What MEC means and where it comes from
Minimum essential coverage (MEC) refers to a medical insurance policy that meets the standards established by the Affordable Care Act (also called Obamacare).
In short, to meet the standards, a policy has to cover at least 60 percent of covered costs and cover the 10 essential health benefits.
Those 10 essential health benefits (EHBs) include:
- Laboratory services: The plan needs to provide coverage for laboratory tests and some preventative screening tests (e.g. diabetes or cholesterol screenings).
- Emergency services: The plan should cover emergency services. If you need to go to the emergency room, even if it is an out-of-network facility, your insurance plan should cover the expense.
- Prescription drugs: The plan should provide coverage for prescription drugs.
- Mental health/substance abuse: The plan should provide coverage for mental health and substance abuse services. This includes coverage for your emotional and psychological well-being, including counseling, psychotherapy, mental health inpatient services, and even treatment for substance abuse.
- Maternity and newborn care: The plan should cover maternity or newborn care. If you're pregnant, it should cover your prenatal expenses. It should also cover the cost of labor and delivery, along with newborn care expenses.
- Pediatric services: The plan should provide coverage for pediatric services, which means care for children. This includes not only routine medical care but also dental and vision care.
- Rehabilitative and habilitative services and devices: The plan is designed for people with disabilities, injuries, or chronic conditions. This EHB includes coverage for physical, occupational, and speech therapy visits.
- Ambulatory patient services: The plan should cover the cost if you need ambulatory care. These are services you get at outpatient care, which is a medical facility that doesn’t keep you overnight after a procedure.
- Preventive/wellness services and chronic disease management: The plan should provide coverage for preventive care. Preventive services help you stay healthy and are 100 percent covered by ALL plans. This means you can get certain cancer screenings, annual checkups, and much more at no cost.
- Hospitalization: This plan should help cover the cost of hospitalization if necessary. This can include routine inpatient hospital stays, surgical procedures, and stays in the intensive care unit (ICU).
Policies that meet MEC include, but aren’t limited to:
- Health insurance purchased on a marketplace exchange (Healthcare.gov, Covered California, MNsure.com, etc.)
- Health insurance purchased directly from an insurance company (some policy types do not qualify)
- A spouse’s employer-provided health insurance (Group)
- Health insurance from a second employer
- Government-sponsored insurance (Medicare, CHIP, TRICARE, etc.)
- COBRA
- Employer-provided retirement policy
- A parent’s health insurance policy that qualifies as one of the above