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The Center for Consumer Information & Insurance Oversight

 

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
  • TRICARE
  • 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:

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 mec@cms.hhs.gov.