What is Minimum Essential Coverage?

What is Minimum Essential Coverage?

Minimum essential coverage, or MEC, is any insurance that meets the Affordable Care Act (ACA) requirement for having health coverage. If you have MEC, you don’t have to pay the fee for being uninsured.

Examples of health coverage that qualifies as MEC include:

  • Most MassHealth coverage;
  • A Health Connector or ConnectorCare plan;
  • Insurance from a job, including COBRA;
  • Medicare Part A or Part C;
  • Most student health insurance plans;
  • Some other types of coverage recognized by the Secretary of the U.S. Department of Health and Human Services as minimum essential coverage (MEC).
  • See a full list of what coverage qualifies as MEC in the chart below.

Minimum Essential Coverage Chart
See the original chart and more information on the Individual Shared Responsibility Provision on the IRS website →

Coverage Type Qualifies As Minimum Essential Coverage?
Employer-sponsored coverage:

  • Group health insurance coverage for employees under –
    • A governmental plan, such as the Federal Employees Health Benefit program
    • A plan or coverage offered in the small or large group market within a state
    • A grandfathered health plan offered in a group market
  • A self-insured group health plan for employees
  • COBRA coverage
  • Retiree coverage
  • Coverage under an expatriate health plan for employees
Yes. Qualifies as MEC
Individual health coverage:

  • Health insurance you purchase directly from an insurance company
  • Health insurance you purchase through the Health Insurance Marketplace
  • Health insurance provided through a student health plan
  • Catastrophic plans
  • Coverage under an expatriate health plan for non-employees such as students and missionaries
Yes. Qualifies as MEC
Coverage under government-sponsored programs:

  • Medicare Part A coverage
  • Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • Health coverage provided to Peace Corps volunteers
  • Department of Defense Nonappropriated Fund Health Benefits Program
  • Refugee Medical Assistance
  • Coverage through a Basic Health Program (BHP) standard health plan
Yes. Qualifies as MEC
Other coverage:

  • Certain foreign coverage
  • Certain coverage for business owners
  • Coverage recognized by HHS as minimum essential coverage (plans recognized as minimum essential coverage are listed at  CCIIO Programs and Initiatives – after you click on the CCIIO link, scroll down and click on the link for the list of approved plans)
Yes. Qualifies as MEC
Certain coverage that may provide limited benefits:

  • Coverage consisting solely of excepted benefits, such as:
    • Stand-alone dental and vision insurance
    • Accident or disability income insurance
    • Workers’ compensation insurance
  • Medicaid providing only family planning services*
  • Medicaid providing only tuberculosis-related services*
  • Medicaid providing only coverage limited to treatment of emergency medical conditions*
  • Pregnancy-related Medicaid coverage*
  • Medicaid coverage for the medically needy*
  • Section 1115 Medicaid demonstration projects*
  • Space available TRICARE coverage provided under chapter 55 of title 10 of the United States Code for individuals who are not eligible for TRICARE coverage for health services from private sector providers*
  • Line of duty TRICARE coverage provided under chapter 55 of title 10 of the United States Code*
  • AmeriCorps coverage for those serving in programs receiving AmeriCorps State and National grants
  • AfterCorps coverage purchased by returning members of the PeaceCorps

*Medicaid programs that provide limited benefits generally don’t qualify as minimum essential coverage. However, HHS will provide a hardship exemption to individuals with certain types of limited-benefit Medicaid coverage.

No. Does not qualify as MEC

 

July 20, 2016    Applying For Coverage, Eligibility  
Wednesday, July 20th, 2016|