a portion of the cost of some services. 

For more information about your MA coverage benefits and costs see the MHCP Summary of Coverage, Cost Sharing and Limits (DHS-3860) (PDF).

For more information on which health care services MA will pay for, call the DHS Health Care Consumer Support team at 651-297-3862 or 800-657-3672.  Hours are 8:00 a.m. to 4:00 p.m., Monday through Friday.

In-network providers

MA and MinnesotaCare enrolls clinics, hospitals, pharmacies, doctors, dentists and many other health professionals. You must get care only from these enrolled providers or in-network providers. We do not pay for services from non-enrolled or out-of-network providers.

There is limited coverage for services outside of Minnesota. Also, we do not enroll providers located out of the United States. More details about coverage and limits are in the next section.

When you show the provider your member ID card and the provider gives you services, the provider sends the bill to us for payment. We will send you a letter (called explanation of benefits) to show what the provider was billed and any amount you are responsible to pay for your services. The provider can then send you a bill requesting payment.

Find in-network providers

Use the Fee-for-Service MA Provider Directory to locate doctors and other health care providers.

If you need help finding a provider, contact the HCCS help desk. The phone numbers also are on the back of your member ID card.

To make an appointment:

1. Call the clinic ahead of time.
2. Make a separate appointment for each person.
3. Tell your clinic that you are an MA member.
4. Tell your clinic if you have any other insurance.
5. Write down the appointment date and time. Always call the clinic if you have to cancel (cannot get to the appointment).
6. Request transportation assistance or interpreter assistance if needed (see the next two sections).

MA can help pay for transportation. Learn more about transportation (DHS-8573A) (PDF) options.

It is important to understand the information your doctor gives you. If you do not speak the same language as your doctor, your clinic must provide a person to explain the information the doctor tells you in the language you speak. This person is called an interpreter. If you need an interpreter at your medical appointment, tell the person this when you make the appointment. Your clinic may also be able to give you written information in your own language.

If you ask for an interpreter and your provider does not provide an interpreter, contact the HCCS help desk.

To request an interpreter

Tell the provider that you will need an interpreter for the appointment. Be sure you give the provider a reasonable amount of time to arrange for an interpreter.

All providers are required to provide language interpreter services for all patients who are deaf or hard of hearing or have limited English proficiency. Providers are responsible for arranging the interpreter service and paying the interpreter. They may bill the state for the interpreter's services. Sign language interpreter services may be provided using a video relay. International language interpreter services may be provided over the phone.

Complaints about interpreter services

Hospital and clinics hire their own interpreters. If you have a concern or complaint about an interpreter, report it to the provider, clinic or hospital. Talk to the patient representative, the clinic director or hospital manager.

If you need more help with the concern, call the HCCS help desk.

You may receive a bill if MA does not cover the service you received. See the MHCP member evidence of coverage for people not enrolled in a health plan for more information about non-covered services.

Providers may bill you for services that are never covered by MHCP. They must first tell you that the service is not covered. They must have you sign one of these forms before providing the service:

• Advance Recipient Notice of Non-covered Service/Item DHS-3640 (PDF)
• Advance Recipient Notice of Non-covered Prescription DHS-3641 (PDF)

Retroactive coverage is when MA backdates the date your coverage begins. If retroactive coverage is approved, MA can pay for health care you received as much as three months before you applied. Providers are not required to bill MA retroactively, however, many do.

If retroactive coverage is approved, ask a provider to bill us (instead of you) for health care you received before you were enrolled in MA:

1. Contact the provider
2. Give them your MA member ID number
3. Ask them to bill fee-for-service (some providers call this billing straight MA)

Retroactive pharmacy expenses

To request reimbursement for pharmacy expenses, give your receipts and MA member ID card to the pharmacy where you purchased your medications. If the pharmacy bills us and receives payment, they must give you a refund. Note that some pharmacies have a company policy that they cannot give refunds after a certain amount of time.

All MA providers may send in claims for services up to a year after the date you received the health care. You may need to speak to a store manager or contact the pharmacy's corporate headquarters for claims that are over a few weeks old.

If you have questions about retroactive coverage or services that MA does not pay for, you can call:

• HCCS help desk
• County and tribal offices