Health Coverage Providers: Understanding Minimum Essential Coverage

The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals.

These reporting requirements affect:

• Health insurance issuers or carriers
• The executive department or agency of a governmental unit that provides coverage under a government-sponsored program
• Plan sponsors of self-insured group health plan coverage
• Sponsors of coverage that the Department of Health and Human Services has designated as minimum essential coverage

For purposes of reporting by applicable large employers, minimum essential coverage means coverage under an employer-sponsored plan.

Minimum essential coverage does not include fixed indemnity coverage, life insurance or dental or vision coverage.

Minimum essential coverage does include:

Government-sponsored programs

• Medicare part A, most Medicaid programs, CHIP, most TRICARE, most VA programs, Peace Corps, DOD Non-appropriated Fund Program

Employer sponsored coverage

• In general, any plan that is a group health plan under ERISA, which includes both insured and self-insured health plans. Importantly, employer plans that cover solely excepted benefits, such as stand-alone vision or dental plans, are not MEC

Individual market coverage

• Includes qualified health plans enrolled in through the federally facilitated and state-based marketplaces and most health insurance purchased individually and directly from an insurance company

Grandfathered plans

• Generally, any plan that existed before the ACA became effective and has not changed

Miscellaneous MEC

• Other health benefits coverage recognized by the Department of Health and Human Services as MEC