Minimum Coverage Charts
Posted on May 15, 2013
Minimum Creditable Coverage (MCC), Minimum Essential Coverage (MEC), Essential Health Benefits (EHBs)
| MASSACHUSETTS HEALTHCARE REFORM | FEDERAL HEALTHCARE REFORM Affordable Care Act (ACA) | ||
| Term | Minimum Creditable Coverage (MCC) | Minimum Essential Coverage (MEC) | Essential Health Benefits (EHBs) |
| What Is It? | State MCC is the minimum level of benefits that must be included in a person’s health insurance plan to satisfy the Massachusetts individual mandate. The Health Connector sets MCC benefit levels and services and issues regulations. | Federal MEC is the minimum standard of coverage necessary to comply with the ACA’s individual mandate. Unlike the state‘s MCC, MEC includes a few broad cat- egories of coverage that satisfy the individual mandate. MEC does not have to include essential health benefits to be minimum essential coverage. | EHBs are required to be offered by small group and nongroup plans starting in 2014. EHBs are not subject to annual and lifetime dollar limits based on the requirements. |
| Individual Mandate | Adults in Massachusetts are currently required to have health insurance that meets the state’s MCC standard or be subject to tax penalties. | Effective 2014, both adults and children will be required to have health insurance that meets federal MEC or be subject to tax penalties. | |
| Penalties | Based on Federal Poverty Level. May be anywhere from $158/year to $1,260/year. | • 2014 – $95 per uninsured person or 1% of household income over the filing threshold• 2015 – $325 per uninsured person or 2% of household income over the filing threshold• 2016 and beyond – $695 per uninsured person or 2.5% of household income over the filing threshold | |
| Will an Individual be Subject to Both Penalties? | No, Massachusetts will take a credit approach: if someone owes both state and federal fines, they will not pay both the federal and state fines in full. | ||
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