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How to Determine if You Have Minimum Essential Coverage (MEC)

Written by a TurboTax Expert • Reviewed by a TurboTax CPAUpdated for Tax Year 2024 • October 19, 2024 03:37 AM
OVERVIEW

The Affordable Care Act, also known as Obamacare or ACA, requires most Americans to have health insurance that meets a government standard known as "minimum essential coverage," or MEC. Whether your insurance qualifies as MEC depends not on the plan itself, but on how you obtained your coverage.

 

Key Takeaways

  • If you and your family get health insurance through a job, you should have MEC (Minimum Essential Coverage).
  • Government health insurance programs such as Medicare, Medicaid, Tricare, CHIP, and Veterans' health care benefits provide MEC.
  • Individual health insurance plans bought before Obamacare, through a state or federal online insurance marketplace, or other individual health insurance plans may qualify as MEC.
  • Certain health benefits such as plans that provide only discounts on health care services, plans that cover only dental care or vision, care under workers' compensation plans, and plans that provide care only for a specific condition do not qualify as MEC.

Employer-provided plans

Under Obamacare, any health insurance plan offered to you by an employer qualifies as minimum essential coverage (MEC). So if you and your family get health insurance through a job, you should have MEC which includes:

  • coverage for current employees
  • coverage for retirees
  • COBRA continuation coverage, which allows former employees to hold onto their health insurance for a certain period of time after leaving an employer

College students who get health insurance from their school while they're enrolled are also considered to have MEC.

Government plans

By definition, government health insurance programs provide minimum essential coverage (MEC). These programs include:

  • Medicare, which provides benefits to people over 65 and the disabled
  • Medicaid, which is for low-income people
  • Tricare, which covers military service members and their families
  • Children's Health Insurance Program, or "CHIP," a federal-state effort to cover children and pregnant women in lower-income families
  • Veterans' health care benefits
  • Peace Corps volunteers' health insurance

Individual plans

An "individual" health insurance plan is one you buy directly from an insurance company. That makes it different from the "group" plans typically offered by employers.

The following types of individual health insurance plans also are automatically considered to offer minimum essential coverage (MEC):

  • any individual health insurance plan you had before Obamacare went into effect and you were allowed to keep it
  • any plan you bought through a state or federal online insurance marketplace set up under Obamacare

Other individual health insurance plans may also qualify. If in doubt, your insurance company should be able to tell you whether you have MEC.

TurboTax Tip:

As of 2019, you no longer will be assessed a penalty if you don't have MEC.

What doesn't qualify

Certain health benefits don't count as MEC, even though they may seem like traditional health insurance in some ways. Examples of non-MEC benefits include:

  • plans that provide only discounts on health care services
  • plans that cover only dental care or vision
  • care under workers' compensation plans
  • plans that provide care only for a specific condition, rather than general medical coverage

Getting an Exemption

Beginning in 2019, you no longer will be assessed a penalty if you don't have minimum essential coverage (MEC). Until then, certain individuals and families can qualify for an exemption, which avoids the penalty. If you qualify for an exemption, you can have non-MEC coverage—or no coverage at all. Among the situations that could get you an exemption:

  • your income is so low that you aren't required to file a tax return
  • you can't find insurance that's cheaper than 8% of your income
  • you're a member of a religious group that objects to all forms of insurance
  • you are experiencing a financial hardship that makes it too expensive to get insurance

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~37% of filers qualify. Simple Form 1040 returns only (no schedules except for Earned Income Tax Credit, Child Tax Credit and student loan interest).

Looking for more information?

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The above article is intended to provide generalized financial information designed to educate a broad segment of the public; it does not give personalized tax, investment, legal, or other business and professional advice. Before taking any action, you should always seek the assistance of a professional who knows your particular situation for advice on taxes, your investments, the law, or any other business and professional matters that affect you and/or your business.

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