health care — December 08, 2014

Minimum Essential Coverage and Your Insurance

by Bobby Willover

Minimum Essential Coverage

Minimum essential coverage … sounds like a rule at the beach, doesn’t it? Not exactly, but that’s not a bad idea.

The short (real) answer: Minimum essential coverage is the part of the Affordable Care Act that ensures that your health insurance plan measures up. It’s all about what benefits the coverage provides. MEC also allows everyone to be covered, regardless of pre-existing conditions.

That’s the big picture, now let’s look a little closer at what MEC means to you and your family.

Fundamentals of Minimum Essential Coverage

Generally stated, the ACA aims to make sure we have quality, affordable health insurance. MEC defines the quality part of that equation, in two key ways.

First, an insurance plan that provides MEC must cover at least 60% of out-of-pocket costs. Plans can cover more than 60%, but must cover at least 60%.

Second, pre-existing conditions limiting your health insurance coverage are a thing of the past. You can’t be denied coverage for any reason other than ability to pay. Also, your coverage can’t be denied for renewal based on your health. This means if you are diagnosed with an illness or medical condition, your insurer can’t cancel your insurance.

What’s the catch?

You may be thinking that there’s a catch to this whole MEC thing. Well, there is one: if you don’t have insurance that meets the MEC standard, you’ll be charged a penalty – the technical name is the Individual Shared Responsibility Payment.

But if you purchased your insurance through the Marketplace, you’re all set. And even if you didn’t buy insurance through the Marketplace, your insurance provider should have let you know whether your current plan meets the MEC standard.

It all boils down to this

Basically, the MEC affects you very little if you already have insurance through an employer, government plan, or insurance company. And if you just recently purchased health insurance from the Marketplace, your plan meets the MEC standard. Otherwise, you’ll need to check with your insurance provider to make sure your coverage meets the MEC standard.

Bottom line: MEC is a more level playing field for comparing insurance coverage plans.


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