MinnesotaCare covers the full set of essential health benefits required under the Affordable Care Act, including doctor visits, hospital care, emergency services, prescriptions, mental health and substance use treatment, maternity care, rehabilitative therapy, preventive screenings, dental care, eyeglasses, and hearing aids. Coverage is delivered through managed care health plans that contract with the state, and most services can also be provided by telehealth.1Minnesota Department of Human Services. MinnesotaCare Coverage A handful of services sit outside the program entirely, and a few more carry visit limits or require prior authorization.
Core Medical Services
The medical benefits are broad. MinnesotaCare pays for primary care, specialist visits, and urgent care; inpatient and outpatient hospital services, including outpatient surgery; and emergency room care. Preventive care is covered at no cost when provided in-network, including annual physicals, well-child visits, immunizations, and screenings for cancer, cholesterol, diabetes, and depression.2MNsure. Preventive Care
Beyond the basics, the program covers lab work and X-rays, home care and hospice, family planning, licensed birth center services, and interpreter services. Emergency ambulance transportation is covered for adults, and medical transportation is covered more broadly for children under 19. A few benefits are available only to children: nursing home and intermediate care facility stays, and personal care assistance.1Minnesota Department of Human Services. MinnesotaCare Coverage
Physical therapy, occupational therapy, and speech-language pathology are all covered. Physical therapy is limited to 14 visits per year and occupational therapy to 24 visits per year, with additional visits possible when medically necessary.3Minnesota Department of Human Services. Rehabilitative and Therapeutic Services Durable medical equipment and supplies are covered and become your property on purchase, with a presumed five-year useful life; items of convenience, exercise equipment, and home modifications like ramps or grab bars are not covered.4Minnesota Department of Human Services. Durable Medical Equipment Chiropractic care is covered up to 24 spinal manipulation treatments per year, no more than six in a month, plus one chiropractic evaluation per calendar year.5Minnesota Department of Human Services. Chiropractic Services
Telehealth is available across most of these services, through real-time video, store-and-forward technology, and audio-only phone calls. Audio-only coverage is authorized through July 1, 2027, provided the standard of care can be met.6Minnesota Department of Human Services. Telehealth Policy
Dental, Vision, and Hearing
Every MinnesotaCare enrollee gets dental coverage, though adults who aren’t pregnant have narrower benefits than children or pregnant members. Covered adult services include diagnostic exams and X-rays, preventive cleanings up to twice per year, fillings, root canals, dentures, periodontal scaling, extractions, and dental implants. Many procedures need prior authorization, and frequency limits apply: partial dentures and overdentures are limited to one per arch every three years, and endodontic therapy is covered once per tooth per lifetime.7Minnesota Department of Human Services. Dental Services Cosmetic dental work is not covered.1Minnesota Department of Human Services. MinnesotaCare Coverage
Vision coverage includes comprehensive and intermediate eye exams and eyeglasses, with a $10 copay per pair. New glasses are provided when medically necessary, such as when a prescription changes by at least 0.5 diopters or when the existing pair is lost, broken, or irreparably damaged. There is no fixed replacement schedule. Contact lenses are covered only for specific medical conditions like keratoconus or aphakia, not for routine vision correction, and fashion-tinted lenses, anti-reflective coatings, and backup glasses are not covered.8HealthPartners. Vision Services Coverage
Hearing aid coverage for adults 21 and older is one hearing aid, or one set of binaural hearing aids, every five years. Children under 21 have no replacement limit. A physician’s medical clearance and a referral for an audiological evaluation are required before you can receive a hearing aid, and there is a mandatory 90-day trial period. Related services like programming (up to four times per year), repairs, batteries, and ear molds are included, and bone-anchored hearing aids and cochlear implants are also covered subject to documentation requirements.9Minnesota Department of Human Services. Hearing Aid Services
Mental Health and Substance Use Treatment
Mental health care and substance use disorder treatment are both covered, and there are no copays for mental health services under MinnesotaCare.10Minnesota Department of Human Services. MinnesotaCare Cost Sharing Covered mental health benefits include behavioral health treatment and psychiatric rehabilitation.11MNsure. Essential Health Benefits
On the substance use side, the program pays for outpatient individual and group treatment, residential treatment including room and board, hospital-based inpatient treatment, comprehensive assessments, treatment coordination, recovery peer support, residential withdrawal management, tobacco cessation counseling, and medication-assisted treatment for opioid use disorder. Authorization is required when outpatient treatment exceeds six hours per day or 30 hours per week.12Minnesota Department of Human Services. Substance Use Disorder Services
Prescription Drugs
Prescriptions and medication therapy management are covered. Copays are $10 for generic drugs and $25 for brand-name drugs, with a $70 monthly cap on prescription copays.13Minnesota Department of Human Services. MinnesotaCare Costs Managed care organizations follow the state’s Uniform Preferred Drug List. Preferred drugs are available without prior authorization; nonpreferred drugs generally require prior authorization or a continuation-of-therapy override.14Minnesota Department of Human Services. Preferred Drug List
Several drug categories are excluded: weight-loss drugs, erectile dysfunction medications, medical cannabis, and investigational or experimental medications.1Minnesota Department of Human Services. MinnesotaCare Coverage
Pregnancy and Gender-Affirming Care
Pregnant enrollees receive enhanced benefits. During pregnancy, you get the same benefits as a Medical Assistance enrollee, with no deductibles, copays, or service limitations. If you paid copays of $30 or more after your pregnancy was diagnosed, you can request a refund from the provider. This coverage extends from the first day of the month of conception through the end of a 60-day postpartum period, and during that window your coverage cannot be canceled for nonpayment of premiums or excess income.15Minnesota Department of Human Services. MinnesotaCare Pregnancy Benefits As of January 2025, the program also covers low-risk home birth services provided by enrolled midwifery providers.16Minnesota Department of Human Services. Home Birth Coverage Bulletin
Medically necessary gender-affirming care is covered. Under state law effective January 1, 2025, most health insurance plans in Minnesota are required to cover gender-affirming care, including hormone replacement therapy for adults, puberty-pausing medication for adolescents, and surgical procedures.17Minnesota Attorney General. Transgender Rights Top surgeries, bottom surgeries, and hair removal may be covered when deemed medically necessary. All gender-affirming surgeries require prior authorization and referrals from qualified clinicians.18Minnesota Department of Human Services. Gender-Affirming Surgery Policy
What MinnesotaCare Does Not Cover
Several categories are explicitly excluded from the program:
- Fertility treatments, including in vitro fertilization and fertility drugs.
- Cosmetic surgery and cosmetic dental work.
- Weight-loss drugs, erectile dysfunction medications, medical cannabis, and investigational or experimental drugs and devices.
- Vocational and educational services, autopsies, and charges for missed appointments.
- Personal care assistance for adults (covered only for children under 19).
Some services not on this list may still require prior authorization, so it’s worth checking with your health plan before an appointment to confirm how a specific service will be handled.1Minnesota Department of Human Services. MinnesotaCare Coverage
What You’ll Pay Out of Pocket
MinnesotaCare has no deductibles. Monthly premiums run from $0 to $80 per person based on household income, and children under 21, American Indian and Alaska Native families, and certain recently discharged military members are exempt from premiums.13Minnesota Department of Human Services. MinnesotaCare Costs
Standard copays for adults 21 and older in 2026 are:
- Doctor office visits: $28, with preventive visits free.
- Emergency room: $100, waived if the visit results in hospitalization.
- Inpatient hospital admission: $250.
- Radiology services: $45 per visit.
- Generic prescriptions: $10, with a $70 monthly cap on all prescription copays.
- Brand-name prescriptions: $25.
- Eyeglasses: $10 per pair.
Outpatient surgery, durable medical equipment, dental visits, and some mental health medications carry no copay. Pregnant members and children under 21 are exempt from all copays, and American Indians enrolled in a federally recognized tribe are exempt from all cost sharing.13Minnesota Department of Human Services. MinnesotaCare Costs10Minnesota Department of Human Services. MinnesotaCare Cost Sharing