Health Insurance Lingo: Minimum Essential Coverage

Health Insurance Lingo: Minimum Essential Coverage

1000 667 Jennifer Nelson

Minimum essential coverage, or MEC, can seem intimidating — “minimum” conjures up bad associations, like the minimum payment on your credit card bill. Throw in “essential,” and you’re frantically searching to make sure you have it.

If you’re mid-frantic search, take a deep breath. Let’s break MEC down.

What Is Minimum Essential Coverage?

Under the Affordable Care Act (ACA), major medical plans and qualified health plans must offer MEC. These plans:

  1. Have an actuarial value of at least 60 percent. This refers to the average percent of your costs that will be paid by the plan, with you picking up the rest until you meet your out-of-pocket maximum. But keep in mind that different plan levels come with different actuarial values. While Bronze plans pay 60 percent, for example, Silver plans pay 70 percent, Gold plans pay 80 percent and Platinum plans pay 90 percent.
  2. Cover the 10 essential health benefits. These include:
  • Laboratory services
  • Emergency services
  • Prescription drug benefits
  • Mental health and substance abuse services
  • Maternity and newborn care
  • Pediatric services, including dental and vision
  • Rehabilitation and habilitative services
  • Preventive and wellness services
  • Ambulatory patient services
  • Hospitalization

Do I Need Minimum Essential Coverage?

If you have an employer-sponsored or major medical plan through the ACA, you have MEC. People without an MEC-qualified plan used to pay an individual mandate penalty. But since there’s no penalty for 2019, you don’t need to choose an MEC plan to dodge a financial bullet.

That said, if you expect to have expensive health care needs, comprehensive coverage might appeal. If you can’t get a plan with minimum essential coverage, you can fill insurance gaps by enrolling in a supplemental plan. On the other hand, if you don’t foresee any major medical needs, you might not worry about having MEC.

A policy without it, such as a short-term insurance plan, is likely to be less expensive and might cover just what you need. Keep in mind, though, that short-term plans require underwriting to set coverage and premium levels — or turn down applications altogether. Similarly, they’re not guaranteed to be renewed when the term is up. They do not cover pre-existing conditions and, again, do not cover MEC. This is why it’s critical to understand your needs when you’re shopping for insurance.

Health care doesn’t lend itself to universal solutions, and minimum essential coverage — as intimidating and, well, essential, as it might sound — isn’t necessarily the be-all and end-all of health insurance. Consider what your needs are, and find a plan that meets them.

Jennifer Nelson

Jennifer Nelson is an award winning health, health IT, and personal finance writer.

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