Mnsure application pdf 2026

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  1. Click ‘Get Form’ to open the mnsure application PDF in the editor.
  2. Begin by filling in your personal information. Enter your first name, middle name, last name, phone number, street address, city, state, zip code, and email address in the designated fields.
  3. If you are working with a MNsure Community Assistance Partner, provide their name and email address where indicated.
  4. Select the type of identity document you are attaching from the provided list. Ensure you check only one option that applies to you.
  5. If unable to submit the primary documents, choose two alternative documents from the second list and indicate them accordingly.
  6. Review all entered information for accuracy. Then sign and date the form at the bottom before submission.
  7. Mail this completed form along with any attached identity documents to the specified MNsure address.

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MinnesotaCare is paid for with state and federal tax dollars, provider taxes and premiums paid by people who are enrolled. It takes 30-45 days to process the application. Enrollees pay a monthly premium based on family size, income and the number of people in their family who are covered.
Who can use MNsure? Any Minnesota resident who is a U.S. citizen, U.S. resident, or lawfully present can purchase health insurance through MNsure.
\u200bComplete the form below to report your MNsure account displays "Contact Us." All fields are required. \u200bIf you need immediate assistance, call our Contact Center at 651-539-2099 (855-366-7873 outside the Twin Cities).

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People also ask

Clients must pay the initial and optional (retroactive) MinnesotaCare premiums by the end of the month following the month of premium billing. The Retroactive MinnesotaCare Notice (DHS-3446) explains that the applicant has 30 days from the date of billing to pay the premium.
MNsure marketplace savings are based on income for all household members, not just the ones who need insurance.
MinnesotaCare is for families with income at or below 200% of the Federal Poverty Guidelines (FPG) ($25,760 per year for an individual; $53,000 for a family of four), but above 138% of FPG ($18,754 for an individual; $38,295 for a family of four).
MinnesotaCare is paid for with state and federal tax dollars, provider taxes and premiums paid by people who are enrolled. It takes 30-45 days to process the application. Enrollees pay a monthly premium based on family size, income and the number of people in their family who are covered.
You can apply any time of year to see what financial help you may qualify for.

mnsure application form pdf