Minimum Essential Coverage: What You Need To Know

If you are like most people, you probably don’t spend a lot of time thinking about health insurance. You may know that you need it, but beyond that, you probably don’t know much about it. What is minimum essential coverage? What does it cover? How much does it cost? In this post, we will answer all of these questions and more! We will explain what minimum essential coverage is and how it can benefit you and your family.

What Is Minimum Essential Coverage?

Minimum essential coverage is a type of health insurance that covers the minimum amount of benefits required by the Affordable Care Act. This includes things like preventive care, immunizations, and screenings for women, children, and adults. Minimum essential coverage does not have to be provided by an employer, but can be purchased through the marketplace or a private insurer.

What Does It Cover?

Under the Affordable Care Act, all health insurance plans must offer a set of essential health benefits. These benefits must be offered to all enrollees, regardless of their age, gender, or health status. The essential health benefits fall into 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorders
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

What It Doesn’t Cover?

MEC plans must cover certain types of services, including hospitalization, prescription drugs, and mental health care. However, there are some limitations to MEC plans.

  • First, they do not have to cover all types of medical services. For example, MEC plans are not required to cover dental or vision care.
  • Second, MEC plans can have annual and lifetime limits on the amount of coverage they provide. This means that if you have significant medical expenses, you could reach your limit and be responsible for paying all of your costs.
  • Finally, MEC plans can include cost-sharing features, such as deductibles, copayments, and coinsurance. This means that you may have to pay a portion of your medical costs out of pocket even if you have insurance.

How Much Does It Cost?

  • The cost of minimum essential coverage (MEC) plans depends on several factors, including the age and health of the enrollee, the type of plan selected, and the state in which the enrollee lives.
  • In general, MEC plans are more expensive than traditional health insurance plans, but they offer a more comprehensive level of coverage. For example, MEC plans must cover pre-existing conditions, whereas traditional plans may not.
  • In addition, MEC plans must provide a minimum level of benefits, including hospitalization, prescription drugs, and maternity care. As a result, enrollees in MEC plans can expect to pay higher premiums than those in traditional health insurance plans.

What Are The Benefits Of Minimum Essential Coverage?

  • First of all, it helps to protect you from financial ruin in the event of a serious illness or accident. Without health insurance, you could be faced with tens of thousands of dollars in medical bills.
  • Secondly, minimum essential coverage ensures that you have access to quality care. When you have health insurance, you can see the doctor or specialist that you need without worrying about how you will pay for it.
  • Finally, minimum essential coverage helps to keep your family healthy. When everyone in your household has health insurance, they are more likely to get the preventive care they need and be less likely to spread illnesses to others.

Consequences Of Not Having Minimum Essential Coverage

Not having Minimum Essential Coverage can have several consequences.

  • First, individuals who do not have health insurance are more likely to forgo necessary medical care. This can lead to serious health problems down the road, as well as increased costs when they do eventually seek treatment.
  • Second, those without health insurance are also more likely to experience financial hardship in the event of an unexpected illness or injury. Without coverage, medical bills can quickly pile up, putting individuals and families at risk of bankruptcy.
  • Finally, the lack of health insurance can have a ripple effect on society as a whole. When people forgo necessary care, it puts a strain on the health care system and can result in higher costs for everyone.


Although it may be tempting to forgo healthcare coverage to save money, doing so could come with steep penalties. Make sure you have the appropriate coverage for you and your family by checking that you have minimum essential coverage and filing the correct forms with your tax return. If you have any questions about whether or not you qualify for an exemption or what steps to take next, consult a qualified tax professional. Thanks for reading!

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