Qualifying Health Care Coverage

Qualifying health care coverage is also referred to as Minimum Essential Coverage (MEC) and includes:
  • 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.
For detailed information, go to IRS Pub 4012 pg H-5.

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
  • Incarceration
  • 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.