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    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 through an employer to an employee and their spouse and 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.

    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 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.

    A change to a health care rule makes more families eligible for lower-cost health insurance.

    This change fixed the “family glitch” – a situation where the cost of family coverage was unaffordable for the household, but the Affordable Care Act considered it affordable, keeping the family from accessing tax credits to lower the cost of their insurance. Because of the change family members of Minnesotans with offers of family ESI may now qualify for an advanced premium tax credit through MNsure if their access to family ESI is considered unaffordable using the cost of family coverage.

    To find out if your ESI may be considered unaffordable, use the Employer Insurance Affordability Estimator.

    Note: A special enrollment period is open through October 31, 2023, to individuals currently enrolled in unaffordable family ESI that does not renew on January 1 of the calendar year.

    Get Free Help

    Need help understanding ESI and how to report it on your application? Get free help from a MNsure-certified broker.

    How ESI Can Affect Eligibility for Financial Help  

    Consumers who have access to ESI or other minimum essential coverage (MEC) may not be eligible for financial help.

    Private health plans with financial help (advanced premium tax credit):

    • If you are enrolled in ESI, you are not eligible for financial help.
    • If you have access to but are not enrolled in ESI, you are not eligible for advanced premium tax credit if all of the following apply:
      • Your employer's plan meets the minimum value standard. This means it covers 60% of the total allowed costs of benefits provided under the plan.
      • Your employer's plan is considered affordable. This means the annual premium amount the employee pays for coverage in 2023 is not more than 9.12% of the employee's projected annual tax household income for 2023. The affordability calculation for self-only ESI uses the cost of coverage for the employee only. To determine affordability for family coverage the cost to cover the employee’s family is used and must not be more than 9.12% of the employee’s projected annual tax household income for 2023.
      • The percentage used to determine affordability of ESI is established by the IRS and changes for each tax year.

    MinnesotaCare:

    • If you are enrolled in ESI, you are not eligible for MinnesotaCare.
    • If you have access to but are not enrolled in ESI, you are not eligible for MinnesotaCare if all of the following apply:
      • Your employer's plan meets the minimum value standard. This means it covers 60% of the total allowed costs of benefits provided under the plan.
      • Your employer's plan is considered affordable. This means the annual premium amount the employee pays for coverage in 2023 is not more than 9.12% of the employee's projected annual tax household income for 2023. The affordability calculation for self-only ESI uses the cost of coverage for the employee only. To determine affordability for family coverage the cost to cover the employee’s family is used and must not be more than 9.12% of the employee’s projected annual tax household income for 2023.
      • The percentage used to determine affordability of ESI is established by the IRS and changes for each tax year.

    Medical Assistance:

    • You can be eligible for Medical Assistance if you are enrolled in ESI or if you have access to ESI, even if the coverage meets the minimum value standard and is considered affordable.
    • If the ESI is considered ‘cost-effective’, Medical Assistance may pay the employee’s premiums.

    ESI and Dependents and Spouses

    A person who is eligible for coverage under ESI because they are a spouse or dependent of an employee, is considered to have access to MEC if enrolled in or eligible to enroll in the employee’s ESI.

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