Minimum Essential Coverage - Publication 974 - Page 8
Minimum Essential Coverage – Publication 974 – Page 8
Minimum Essential Coverage - Minimum Value - Comparison Chart
Minimum Essential Coverage – Minimum Value – Comparison Chart
Minimum Essential Coverage from Covered CA Enrollment Site
Minimum Essential Coverage from Covered CA Enrollment Site

§5000 A  (f)  (1)Minimum Essential Coverage” MEC   means any of the following:

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See also, 10 minimum [Mandated] essential benefits ♦ Minimum Value Notice 2012-31 ♦ 36B c 2 c ii (60% rule) ♦ Metal Levels (Bronze)
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Blue Shield 17 page pdf Summary and Reporting

1095 B Rules & Information

(A) Government sponsored programs

Coverage under—
(i) the Medicare program under part A of title XVIII of the Social Security Act,
(ii) the Medicaid program under title XIX of the Social Security Act,
(iii) the CHIP program under title XXI of the Social Security Act,
(iv) medical coverage under chapter 55 of title 10, United States Code, including coverage under the TRICARE program; [2] (v) a health care program under chapter 17 or 18 of title 38, United States Code, as determined by the Secretary of Veterans Affairs, in coordination with the Secretary of Health and Human Services and the Secretary,
(vi) a health plan under section 2504 (e) of title 22, United States Code (relating to Peace Corps volunteers); [2] or
(vii) the Nonappropriated Fund Health Benefits Program of the Department of Defense, established under section 349 of the National Defense Authorization Act for Fiscal Year 1995 (Public Law 103–337; 10 U.S.C. 1587 note).

(B) Employer-sponsored plan
Coverage under an eligible employer-sponsored plan.

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(C) Plans in the individual market
Coverage under a health plan offered in the individual market within a State.

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(D) Grandfathered health plan
Coverage under a grandfathered health plan.

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(E) Other coverage
Such other health benefits coverage, such as a State health benefits risk pool, as the Secretary of Health and Human Services, in coordination with the Secretary, recognizes for purposes of this subsection.

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(2) Eligible employer-sponsored plan
The term “eligible employer-sponsored plan” means, with respect to any employee, a group health plan or group health insurance coverage offered by an employer to the employee which is—

(A) a governmental plan (within the meaning of section 2791(d)(8) of the Public Health Service Act), or
(B) any other plan or coverage offered in the small or large group market within a State.
Such term shall include a grandfathered health plan described in paragraph (1)(D) offered in a group market.

(3) Excepted benefits not treated as minimum essential coverage
The term “minimum essential coverage” shall not include health insurance coverage which consists of coverage of excepted benefits—

(A) described in paragraph (1) of subsection (c) ofsection 2791 of the Public Health Service Act; or
(B) described in paragraph (2), (3), or (4) of such subsection if the benefits are provided under a separate policy, certificate, or contract of insurance.

(4) Individuals residing outside United States or residents of territories
Any applicable individual shall be treated as having minimum essential coverage for any month—

(A) if such month occurs during any period described in subparagraph (A) or (B) of section 911 (d)(1) which is applicable to the individual, or
(B) if such individual is a bona fide resident of any possession of the United States (as determined under section 937 (a)) for such month.

(5) Insurance-related terms
Any term used in this section which is also used in title I of the Patient Protection and Affordable Care Act shall have the same meaning as when used in such title.

Resources & Links

Kaiser Foundation FAQ’s

Center on Budget & Policy Priorities 

 Guidance  CMS 10 page pdf 10.31.2014

IRS Website on MEC

Request for your Social Security # so that the Insurance Company can report proof of Insurance to the IRS  Form # 1095  A  Covered CA  B All other Insurance Companies or C  Large Employers

IRS Chart of Minimum Essential Coverage

Blue Shield Tools & Info  & FAQ’s

Publication 974  Premium Tax Credit

Code of Federal Regulations
Subpart G—Minimum Essential Coverage

§156.600 The definition of minimum essential coverage.   §5000 A  (f)
§156.602   Other coverage that qualifies as minimum essential coverage.
§156.604   Requirements for recognition as minimum essential coverage for types of coverage not otherwise designated minimum essential coverage in the statute or this subpart.

§156.606   HHS audit authority.

Related Pages in Individual and Family » Individual Mandate  Section

Issue Number:    HCTT 2016-31

Inside This Issue

Health Care Law: Do You Have Minimum Essential Coverage?

The individual shared responsibility provision requires you and each member of your family to have basic health coverage – also known as minimum essential coverage – qualify for a health coverage exemption, or make an individual shared responsibility payment for months without coverage or an exemption when you file your federal income tax return.

Many people already have minimum essential coverage and do not need to do anything more than maintain that coverage and report their coverage when they file their tax returns. Most taxpayers will simply check a box to indicate that each member of their family had qualifying health coverage for the whole year.

Here are some examples of coverage that qualify as minimum essential coverage:

Employer-sponsored coverage

  • Group health insurance coverage for employees under
    • a governmental plan such as the Federal Employees Health Benefit program
    • a plan or coverage offered in the small or large group market within a state
    • a grandfathered health plan offered in a group market
  • Self-insured group health plan for employees
  • COBRA coverage
  • Retiree coverage

Individual health coverage:

  • Health insurance you purchase directly from an insurance company
  • Health insurance you purchase through the Health Insurance Marketplace
  • Health insurance provided through a student health plan

Coverage under government-sponsored programs:

  • Medicare Part A coverage
  • Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program, also known as CHIP
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • Department of Defense Nonappropriated Fund Health Benefits Program
  • Refugee Medical Assistance

U.S. citizens, who are residents of a foreign country for an entire year, and residents of U.S. territories, are considered to have minimum essential coverage for the year.

For more information on the types of coverage that qualify as minimum essential coverage and those that do not, as well as information on certain coverage that may provide limited benefits, visit the MEC page on IRS.gov/aca.

If you need health coverage, visit HealthCare.gov to learn about health insurance options that are available for you and your family, how to purchase health insurance, and how you might qualify to get financial assistance with the cost of insurance.

Subscribe to IRS Tax Tips to get easy-to-read tips via e-mail from the IRS.

 

Health Coverage Providers: Understanding Minimum Essential Coverage

The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals.

These reporting requirements affect:

  • Health insurance issuers or carriers
  • The executive department or agency of a governmental unit that provides coverage under a government-sponsored program
  • Plan sponsors of self-insured group health plan coverage
  • Sponsors of coverage that the Department of Health and Human Services has designated as minimum essential coverage

For purposes of reporting by applicable large employers, minimum essential coverage means coverage under an employer-sponsored plan.

Minimum essential coverage does not include fixed indemnity coverage, life insurance or dental or vision coverage.

Minimum essential coverage does include:

Government-sponsored programs

  • Medicare part A, most Medicaid programs, CHIP, most TRICARE, most VA programs, Peace Corps, DOD Non-appropriated Fund Program

Employer sponsored coverage

  • In general, any plan that is a group health plan under ERISA, which includes both insured and self-insured health plans. Importantly, employer plans that cover solely excepted benefits, such as stand-alone vision or dental plans, are not MEC

Individual market coverage

  • Includes qualified health plans enrolled in through the federally facilitated and state-based marketplaces and most health insurance purchased individually and directly from an insurance company

Grandfathered plans

  • Generally, any plan that existed before the ACA became effective and has not changed

Miscellaneous MEC

  • Other health benefits coverage recognized by the Department of Health and Human Services as MEC

For more information, see our Questions and Answers on Information Reporting by Health Coverage Providers on IRS.gov/aca.

 

Health Coverage Providers: Understanding Minimum Essential Coverage

The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals.

These reporting requirements affect:

  • Health insurance issuers or carriers
  • The executive department or agency of a governmental unit that provides coverage under a government-sponsored program
  • Plan sponsors of self-insured group health plan coverage
  • Sponsors of coverage that the Department of Health and Human Services has designated as minimum essential coverage

For purposes of reporting by applicable large employers, minimum essential coverage means coverage under an employer-sponsored plan.

Minimum essential coverage does not include fixed indemnity coverage, life insurance or dental or vision coverage.

Minimum essential coverage does include:

Government-sponsored programs

  • Medicare part A, most Medicaid programs, CHIP, most TRICARE, most VA programs, Peace Corps, DOD Non-appropriated Fund Program

Employer sponsored coverage

  • In general, any plan that is a group health plan under ERISA, which includes both insured and self-insured health plans. Importantly, employer plans that cover solely excepted benefits, such as stand-alone vision or dental plans, are not MEC

Individual market coverage

  • Includes qualified health plans enrolled in through the federally facilitated and state-based marketplaces and most health insurance purchased individually and directly from an insurance company

Grandfathered plans

  • Generally, any plan that existed before the ACA became effective and has not changed

Miscellaneous MEC

  • Other health benefits coverage recognized by the Department of Health and Human Services as MEC

For more information, see our Questions and Answers on Information Reporting by Health Coverage Providers on IRS.gov/aca.

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