QUESTION

If I buy a plan outside the health insurance marketplace, how do I know it is minimum essential coverage?

Individuals with no coverage | Coverage Outside the Marketplace
ANSWER

Most people that have health coverage today have a plan that will count as minimum essential coverage, and will not need to do anything more than continue the coverage that they have. If you have any of the following coverage, you likely have minimum essential coverage:

  • Employer sponsored coverage, including COBRA continuation coverage and retiree coverage
  • Coverage purchased in the individual market, including a plan purchased in a health insurance marketplace
  • Medicare Part A coverage and Medicare Advantage Plans
  • Most Medicaid coverage
  • Most Children’s Health Insurance Program coverage
  • Veteran’s health coverage administered by the Veterans Administration that are comprehensive
  • Most types of TRICARE (coverage for members of the military)
  • Certain self-funded student health coverage and other coverage may be recognized as minimum essential coverage, see this list for approved plans
  • Coverage for Peace Corps volunteers
  • Refugee Medical Assistance from the federal Administration for Children and Families
  • Department of Defense health benefit program for civilian employees known as “non-appropriated fund” personnel

You can also buy a traditional individual or family health insurance policy outside of the marketplace that qualifies as minimum essential coverage. These insurers will provide a Summary of Benefits and Coverage indicating that the coverage qualifies as minimum essential coverage. However, be aware that some types of coverage available outside the marketplace do not qualify as minimum essential coverage, such as short-term, limited duration plans, association health plans, health care sharing ministries, and farm bureau plans.

If you are uncertain whether your plan qualifies as minimum essential coverage, contact your employer’s human resources department or your health insurer. (26 U.S.C. § 5000A).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues