What is Minimum Essential Coverage

Wondering what MEC plans are? We’re sometimes asked what minimum essential coverage exactly is, and what to do if you're comparing it to a plan that has a minimum value. Read on to see what MEC is and what purpose it serves.

So what does MEC actually cover? A minimum essential coverage plan – or a “MEC” plan – covers everything, according to the requirements of the ACA, or the Affordable Care Act. You can find minimum essential coverage in just about any major medical plan, standard market plan, self-funded plans, and even Medicare and Medicaid plans. But many are left wondering what exactly it is that a MEC plan covers.

To summarize, there are three different levels of a MEC plan that can really help anyone get ahead of their healthcare. The first is a basic MEC. A Basic MEC gives you a PPO network that allows you to have in-person doctor visits, with just about any doctor on a national PPO. With this, there are about 88 different types of preventative or wellness visits that you can get at a $0 copay, all included in a basic MEC.

In addition, a basic MEC also includes telemedicine and teledoc $0 copay unlimited teledoc visits. Depending on how the call goes – for example, if you need a prescription – there's almost always a discount embedded in that plan.

If you need more care, you can work toward an enhanced type of MEC, where you get everything the basic MEC has, but you also get a very low copay for a primary care visit. You'll get discounts on urgent care labs and X-rays, and you'll even get $10 and $25 generic co-pays with no deductible.

Thirdly, there is, what we like to call, Ultimate MEC. This is where you get everything that the last two MEC plans offer, but you also get first-dollar co-pays for physician visits, specialist visits, labs, and urgent care x-rays. Everything would also be on a PPO network – meaning you get unlimited telemedicine, behavioral and mental health visits, and a four-tier drug program. This has two different tiers of generic and two different tiers of formulary.

In addition, if your clients have 50 or more employees or 50 or more full-time equivalents, you got to run these employees through an FTE Calculator to find out how many actual FTEs they have. By doing this, you can help your clients avoid audits and prevent them from getting the 226J letter.

With this newfound knowledge on MEC plans, you can grow your business with the clients you already have, as well as organically grow your revenue with the clients you already have. Hopefully, this answers your questions on what MECs are and what they do.