Employer-Sponsored Insurance (ESI)
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 affect your eligibility for financial help.
ESI is coverage under a group health plan (including self-insured plans), such as:
- Coverage provided by an employer to an employee and their dependents, including some health reimbursement arrangements (HRAs)
- 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 Help
Consumers who have access to ESI or other MEC may not be eligible for financial help.
For MinnesotaCare and advanced premium tax credit (APTC) eligibility:
- If a consumer is enrolled in ESI, they are considered eligible for MEC and are not eligible for financial help.
- If a consumer has access to but is not enrolled in ESI: They can still be considered eligible for MEC and not eligible for financial help if the employer’s plan meets the minimum value standard and is considered "affordable" (see below) to the employee.
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," Medical Assistance may pay the employee's premiums.
What are the affordability and minimum value standards?
- Affordability standard: The amount of the annual premium that the employee pays is not more than 9.61% (for 2022) of the employee's annual household income. This percentage is decided by the IRS, and is subject to change.
- Minimum value standard: The plan covers 60% of the total allowed costs of benefits provided to the employee under the plan (the equivalent of a bronze plan).
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 MEC if enrolled in or eligible to enroll in the plan.
Does the annual premium for ESI for family coverage have to meet the same affordability standard as employee-only coverage?
No. If the cost of employee-only coverage meets the affordability test then all household members who are eligible to enroll in the ESI plan are considered to have access to MEC, regardless of the cost of family coverage. This means those household members would not be eligible for MinnesotaCare or for tax credits if they enroll in a private plan through MNsure.
Special Rule for Dependents and Spouses
An individual that does not have MEC 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.