What Does Minimum Essential Coverage Entail?

Minimum Essential Coverage, also known as Minor Medical, was created when the Affordable Care Act was enacted. Before the Affordable Care Act began, people who already had medical conditions or had used too much medical care in the past were able to be denied coverage by insurers. Minimum Essential Coverage ensures that all ACA-compliant health care plans offer insurance to all enrollees regardless of health status or which plan they select.

What Exactly does Minimum Essential Coverage Entail?

To be considered minimum essential coverage, health plans must cover ten benefits. The amount of those benefits that they cover depends on the actuarial value. This number is determined by metal tiers, which depend on how much you pay per month. The more you pay the more is covered.

What are the Benefits that are Covered Under Minor Medical?

Every plan must include these necessary benefits to ensure affordable health care for all. This saves people from spending ungodly amounts of money on health care services. These benefits include:

Laboratory Services

This includes diagnostic lab tests and preventive screening tests, like diabetes and cholesterol screenings.

Rx Discount Plan and Generic Rx Drug Program

The medications are categorized by tiers, each tier contains at least one drug that your insurance will assist in paying for. However, not all medications are within the tier, so similar medications to the ones included will not be covered under insurance.

Specialist Visits

All plans include some kind of coverage for emotional and psychological well-being. These services include counseling, psychotherapy, mental health inpatient services, and treatment for substance abuse.

Plans include a few services that care for you and your baby during all stages of your pregnancy, the delivery, and after delivery.

Pediatric Services

For children who are included in your health plan, your insurance may cover services that keep them healthy, including oral, vision care, vaccinations, and well-child visits.

Rehabilitation and Habilitative Services and Devices

These services and devices are designed for people with injuries, chronic conditions, and disabilities. It also includes physical, occupational, and speech therapy visits.

Preventive Care/Screening

Any services that assist you in staying healthy are covered by all insurance plans. This includes cancer screenings, annual checkups, and other preventative measures.

Telehealth

Telehealth services are included in all Minor Medical plans we offer. This means that you can get a hold of a doctor via video or phone call. Telehealth services offer greater access to services for everyone with coverage. Whether that is because you’re in a remote area without easy access to a doctor’s office, or if you cannot leave the house, you can still get access to care.

Urgent Care

One urgent care visit a year is offered under Minor Medical, with a $15 copay. 

X Ray Services

Lastly, 3 visits a year, X-Ray services are covered with a $50 copay under Minor Medical. 

In addition to these benefits covered under Minor Medical, COVID-19 testing is also considered an essential health benefit. You must meet the CDC testing criteria to receive the test. If you live outside of California, New York, and Washington you will be required to pay any deductibles, copay, or coinsurance.

At SBMA, we are committed to providing top-of-the-line ACA-compliant solutions to your insurance needs. Contact us for more information.