Employer-Sponsored Insurance (ESI)

When you apply for health coverage with financial help, you need to report any employer-sponsored insurance (ESI) available to you. You must include this information—even if you are not enrolled in it. Access to ESI can affect your eligibility for financial help.

What Counts as ESI?

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 COBRA coverage

Reporting ESI

Ask your employer for help filling out the Appendix A: Health Coverage from Jobs form (PDF). This will help you answer ESI questions on the MNsure application.

You should always 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 only the cost of individual coverage was used to determine if the plan was affordable for the family, even if the cost of family coverage was much higher. Because of the change more family members with offers of family ESI may now qualify for an advanced premium tax credit.

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

Get Free Help

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

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How ESI Can Affect Eligibility for Financial Help

Consumers with access to ESI may not be eligible for financial help through MNsure.

If you are enrolled in ESI

  • You are not eligible for financial help (tax credits) to lower the cost of a plan through MNsure.
  • You are not eligible for MinnesotaCare.
  • You may be eligible for Medical Assistance in some cases. If the ESI is 'cost-effective,' Medical Assistance may pay the employee’s premiums.

If you have access to ESI, but are not enrolled in it

You are not eligible for financial help (tax credits) to lower the cost of a plan through MNsure or MinnesotaCare if all of the following are true:

  • The employer's plan meets the minimum value standard. It covers at least 60% of the total allowed costs of medical services and covers most inpatient hospital and physician services.
  • The employer's plan is considered affordable. The percent of income used in the formula is set by the IRS (not MNsure) and changes for each tax year.
    • For employees, the annual premium amount for just the employee (self-only) is not more than 9.96% of the household's projected annual income for 2026.
    • For family coverage, the cost to cover the employee’s family must not be more than 9.96% of the household’s projected annual income for 2026.

You may be eligible for Medical Assistance in some cases. If the ESI is 'cost-effective', Medical Assistance may pay the employee’s premiums.