Your right to understand your coverage.
April 10, 2024
It’s important to understand how the Affordable Care Act (ACA) impacts your employer-sponsored health benefits.
ACA's individual mandate
Under the ACA, individuals must have qualifying health coverage, or minimum essential coverage (MEC). You can obtain this coverage through an employer-sponsored plan, an individually purchased plan, or a government-sponsored plan.
California, New Jersey, Rhode Island, Vermont, Massachusetts, and the District of Columbia, impose fines if individuals don’t have qualifying coverage.
ACA’s employer mandate
The ACA also includes an employer mandate for employers who have 50 or more full-time employees. If your employer has 50 or more full-time employees, they are legally required to offer you a health plan option that meets minimum essential coverage and minimum value standards. Failure to do so results in penalties and fines.
What is minimum essential coverage (MEC)?
For your health plan to qualify as MEC, it needs to cover preventive care as outlined by the ACA and adhere to the Patient’s Bill of Rights.
What is minimum value?
For your health plan to qualify as meeting minimum value standards, it needs to cover a minimum of 60% of the overall costs for plan covered services and include a broad range of medical services, including inpatient and outpatient surgery, maternity care, and emergency and urgent care.
Learn More
- To learn more about the individual mandate, visit healthinsurance.org.
- To learn more about the employer mandate, visit irs.gov.
- For a detailed list of what qualifies as MEC, visit healthcare.gov.
- Read more about the original Patient’s Bill of Rights here.
- Red more about the ACA's expansion of the Patient's Bill of Rights here.
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