Minimum essential coverage (MEC) is a crucial term in the realm of health insurance, particularly under the Affordable Care Act (ACA), commonly known as Obamacare. It defines the minimum standards a medical insurance policy must meet to comply with the ACA regulations. Here’s what you need to know about MEC and its implications for your healthcare coverage.
What is MEC?
In essence, MEC is a medical insurance policy that covers at least 60 percent of the covered costs and includes the 10 essential health benefits mandated by the ACA.
The 10 Essential Health Benefits (EHBs)
MEC policies must cover the following essential health benefits (in no particular order):
- Laboratory services: This includes diagnostic lab tests and certain preventive screening tests such as diabetes or cholesterol screenings.
- Emergency services: Your insurer will assist in paying for emergency care at a hospital, even if it's out of network.
- Prescription drugs: Medications are categorized into tiers, and your insurer is obliged to contribute towards at least one drug in each tier.
- Mental health/substance abuse: Coverage for emotional and psychological well-being, including counseling, psychotherapy, mental health inpatient services, and substance abuse treatment.
- Maternity and newborn care: Encompasses various services during pregnancy, delivery, and post-delivery for both the mother and baby.
- Pediatrics services, including oral and vision care: Coverage for routine dental checkups, yearly eye exams, vaccinations, and well-child visits.
- Rehabilitative and habilitative services and devices: Coverage for physical, occupational, and speech therapy visits, designed for individuals with disabilities, injuries, or chronic conditions.
- Ambulatory patient services: Services provided at outpatient care facilities, which don’t require an overnight stay after a procedure.
- Preventive/wellness services and chronic disease management: These services are fully covered by all plans and include certain cancer screenings, annual checkups, and more at no additional cost.
- Hospitalization: Coverage for inpatient care, where your plan assists in paying for medical bills if you stay overnight in a hospital.
Policies that Meet MEC
MEC policies can include, but are not limited to:
- Health insurance purchased on a marketplace exchange (e.g., eHealth, Healthcare.gov, Covered California, MNsure.com)
- Directly purchased health insurance from an insurance company (note: some policy types may not qualify)
- Employer-provided (group) health insurance (including coverage from a spouse’s or second employer)
- Government-sponsored insurance (e.g., Medicare, CHIP, TRICARE)
- COBRA coverage
- Employer-provided retirement policies
- A parent’s health insurance policy that qualifies under the above categories
Important Note Regarding ICHRA Policy Requirements
Not all MEC policies are eligible for reimbursement through an Individual Coverage Health Reimbursement Arrangement (ICHRA), such as Group Insurance. It's essential to have an individual coverage policy for eligibility. For more information on eligible and non-eligible policies, refer to our article on ICHRA Insurance Requirements.
If you have any further questions regarding MEC or your insurance coverage, don't hesitate to reach out to Support for assistance.