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Minimum Essential Coverage

The Affordable Care Act (ACA) requires that nearly all Americans must have health insurance coverage that meets a minimum value standard (called minimum essential coverage or MEC).

To find out if your job-based plan meets the minimum standard, have the employer fill out this form (PDF).

Examples of plans that qualify as MEC include:

  • Private health plans offered through MNsure (also known as qualified health plans or QHPs) 
  • Employer-sponsored insurance 
  • Most Medicaid coverage, like Medical Assistance 
  • MinnesotaCare 
  • Most TRICARE plans 
  • Medicare Part A or Part C 
  • Children’s Health Insurance Program (CHIP) 
  • Coverage under a parent's plan 
  • Most student health plans 
  • Refugee Medical Assistance 
  • Health coverage for Peace Corps volunteers 
  • Certain types of coverage for veterans through the Department of Veterans Affairs

Some plans that don’t qualify as MEC include:

  • Vision-only or dental-only plans 
  • Workers’ compensation 
  • Coverage only for a specific disease or condition 
  • Discount plans for medical services 
  • Coverage only for accident or disability
  • Emergency Medical Assistance 
  • Supplemental liability insurance coverage 
  • Short-term plans purchased from insurance companies 
  • Coverage for on-site medical clinics 
  • Benefits for long-term care, nursing home care, home health or community care 
  • Hospital indemnity or fixed indemnity insurance 
  • Family planning-only coverage

For more information, see the IRS website

MEC and Affordability Standards

If a consumer has access to employer-sponsored insurance (ESI), but is not enrolled, the employer-sponsored insurance must meet BOTH of the following standards to disqualify the consumer for MinnesotaCare or advanced premium tax credits (APTC).

  • Minimum value standard: the plan covers 60 percent of the total allowed costs of benefits provided to the employee under the plan (the equivalent of a bronze plan).
  • Affordability standard: the employee portion of the annual premium for self-only coverage is not more than 9.66% of the employee's annual household income (percent is decided by the IRS, and is subject to change).

If the ESI meets these two standards, the individual is treated as eligible for MEC and is not eligible for MinnesotaCare or APTC.

 

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