Minimum essential coverage explained
To meet standards set by the ACA, health insurance plans must provide a stated level of coverage. Plans offered by the government, employers or through the federal Health Insurance Marketplace® (HealthCare.gov Opens in new window) must cover certain services and procedures. Health plans for military members and veterans have minimum essential coverage as well.
MEC doesn’t apply to some types of health insurance Opens in new window, including short-term health, vision- or dental-only, critical illness, worker’s compensation and medical discount plans.
Before 2019, individuals with health insurance that didn’t meet MEC standards had to pay a fine when they filed their federal taxes Opens in new window. Today most people don’t get dinged for that.
Even so, some states have kept the MEC requirement. Those living in California, Massachusetts, New Jersey, Rhode Island and Vermont—as well as the District of Columbia— face potential state fines for not having enough coverage.
What does minimum essential coverage include?
Most MEC plans cover 10 essential health benefits:
- Preventative and wellness visits, including annual physicals, Pap smears and some cancer screenings
- Prescription drugs
- Maternity and newborn care
- Mental and behavioral health services, including substance abuse treatment
- Pediatric care, including dental and vision benefits
- Emergency room services
- Hospitalization and surgery
- Outpatient care or ambulatory patient services, including hospital visits that don't require an overnight stay
- Services, equipment and devices to aid those with injuries, chronic conditions and disabilities
- Lab work and imaging
Even though a health insurance company must cover all these services and procedures under MEC rules, they don’t have to cover 100% of the cost. The covered amount will depend on the need, ACA rules and the specific type of plan. For example, preventative services, like flu shots and annual physicals, are always free if you have a MEC-standard plan. How much you pay out of pocket for certain surgeries, however, will depend on the details of your plan (even if it provides MEC-level coverage).
Another important rule to keep in mind: Plans that meet MEC standards must provide dental coverage to children Opens in new window—but they don’t have to do so for adults. So, before you opt into a plan, find out of it covers adult dental care.