Is it Right for You?
Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?
This page looks at whether you might be able to get employer-sponsored coverage. If you can, it is good for you to sign up, because you probably won’t qualify for other options like MinnesotaCare and subsidized individual coverage.
If you can’t get employer-sponsored coverage, consider other options introduced in DB101’s Health Coverage section, such as Medical Assistance, MinnesotaCare, Medicare, and individual health plans.
Does your employer, your spouse’s employer, or your parent’s employer offer coverage?
Many employers offer health coverage as a job benefit, but others do not. Employers are not required to offer this benefit. Contact your employer’s Human Resources department to check.
If an employer offers health coverage as a job benefit for employees, the employer also has to offer the same health coverage to the employees’ children until they turn 26. Note: Dependent children with disabilities can be covered under their parent’s plan, no matter how old the children are. To qualify as a “dependent child,” you must be dependent on your parents for support and unable to support yourself through employment.
If an employer offers coverage to an employee and the employee’s children, they may also let the employee’s spouse join the plan, but they are not legally required to do so.
If your employer, your parent’s employer, or your spouse’s employer offers health coverage, continue reading this article.
If not, check out DB101’s other health coverage articles.
Can you get the coverage your employer offers?
Many employers offer health coverage for employees and their families only if their employees meet certain requirements. They can include things like:
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The employee must work a certain number of hours each week (called the active work requirement).
- Example: Your wife’s employer only provides health coverage to employees who work 30 or more hours per week.
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The employee must have worked for the employer for a certain amount of time (called the waiting period). A waiting period cannot be longer than 90 days.
- Example: Your father’s employer provides health coverage to employees who have worked there for at least 90 days.
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You must sign up during open enrollment.
- Example: After you are hired, you have to sign up for your employer-sponsored coverage during your first month on the job. If you don’t, you have to wait until the next open enrollment period to sign up for coverage starting next year.
If your employer, your parent’s employer, or your spouse’s employer offers coverage and you can get that coverage, you probably should. Continue reading this article to learn more about it.
If you cannot get the coverage, check out DB101’s other health coverage articles.
If you can get employer-sponsored coverage, it may mean you can't get tax credits on MNsure or get MinnesotaCare. It depends on whether the employer-sponsored plan is considered "affordable."
When an employer offers coverage for the employee:
- If it costs less than 8.39% of the employee's household's total income and meets a certain benefits level, it's "affordable." The employee won't qualify for government help through tax subsidies to reduce the premium on an individual plan or for MinnesotaCare.
- If it costs more than 8.39% of the household’s total income, it's not affordable and the employee may qualify for tax subsidies to get a plan on MNsure or for MinnesotaCare.
When an employer offers coverage for the employee and the employee's spouse and children:
- If the coverage for the entire family costs less than 8.39% of the employee's household’s total income and meets a certain benefits level, it's "affordable." Nobody in the family will qualify for subsidies on MNsure or for MinnesotaCare.
- If it costs more than 8.39% of the household’s total income, it's not affordable and the spouse and children may qualify for subsidies on MNsure or for MinnesotaCare. However, the employee will not qualify for subsidies or MinnesotaCare unless the cost of insurance for the employee alone is more than 8.39% of the household’s total income.
Note: Before 2023, the spouse or children of an employee would not qualify for subsidies on MNsure if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch."
Other Options for People Who Can Get Employer-Sponsored Coverage
Depending on your situation, you may still be able to get Medical Assistance (MA) if you are offered employer-sponsored coverage. Also, some family members may find that buying an individual plan on MNsure is cheaper than the plan the employer offers, even without government subsidies, or that an individual plan may provide coverage for services that are not covered by the employer-sponsored plan.
Medical Assistance (MA)
Medical Assistance (MA) is a major government-funded health program that helps people with low income. If you qualify for MA, you can get it at the same time as you get employer-sponsored coverage. You may qualify for MA if you are in one of these situations:
- Your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($20,783 for an individual; $43,056 for a family of four). There are no limits to how much money or other assets you have. This is the most common type of MA. You can read more about this in DB101’s income-based MA article.
- You are a child under the age of 18 or are pregnant, and your family’s income is at or below 280% of FPG ($87,360 per year for a family of four).
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You have a disability or are elderly:
- Disability-based MA offers people with disabilities and seniors additional services, but there are more eligibility requirements, such as an asset limit and different income rules. Read more in DB101's disability-based MA article.
- Medical Assistance for Employed Persons with Disabilities (MA-EPD) lets people with disabilities who make more money than the income limits for other types of MA get MA coverage. However, you may have to pay a premium for this type of coverage and there is an asset limit. Learn more about it in DB101’s MA-EPD article.
| Your family size: | |
Income limits for your family: | |
| Income-based MA, adults (138% FPG) | |
| Income-based MA, children/pregnant women (280% FPG) | |
| MinnesotaCare (200% FPG) | |
| Subsidized private plans, reduced fees (250% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
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MA and Employer-Sponsored Health Coverage
If you qualify for Medical Assistance (MA), it will always be a good choice. However, if your employer, your parent’s employer, or your spouse’s employer offers affordable health insurance, you are required to get it as well. In that case, if MA decides that the plan your employer offers is cost-effective, MA (or MA-EPD) will pay your portion of the monthly premium for the insurance plan your employer offers as well as copayments and deductibles.
This can give you the best of both worlds – you get coverage for your medical needs from both your employer’s plan and MA at a lower cost to you. Here are a couple of reasons to consider having both private and public health coverage:
- Many private health plans don’t cover things like transportation, private-duty nursing, and Personal Care Assistant (PCA) services.
- With private coverage, you may have a wider pool of doctors and other medical service providers to choose from than with public coverage.
If you have employer-sponsored coverage, be sure to list it on your application when you apply for MA. Your county worker will ask you how much you pay for the coverage, and for an explanation of medical benefits to figure out if your coverage is cost-effective.
To learn more about this option, Chat with a Hub expert or contact your local county or tribal human services office.
Nadif is a single father living on his own with his two daughters. He makes $16 an hour repairing shoes and works 30 hours a week, so he makes a total of about $2,100 a month. Because he works 30 hours a week, his employer offers him and his daughters health insurance, but to get it, he would have to pay a $400 premium each month.
Nadif decides to go to his local county or tribal human services office to see if his family would qualify for Medical Assistance (MA), because the monthly premium for insurance through his job is really expensive. The caseworker looks at his income and explains that he does qualify for income-based MA, because his income is less than 138% of the Federal Poverty Guidelines (FPG) for a family of three.
Then, the caseworker says, “Because your employer offers you and your daughters insurance, we need to figure out if the insurance is considered cost-effective. If your employer-sponsored insurance is cost-effective, then MA will pay the premiums and other out-of-pocket costs for you and your daughters.”
Medicare and Employer-Sponsored Coverage
When you first become eligible for Medicare, you’ll automatically be enrolled in Medicare Part A. You’ll also be enrolled in Part B, unless you tell Medicare that you have private coverage. If you already have employer-sponsored private coverage that covers the same things Part B covers, you avoid paying Part B’s monthly premium. You can always sign up for Part B later without paying a penalty as long as your private coverage meets certain requirements.
You can also choose not to get Medicare Part D. As long as your current private coverage is creditable, which means that it is at least as good as the Part D benefit, you can sign up for Part D at a later time without paying penalties.
Learn more about what Medicare options are right for you when you have employer-sponsored coverage.
Depending on your situation, you might get employer-sponsored coverage, MA, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.
The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.
How Medicare works with other insurance shows how it works when you have Medicare and other coverage.
Union and Association-Sponsored Group Coverage
Some people who are self-employed may not be able to get employer-sponsored group coverage, but could get group coverage through unions or professional associations. Speak to your union or association representative to learn if this is an option for you.
If you are covered through your union or professional organization, contact the Minnesota Department of Health to learn more about your rights. If your union’s plan is self-insured, you can contact the U.S. Department of Labor Employee Benefits Security Administration to learn more about your rights.
Note: Starting in 2014, anybody can sign up for individual health coverage on MNsure. Look into MNsure, where you may qualify to get government help paying for individual coverage though tax subsidies. You cannot get this government help for a union-sponsored or association-sponsored plan.
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