Qualifying Health Care Coverage
Qualifying health care coverage is also referred to as Minimum Essential Coverage (MEC) and includes:
For detailed information, go to IRS Pub 4012 pg H-5.
- Most health insurance coverage provided by an employer.
- Health insurance purchased through the Health Insurance Marketplace.
- Coverage under government-sponsored programs including Medicare, most types of Medicaid, and health care programs for veterans.
- Health insurance purchased directly from an insurance company.
- Other coverage including certain foreign coverage and coverage for business owners who are not considered employees.
Qualifying Health Care Exemptions
For detailed information, go to IRS Pub 4012 page H-14.
May be Granted Only by the Marketplace
- Members of certain religious sects
- General hardship
- Determined ineligible for Medicaid in a state that did not expand Medicaid coverage
- Unable to renew existing coverage
- Coverage considered unaffordable based on projected income
- Coverage under certain Medicaid programs that are not minimum essential coverage
May be Granted by the Marketplace or Claimed on the Tax Return
- Members of a health care sharing ministry
- Members of Indian Tribes, and individuals eligible for services through an Indian health care provider or the Indian Health Service
May be Claimed Only on the Tax Return
- Coverage is considered unaffordable
- Short coverage gap: less than 3 consecutive months without Minimum Essential Coverage.
- If there was no MEC in January and/or February, the months of November and December 2016 must be considered to determine if the coverage gap was less than three continuous months.
- If there was more than one short coverage gap, only the first gap can be exempted.
- Resident of a state that did not expand Medicaid, with household income below 138 percent of the federal poverty line
- Citizens living abroad and certain noncitizens
- Aggregate cost of employer-sponsored self-only coverage considered unaffordable
- Income below filing threshold
This information is taken from IRS Pub 5156.