Minimum Essential Coverage
Under the Patient Protection and Affordable Care Act (PPACA), the federal government, state governments, insurers, employers and individuals each are given roles in reforming and improving the availability, quality and affordability of health insurance coverage in the United States. Starting January 1, 2014, the individual shared responsibility provision called for each individual to have minimum essential health coverage (known as “minimum essential coverage”) for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.
Under the Tax Cuts and Jobs Act, which was enacted on December 22, 2017, the individual shared responsibility payment was reduced to $0, effective for months after December 31, 2018. Therefore, starting with the 2019 tax year, taxpayers will not have to pay the individual shared responsibility payment if they do not have minimum essential coverage or qualify for an exemption. However, some consumer protections under federal law continue to depend on whether someone has minimum essential coverage. For example, certain special enrollment periods to enroll in coverage in the individual market outside of the yearly open enrollment period are only available to individuals who had or lost minimum essential coverage.
Minimum Essential Coverage Categories
Minimum essential coverage designated by statute or regulations includes the following:
- Employer-sponsored coverage (including Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage and retiree coverage)
- Coverage purchased in the individual market, including a qualified health plan offered through the Health Insurance Marketplace (also known as an Affordable Insurance Exchange)
- Medicare Part A coverage and Medicare Advantage (MA) plans
- Most Medicaid coverage
- Children's Health Insurance Program (CHIP) coverage
- Certain types of veterans health coverage administered by the Veterans Administration
- Coverage provided to Peace Corps volunteers
- Coverage under the Nonappropriated Fund Health Benefit Program
- Refugee Medical Assistance supported by the Administration for Children and Families
- Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these programs may apply to HHS to be recognized as minimum essential coverage)
- State high risk pool coverage established on or before November 26, 2014 in any State
National health plans of other countries are not a PPACA-recognized category of minimum essential coverage. A country that would like its national health plan to be recognized as minimum essential coverage must submit an application (see Minimum Essential Coverage Application Process) and have it approved. To see the list of national health plans that have been granted minimum essential coverage recognition to date, you can click on the Approved Plans below.
For information regarding the IRS Individual Shared Responsibility Provision and Exemptions see:
- Questions and Answers on Individual Shared Responsibility Provision - Opens in a new window
- Individual Shared Responsibility Provision – Exemptions: Claiming and Reporting - Opens in a new window
Minimum Essential Coverage Application Process
The Centers for Medicare & Medicaid Services (CMS) is accepting applications from organizations seeking minimum essential coverage recognition for their health plans or policies. If your organization provides coverage in any of the minimum essential coverage categories above, your organization does not need to apply to CMS for minimum essential coverage recognition. Applicants who are not part of the categories identified above and would like to have their plan or policy recognized as minimum essential coverage, should use the process outlined in sub-regulatory guidance issued by the Center for Consumer Information and Insurance Oversight (CCIIO). If you have questions related to minimum essential coverage, please feel free to email us at firstname.lastname@example.org.
- Subregulatory Guidance: Process for Obtaining Recognition as MEC (PDF) (10/31/13)(PDF – 181 KB)
- Subregulatory Guidance: Minimum Essential Coverage Application Review Process (PDF) (2/13/15)
- MEC Application Form (XLSX) (updated 12/19/2013) (XLSX – 15 KB)
- MEC Application Form – Accessible Format (PDF) (updated 12/19/2013) (PDF - 13744KB)
- Certification Statement (PDF) (PDF – 83 KB)
- MEC Data Dictionary (PDF) (PDF - 111KB)
- Approved Plans (PDF) (updated 7/3/2019)
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation
*This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19.
- April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)