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 cash benefit plans, 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:
- Outpatient care—the kind you get without being admitted to a hospital
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Care before and after your baby is born
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
- Your prescription drugs
- 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.
- Your lab tests
- Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
- 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:
- Any health plan bought through the Health Insurance Marketplace
- Individual health plans bought outside the Health Insurance Marketplace, if they meet the standards for qualified health plans
- Any “grandfathered” individual insurance plan you’ve had since March 23, 2010 or earlier
- Any job-based plan, including retiree plans and COBRA coverage
- Medicare Part A or Part C (but Part B coverage by itself doesn’t qualify)
- Most Medicaid coverage, except for limited coverage plans
- The Children’s Health Insurance Program (CHIP)
- Coverage under a parent’s plan
- Most student health plans (check with your school to see if the plan counts as qualifying health coverage)
- Health coverage for Peace Corps volunteers
- Certain types of veterans health coverage through the Department of Veterans Affairs
- Most TRICARE plans
- Department of Defense Nonappropriated Fund Health Benefits Program
- Refugee Medical Assistance
- State high-risk pools for plan or policy years that started on or before December 31, 2014 (check with your high-risk pool plan to see if it counts as qualifying health coverage)
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: