Minimum Essential Coverage

Minimum essential coverage is a type of health plan, not a list of benefits the plan offers.

Usually, these plans provide minimum essential coverage:

  • Employer-sponsored coverage, including self-insured plans, COBRA coverage, and retiree coverage
  • Coverage bought in the individual market
  • Federal marketplace (healthcare.gov) or state marketplace insurance
  • Medicare Part A coverage and Medicare Advantage (Medicare Part C) plans
  • Most Medicaid coverage
  • Children's Health Insurance Program (CHIP) coverage
  • Certain types of veterans health coverage administered by the Veterans Administration
  • Most types of TRICARE coverage under chapter 55 of title 10 of the United States Code
  • 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 can apply to the Department of Health and Human Services [HHS] to be recognized as minimum essential coverage.)
  • State high-risk pools for plan or policy years that begin on or before Dec. 31, 2014. (For later plan or policy years, sponsors of these programs can apply to HHS to be recognized as minimum essential coverage.)
  • Other coverage recognized by the Secretary of HHS as minimum essential coverage

There are several types of benefits that don’t qualify as minimum essential coverage. So, they won’t fulfill your health insurance requirement. These include:

  • Standalone vision care or dental care
  • Accident or disability policies
  • Workers’ compensation

The following plans aren’t considered minimum essential coverage. However, for 2014 only they qualified for a shared responsibility payment exemption:

  • Pregnancy-related Medicaid coverage
  • Medicaid coverage for the medically needy
  • Medicaid providing only family planning services
  • Medicaid providing only tuberculosis-related services
  • Medicaid providing only coverage limited to treatment of emergency medical conditions
  • Section 1115 Medicaid demonstration projects
  • Line-of-duty TRICARE coverage provided under chapter 55 of title 10 of the United States Code
  • Space available TRICARE coverage that’s provided for someone who’s not eligible for TRICARE coverage for health care services from private sector providers

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Calculators

So how much will you get (or owe) this year? That’s the million-dollar question. We happen to have three very useful calculators to help you estimate your refund or balance due.

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