What is Minimum Essential Coverage (MEC)?

Minimum Essential Coverage is the type of coverage you’ll need to avoid the fee for not having insurance under ObamaCare (the Affordable Care Act). In order to be in compliance with the law you must maintain minimum essential coverage throughout the year, get an exemption, or pay a fee for each month you go without it (although you are allowed less than three months in a row each year without coverage, due to a coverage gap exemption). You’ll report minimum essential coverage on your Federal Income Taxes for each month you or a dependent had coverage.

Most coverage you’ll get inside and outside the Marketplace during that types open enrollment period is minimum essential coverage. See the full list of what counts and what doesn’t below.

Benefits and Minimum Essential Coverage Types

The Affordable Care Act creates a lot of new rules and regulations for health insurance and adds some pretty ground breaking new benefits, rights, and protections. Some types of health insurance are required to follow all of ObamaCare’s rules and some aren’t. In a general sense, major medical plans that have to follow the majority of rules set forth by the ACA count as minimum essential coverage. That being said, minimum essential coverage is based on source rather than specific benefits or rules. You can find the types of coverage considered minimum essential coverage below.

Different types of minimum essential coverage, grandfathered plans, and non-grandfathered non-minimum essential coverage all have unique requirements of what rules they have to follow under the ACA.

What Types of Health Insurance are Minimum Essential Coverage?

In order to avoid the fee for not having health insurance you’ll have to obtain “minimum essential coverage” and maintain it throughout the year. Basically minimum essential coverage includes all Government and job based insurance and most Private Insurance. As a rule of thumb if you were allowed to keep your health insurance in 2014, bought major medical insurance on or off the marketplace, got covered through a public program, or got covered through work you typically have minimum essential coverage.

Minimum Essential Coverage List

Minimum essential coverage includes the following types of health insurance:

  • Employer-sponsored coverage (including COBRA coverage and retiree coverage)
  • Coverage purchased in the Individual Market, including a qualified health plan offered by the Health Insurance Marketplace (also known as an Affordable Insurance Exchange)
  • Medicare Part A coverage and Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • Certain types of veterans health coverage administered by the Veterans Administration
  • Coverage provided to Peace Corps volunteers
  • Coverage under the Non-appropriated Fund Health Benefit Program
  • Refugee Medical Assistance supported by the Administration for Children and Families
  • Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these programs may apply to HHS to be recognized as minimum essential coverage)
  • State high risk pools for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these program may apply to HHS to be recognized as minimum essential coverage)

What Doesn’t Count As Minimum Essential Coverage?

Minimum essential coverage does not include coverage providing only limited benefits, such as coverage only for vision care or dental care, and Medicaid covering only certain benefits such as family planning, workers’ compensation, or disability policies.

Most insurance types offered between each years open enrollment will be short term health insurance, fixed benefit plans and supplemental insurance will not help you avoid the fee on their own, although they will help you be covered health-wise.

The following types of health insurance are not minimum essential coverage:

  • Short Term Health Plans
  • Fixed Benefit Health Plans
  • Supplemental Medicare like Part D and Medigap
  • Some Medicaid covering only certain benefits
  • Vision only, Dental only, and limited benefit plans
  • Grandfathered Plans (You will avoid the fee, but won’t get the new rights and protections)

I Didn’t Find My Minimum Essential Coverage Type?

Some of the Minimum Essential Coverage types are less common than the ones listed above. See the full list from the IRS including types that counted as MEC for 2014 only.

Full List of Minimum Essential Coverage (MEC) From IRS

Coverage Type Qualifies As Minimum Essential Coverage Doesn’t Qualify 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
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
  • Health coverage provided through a student health plan that is self-funded by a university (only for a plan year beginning on or before December 31, 2014, unless recognized as minimum essential coverage by HHS)
  • Catastrophic plans
Coverage under government-sponsored programs:

  • Medicare Part A coverage
  • Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program (CHIP)
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • State high-risk health insurance pools (only for a plan year beginning on or before December 31, 2014, unless recognized as minimum essential coverage by HHS)
  • Health coverage provided to Peace Corps volunteers
  • Department of Defense Nonappropriated Fund Health Benefits Program
  • Refugee Medical Assistance
Other coverage:

  • Certain foreign coverage
  • Certain coverage for business owners
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

*In Notice 2014-10, the IRS announced relief from the individual shared responsibility payment for months in 2014 in which individuals are covered under one of these programs. See the instructions for Form 8965, Health Coverage Exemptions, for information on how to claim an exemption for one of these programs on your income tax return.

Doesn’t Qualify

Not sure if your plan will help you avoid the fee? Simply ask your insurer whether or not your plan is “ACA compliant” or counts as “minimum essential coverage”. You can also check the Minimum Essential Coverage (MEC) guidelines for more information.

What If I Don’t Have Minimum Essential Coverage?

If you don’t have minimum essential coverage for most of 2014 and beyond, and don’t obtain an exemption, you’ll pay a shared responsibility fee for each month you are without minimum essential coverage each year. This is true even if you have coverage that doesn’t count as minimum essential coverage, like short term health insurance. Learn more about ObamaCare’s individual mandate here.

Reporting Minimum Essential Coverage

You’ll have to report which months you or a dependent had minimum essential coverage each year on your 1040 Federal Income Taxes starting April 15, 2015. If you or a dependent didn’t have minimum essential coverage for any month, or an exemption, you’ll have to make a Shared Responsibility Payment (capped at the national average of a bronze plan) for each month without coverage. Your insurer will send you a 1095-A, 1095-B, or 1095-C form which will tell you which months you had coverage and what cost assistance amounts you received. You’ll use that form to fill out Form 8962, Premium Tax Credit (PTC) if you received cost assistance. You’ll attach any related forms to your tax return along with your calculation Shared Responsibly Payment when you report minimum essential coverage.

Learn more about reporting minimum essential coverage to the IRS, exemptions, and the Shared Responsibility Payment.

minimum essential coverage

Minimum Essential Coverage and the Shared Responsibility Provision

The Affordable Care Act Contains a section called “Shared Responsibility for Health Care“. This section includes rules for individuals and families in regards to what types of health insurance they must have and what types of health insurance employers must provide to avoid their respective “shared responsibility fees”. These types of health insurance are known as minimum essential coverage.

These health insurance types are based on source for the most part, rather than benefits, but do include a few rules for employers such as how much of an employee’s premium must be covered and what share of out-of-pocket costs a plan must provide. The types of health insurance that must be maintained to avoid the fee and be in compliance with the shared responsibility requirement is called Minimum Essential Coverage.

In short, minimum essential coverage is the type of coverage you’ll need to avoid the shared responsibility fee under the Affordable Care Act.

Individual Mandate and Employer Mandate

The common names for the requirement to maintain minimum essential coverage or pay a shared responsibility fee are the individual mandate (for individuals and families) and the employer mandate (for employers).

What is Minimum Value?

Most major medical plans, including all Private and employer-sponsored, must meet minimum value standards under the ACA. Generally minimum value, in terms of cost sharing, means that a plan must be equal to a Bronze plan sold on the Health Insurance Marketplace. Thus it must have an actuarial value of at least 60%.

What Are the Rules For Minimum Essential Coverage?

For health insurance to be considered minimum essential coverage it typically must follow ObamaCare’s new rules and regulations for health insurance and must include the new benefits, rights, and protections offered by the law. Although technically the term Minimum Essential Coverage is defined by source of coverage (ie Medicare, Medicaid, marketplace insurance, TRICARE, ) rather than specific benefits, there are some common rules and benefits that minimum essential coverage tends to provide.

Please note that rules for each type of minimum essential coverage are different. In fact the main reason minimum essential coverage is based on the source of insurance and not the benefits, is to ensure certain types of insurance count as coverage. For instance employer sponsored insurance has to meet different standards than Medicaid, but both are considered minimum essential coverage. Also note that some grandfathered plans will help you to avoid the fee for not having minimum essential coverage even though they don’t technically meet the ACA’s new standards.

The list of rules below apply in full only to private major medical health insurance plan, with many aspects applying to other types.

For health insurance to be considered minimum essential coverage it must typically have the following qualities:

  • Affordability: Plans must cover, on average, at least 60% of out-of-pocket costs on required services. They also have limits on annual deductibles and out-of-pocket maximums.
  • Guaranteed Availability of Coverage: You cannot be denied coverage for any reason other than the ability to pay.
  • Guaranteed Renewability of  Coverage: You must be able to renew the policy regardless of health status.
  • Fair Health Insurance Premiums: There are limits to the amount you can be charged based on age, tobacco use, family size, and geography.
  • Medical Loss Ratio (the 80/20 Rule): If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must rebate the portion of premium that exceeded this limit.
  • Ten Essential Benefits: Must provide coverage of at least ten essential health benefits.
  • Dollar Limits: Insurers cannot place annual or lifetime dollar limits on Essential Benefits.
  • Coverage must provide minimum value (Employer Coverage Only): To meet the Minimum Value requirement, a plan must cover, on average, at least 60 percent of total allowed costs – i.e., what the plan pays versus what the customers pays due to deductibles, copays and coinsurance. Plans must also have a reasonable out-of-pocket maximum. This essentially means employer sponsored plans must offer at least the affordability and benefits of a Bronze plan sold on the marketplace.

Know the Law: Minimum Essential Coverage

You can learn more about minimum essential coverage by checking out the following sections of the law and other official resources:



More information can be found under: Title I – Subtitle F—Shared Responsibility for Health Care

How to Get Minimum Essential Coverage

For most Americans getting minimum essential coverage will mean buying a qualified health plan either inside or outside the health insurance marketplace, getting covered through work, or getting public health insurance through Medicare, Medicaid, and CHIP. Please see the types of minimum essential coverage above to know all your options.