What is Employer-Sponsored Insurance?
When applying for health coverage with financial help, you'll need to report information about any employer-sponsored insurance (ESI) available to you, even if you are not enrolled in it. Access to ESI can impact your eligibility for financial help.
Employer-sponsored insurance is coverage under a group health plan (including self-insured plans), such as:
- Coverage provided by an employer to an employee and their dependents
- Retirement benefits
- Continuation coverage required under federal or state law, such as health coverage through the Consolidated Omnibus Budget Act (COBRA)
Union and student health coverage are not considered ESI, but may be considered minimum essential coverage (MEC).
Gathering and Reporting ESI Information
Work with your employer to have the information you'll need to answer ESI questions on the MNsure application with financial help.
Using the form Appendix A: Health Coverage from Jobs (PDF) will help you gather nearly all the information you will need to complete ESI questions on the application.
You should always accurately report access to ESI, even if you may be eligible for Medical Assistance.
ESI and Eligibility for Financial Assistance
Consumers who have access to ESI and minimum essential coverage (MEC) may not be eligible for financial assistance.
For MinnesotaCare and advanced premium tax credit (APTC) eligibility:
- If a consumer is enrolled in ESI, they are treated as eligible for MEC and are not eligible for financial assistance.
- If a consumer has access to but is not enrolled in ESI, they are treated as eligible for MEC and are not eligible for financial assistance as long as the ESI coverage meets minimum value and affordability standards.
For Medical Assistance:
- Being enrolled in ESI is not a barrier to eligibility.
- Having access to ESI is not a barrier to eligibility, even if the ESI coverage meets minimum value and affordability standards.
- If the ESI is considered "cost-effective," MA may pay the employee's premiums.
ESI and Dependents and Spouses
A person who is eligible for coverage under an employer-sponsored plan because they are a dependent or spouse of an employee, is considered to have access to minimum essential coverage (MEC) if enrolled in or eligible to enroll in the plan. According to federal law, if the cost of the employee-only coverage is deemed affordable for the employee, all household members who are eligible to enroll in the plan are considered to have access to MEC, regardless of the cost of the family coverage.
A health plan meets the minimum value standard if both of these apply:
- It's designed to pay at least 60% of the total cost of medical services for a standard population
- Its benefits include substantial coverage of physician and inpatient hospital services
If the employer’s plan meets this standard and is considered "affordable," you won’t be eligible for a premium tax credit if you buy a private insurance plan through MNsure.
To find out if your job-based plan meets the minimum value standard, ask your employer.
If a household member can get insurance through more than one employer, enter the lowest cost "self-only" plan that meets the minimum value standard.
Special Rule for Dependents and Spouses
An individual that does not have minimum essential coverage through ESI can be eligible for MinnesotaCare or APTC if:
- They are a dependent of the employee, but do not qualify as a personal tax exemption deduction for the employee.
- They are a spouse that does not qualify for a personal tax exemption deduction by the employee AND they do not file taxes jointly with the employee.