Do Off-Exchange Plans need to meet MEC requirements or are they void of that requirement?

Yes, most Off-Exchange plans still need to meet Minimum Essential Coverage (MEC) requirements to be ACA-compliant. However, not all Off-Exchange plans inherently do so.

Here’s a clear breakdown:

✅ Off-Exchange Plans That Meet MEC

• ACA-Compliant Individual/Family Plans:

  • Purchased directly from insurance carriers.

  • Provide all Essential Health Benefits (EHBs).

  • Comply with ACA rules and meet MEC.

• Employer-sponsored plans purchased Off-Exchange (fully insured or self-funded):

  • Typically meet MEC, even if minimal ("skinny" MEC plans).

Example:
A comprehensive health insurance plan bought directly from SelectHealth or Blue Cross Blue Shield off the ACA exchange website still counts as MEC because it adheres to ACA standards.

🚫 Off-Exchange Plans That DO NOT Meet MEC

• Short-Term Medical Insurance:

  • Temporary, limited-duration coverage.

  • Typically excludes many Essential Health Benefits.

• Fixed Indemnity and Supplemental Plans:

  • Pay fixed amounts for specific illnesses or injuries.

  • Not comprehensive, not ACA-compliant.

• Health Care Sharing Ministries:

  • Cost-sharing groups based on religious or ethical agreements.

  • Not regulated insurance products.

• Limited-benefit plans (Critical Illness, Accident-only, etc.):

  • Specifically excluded from MEC definitions.

Example:
A 6-month short-term plan purchased off-exchange will not qualify as MEC.

⚖️ Summary and Clarification

Off-Exchange Plan TypeMEC ComplianceACA-Compliant Individual or Family Plan✅ YesShort-Term Medical Insurance❌ NoFixed Indemnity / Supplemental Plans❌ NoHealth Sharing Ministries❌ No

🎯 Bottom Line:

• ACA-compliant Off-Exchange plans: DO meet MEC requirements.

• Non-ACA-compliant Off-Exchange plans: DO NOT meet MEC.

Always verify MEC compliance explicitly with the insurer or broker, especially when choosing non-traditional or limited-benefit policies.