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Health Care Law: Do You Have Minimum Essential Coverage?

IRS Health Care Tax Tip 2016-31, March 15, 2016                                             Español

The individual shared responsibility provision requires you and each member of your family to have basic health coverage – also known as minimum essential coverage – qualify for a health coverage exemption, or make an individual shared responsibility payment for months without coverage or an exemption when you file your federal income tax return.

Many people already have minimum essential coverage and do not need to do anything more than maintain that coverage and report their coverage when they file their tax returns. Most taxpayers will simply check a box to indicate that each member of their family had qualifying health coverage for the whole year.

Here are some examples of coverage that qualify as minimum essential coverage:

Employer-sponsored coverage

  • Group health insurance coverage for employees under
    • a governmental plan such as the Federal Employees Health Benefit program
    • a plan or coverage offered in the small or large group market within a state
    • a grandfathered health plan offered in a group market
  • Self-insured group health plan for employees
  • COBRA coverage
  • Retiree coverage

Individual health coverage:

  • Health insurance you purchase directly from an insurance company
  • Health insurance you purchase through the Health Insurance Marketplace
  • Health insurance provided through a student health plan

Coverage under government-sponsored programs:

  • Medicare Part A coverage
  • Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program, also known as CHIP
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • Department of Defense Nonappropriated Fund Health Benefits Program
  • Refugee Medical Assistance

U.S. citizens, who are residents of a foreign country for an entire year, and residents of U.S. territories, are considered to have minimum essential coverage for the year.

For more information on the types of coverage that qualify as minimum essential coverage and those that do not, as well as information on certain coverage that may provide limited benefits, visit the MEC page on IRS.gov/aca.

If you need health coverage, visit HealthCare.gov to learn about health insurance options that are available for you and your family, how to purchase health insurance, and how you might qualify to get financial assistance with the cost of insurance.

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Page Last Reviewed or Updated: 16-Mar-2016