In summary, most group plans and full coverage individual health plans purchased through the marketplace (healthcare.gov or takecommmandhealth.com) qualify. The most common exceptions we see are short-term plans and coverage for only vision and dental plans. Also, see our article about sharing plans (like Medi-Share), another type of plan we see often.

If a plan provide Minimum Essential Coverage, it means that it covers the following 10 Essential Health Benefits:

  1. Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3. Treatment in the hospital for inpatient care
  4. Care before and after your baby is born
  5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6. Your prescription drugs
  7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Your lab tests
  9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10. Pediatric services: This includes dental care and vision care for kids

Examples of qualifying health coverage

The following are examples of Minimum Essential Coverage plans:

See a more detailed list of types of plans that do and don’t count as qualifying health coverage from the IRS.

Health plans that don't count as coverage

Some products that help pay for medical services don't qualify. If you have only this kind of product, you may have to pay the fee. Examples include:

  • Sharing ministry plans (this has been updated for 2021)
  • Coverage only for vision care or dental care
  • Workers' compensation
  • Coverage only for a specific disease or condition
  • Plans that offer only discounts on medical services
  • Short-term plans
  • Indemnity plans
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