Minimum essential coverage explained
Minimum essential coverage — also known as qualifying health coverage — describes the minimum amount of coverage that employer-sponsored health insurance plans and the health insurance marketplace must provide, according to the Affordable Care Act (ACA).
Most types of insurance plans qualify for MEC, including:
- Government-backed insurance, such as Medicare, Medicaid, Tricare, Children's Health Insurance Program (CHIP) and veterans benefits
- Employer-sponsored health care
- Plans bought on the health insurance marketplace
- Student health insurance provided by universities
- Peace Corps volunteer health insurance
Plans that don't qualify as MEC are plans that:
- Only offer discounts on health care, not full coverage
- Only offer vision or dental coverage
- Only cover certain conditions or diseases
- Are provided as part of workers' compensation
- Only provide coverage for a short period of time
Before 2019, individuals faced a financial penalty if their insurance didn't meet MEC standards. That has since been eliminated due to the Tax Cuts and Jobs Act of 2017.
What does minimum essential coverage include?
For a plan to meet minimum essential coverage standards, 10 essential health benefits must be covered.
- 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
Some of these, such as preventative doctor's visits and certain cancer screenings, may be completely free. Others, such as surgery or lab work, may still come with significant out-of-pocket expenses.
Costs typically depend on the type of plan and the level of coverage. If you have a high-deductible plan, you'll have greater out-of-pocket costs than someone with platinum-level coverage.
Your costs also may vary based on how a visit is coded by medical billing specialists. For example, an annual screening mammogram is 100% paid for by insurance — unless the screening picks up something, in which case it turns into a diagnostic mammogram. These are usually not paid for completely by insurance.
Look up your policy to see what kind of coverage you have and what you'll be expected to pay. If you don't have an insurance plan that meets minimum essential coverage, consider switching plans to make sure you have enough coverage.