Minimum Essential Coverage (MEC)
Minimum Essential Coverage (MEC) is a term used in the context of the Affordable Care Act (ACA) (applies to both group and u65 insurance plans) to define the basic level of health insurance coverage for Group Insurance.
1. MEC is the minimum level of coverage that plans must have to comply with the Affordable Care Act. It is a lower level of coverage than the more comprehensive "Essential Health Benefits" (EHB) required for plans sold on the ACA marketplaces.
MEC plans generally cover preventive services, such as annual check-ups and immunizations, as well as emergency services and some level of hospitalization and physician services. However, they may not cover other services like:
- Surgery
- Hospitalization
- Maternity care
- Mental health treatment, or
- Prescription drugs.
2. There are several types of plans that qualify as MEC, including:
- employer-sponsored group health plans,
- individual market plans,
- grandfathered health plans, and
- certain government-sponsored plans like Medicare Part A.
Additionally, certain types of limited benefit plans, such as those that provide only dental or vision coverage, can be combined with other qualifying coverage to meet the MEC requirement. The specific benefits covered by an MEC plan can vary, but they must meet the minimum standards set by the ACA.
3. It is important to note that MEC plans may not provide comprehensive coverage for all medical expenses. Individuals with significant healthcare needs or those who want more robust coverage may need to purchase a plan that includes essential health benefits.
Additionally, individuals with lower incomes may qualify for Premium Tax Credits and Cost‑Sharing Reductions if they purchase a plan through the ACA marketplace, which could make more comprehensive coverage more affordable.