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What Counts As Minimum Essential Coverage And What Doesn’t

What Counts As Minimum Essential Coverage And What Doesn’t

In 2016, any individuals or families with incomes under $83,400 will have to pay a flat dollar penalty (up to $2085 per household) for not having minimum essential coverage.

Minimum essential coverage includes government, private, and job-based insurance. The term was introduced and approved with The Affordable Care Act along with the Shared Responsibility For Health Care.

Sorry, there is no point in boring you with history and laws. You are here to know what counts as Minimum Essential Coverage so you do not have to pay the fee.

Here is what you need to know:

Plans that count as Minimum Essential Coverage

For a plan to count as minimum essential coverage it should be:

  • Affordable
  • It must provide you with essential benefits
  • Have comprehensive premiums
  • Never deny you coverage because of any pre-existing condition

Most types out there will count as minimum essential coverage; it is quite difficult not to qualify:

  • Coverage you have bought in the Health Marketplace (the exchanges)
  • Traditional Medicare and Medicare Advantage plans
  • Medicaid/CHIP
  • Veterans Health Coverage
  • TRICARE
  • Coverage for Peace corps volunteers
  • Job-based coverage
  • COBRA coverage
  • Retiree coverage
  • Health coverage provided by universities

Plans that does not count as Minimum Essential Coverage

Having the following plans will not prevent you from owing a fee:

  • Short-term health plans
  • Medigap (Supplemental Medicare)
  • Limited benefit plans such as standalone dental or vision plans
  • Limited Medicaid
  • Grandfathered plans

I did not manage to get minimum essential coverage

You might get an exemption if:

  • You went uninsured for less than 3 months
  • Coverage was not affordable for you (more than 8% of your household income per person)
  • Your state has not expanded Medicaid and you are below the 138% Federal poverty levels.

Ok, I have minimum essential coverage, what now?

On your 1040 Federal income taxes you must report the exact number of months you and your dependents benefitted from minimum essential coverage. If you fail to do so, it would be as if you never had minimum essential coverage in the first place.

While it might not please everyone, the Shared responsibility act makes thing easier for Insurance beneficiaries in need of affordable health care. Also, you can get cheaper plans for less than $2085.

If you are on the look for a new plan that provides you minimum essential coverage you should keep an eye on the Marketplace Open Enrollment (November 1, 2016 to January 31, 2017) or if you are turning 65 you can enroll in Medicare. Its Open Enrollment Period for Medicare Advantage and Medicare Part D also begins on October 15 and it will last until December 7.

Belkys Galvez

At an early age Belkys found an interest in sports and nutrition, inspiring her to open a small business under the concept of a “nutrition bar”. Her establishment offered a ZEN ambiance where people mingled over healthy meals instead of alcohol. She also provided an all ladies boot camp class and provided weight loss programs for her clients. In 2013 she joined ACAP during the first “Obamacare” enrollment period. She was in charge of pre-qualifying all incoming calls soon thereafter managing customer service and now as Director of Operations leading the team in client focused efficiencies. Her passion continues to be natural wellness and the positive effects it has on physical and mental health. Follow her weekly nutrition & exercise posts!

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