What Is Minimum Essential Coverage And What Does It Cover?

What Qualifies As A Minimum Essential Coverage Plan?

A plan that adheres to the Affordable Care Act (ACA), will have minimum essential coverage. Minimum essential coverage plans must do two things.

Have an actuarial value of 60% or more and cover at the very least the 10 essential benefits.

What Is Actuarial Value?

Actuarial value is a percentage of the total average costs that you will be paying for covered benefits. Depending on your actual health care needs and terms of your policy you may need to pay a higher or lower percentage.

Actuarial Percentages By Metal Tier

What Are The 10 Essential Benefits?

One important aspect of the Affordable Care Act is the 10 essential benefits included in every plan. All of the following features are included under all insurance plans with no lifetime or annual limit:

1. Outpatient Care. This is any service that does not require hospitalization. For example a yearly check up is considered Outpatient care.




2. Emergency Services. Visits to the emergency room are covered by all ACA plans.




3. Hospitalization. Services that require hospitalization and services provided when hospitalized are covered.




4. Maternity and newborn care. Care that women receive during pregnancy, during labor, delivery, and post-delivery including care of new born babies.




5. Mental health services and addiction treatment. Inpatient and outpatient services needed to treat mental illnesses or substance abuse.




6. Prescription drugs. Medication that is prescribed by a doctor.




7. Rehabilitative services and devices. Rehabilitative and habilitative services and devices that help individuals gain or recover mental and physical skills lost to injury, disability or chronic condition.




8. Laboratory services. Laboratory tests provided to assist doctors assessment of a patient.




9. Preventive care, wellness services, and chronic disease treatment. Annual check-ups, immunizations, and flu shots, as well as certain tests and screenings, are just a few things that are covered.




10. Pediatric services. Care provided to infants and children is covered by the ACA as well.

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