What Do MEC Plans Cover?

May 09, 2024

It’s already been 14 years since the Affordable Care Act (ACA) if you can believe it, and one of the cornerstones of that legislation was the development of Minimum Essential Coverage (MEC) designed to satisfy individual mandate provisions and offer preventive health benefits.

Today, many of the goals surrounding MEC plans are still the same—such as an increased focus on preventive health and providing more Americans access to healthcare services. Employers with 50 or more full-time employees (who work 30 hours or more) must offer MEC to at least 95% of their population or be subject to the A Penalty under the ACA.

MECs do come with limitations however, as many do not provide sufficient coverage for comprehensive, routine doctor visits, hospitalization, or surgery and therefore many employers choose to provide additional coverage options to round out their benefits packages, such as Minimum Value Plans (MVPs) or other affordable self-funded or full-insured health plans.

Health Services Covered by MEC

Each carrier’s plan design may vary, as well as the MEC plan level chosen by the employer, but all MEC plans cover preventive services such as immunizations and screenings. The screenings covered may include cancer screenings like BRCA or mammograms, chronic condition screenings such as those related to hypertension, anxiety, depression, or diabetes, and reproductive health screenings such as STIs.

They also include several immunizations including COVID-19, HPV, hepatitis, influenza, shingles, varicella, and more, as well as health promotion or wellness benefits like smoking cessation, obesity prevention, contraceptive services, and well-woman visits.

Additionally, some MEC plans have higher tier levels to help cover services such as ambulatory, emergency, generic or basic prescription drug coverage, maternity and newborn care, laboratory, diagnostics such as radiology and advanced imaging, and telemedicine.

Who Typically Offers MEC Plans?

Any large or mid-market employer is required to offer MEC under the ACA, yet some industries offer MEC plans more frequently. Industries such as hospitality, retail, home healthcare, nursing homes, trucking, industrial or manufacturing, staffing, and construction employ a high number of lower-wage workers who hit 30 or more hours a week. In addition, MECs can also be attractive to small employers looking for an affordable, skinny health plan outside of a more traditional major medical plan.

Why Offer a MEC Plan?

Increasing employees’ access to preventive health benefits may reduce delays in care and treat potential health risks early. Basic MEC plans typically have no deductible, are extremely affordable, and are ACA-compliant. They cover very basic health benefits and can be a viable option for employers who may not have traditionally had the means to fund large-group health plans.



Source: Preventive Services Covered by Private Health Plans under the Affordable Care Act | KFF