Questions & Answers

What do I need to know about Massachusetts Minimum Creditable Coverage?

Individuals must be enrolled in a health insurance plan that meets Minimum Creditable Coverage requirements.

What is "Minimum Creditable Coverage" (MCC)?

It's the minimum level of benefits that adult tax filers need to be considered insured and avoid tax penalties in Massachusetts.

Note: MCC is not the same as Minimum Essential Coverage, which is the type of coverage adult tax filers and their dependents need to be considered insured and avoid tax penalties from the Federal government. Visit irs.gov for more information about the federal requirement to have insurance coverage.

How do I know if my plan met MCC?

Massachusetts-licensed health insurance companies must put an MCC-compliance notice on their plans to indicate if it does or doesn't meet MCC. Most plans do meet the MCC standards. If you received a Form MA 1099-HC from your insurer, that form will indicate whether your insurance met MCC requirements. If you had insurance that didn't meet MCC requirements during 2018, you can't report that you were insured during that time period.

What if I didn't receive a Form MA 1099-HC from my insurer?

You can call your insurer or your employer's human resources department or benefits administrator for help, if you get health coverage through your job. If your insurer or your employer is unable to assist you, please refer to the Benefits Required Under MCC section below to see if your policy meets these requirements. If your plan meets all of the requirements, you may certify that you were enrolled in a plan that met the MCC requirements during that time period.

What if my plan doesn't meet MCC?

If you were enrolled in a plan that didn't meet the MCC requirements during 2018, you shouldn't imply that you were enrolled in a plan that met the MCC requirements. You won't be subject to a penalty if it's determined that you didn't have access to affordable insurance that met MCC. If it is determined that you had access to affordable insurance that met MCC, you can request an appeal through the Health Connector by completing the Schedule HC appeals section. No penalty will be imposed pending the outcome of your appeal.

What if I was enrolled in an MCC plan for only part of the year?

If you were enrolled in an MCC plan for only part of the year, you should choose "No" to the "Were you insured for all of 2018?" question. In the following screens, only provide the health insurance information for the MCC plan(s) you were enrolled in. Don't provide health insurance information for a plan that didn't meet the MCC standards.

Benefits Required Under MCC: For most plans*, the 2018 Minimum Creditable Coverage standards include:

  • Coverage for a comprehensive set of services (e.g. doctors visits, hospital admissions, day surgery, emergency services, mental health and substance abuse, and prescription drug coverage).
  • Doctor visits for preventive care, without a deductible.
  • A cap on annual deductibles of $2,000 for an individual and $4,000 for a family.
  • For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than $7,350 for an individual and $14,700 for a family.
  • No caps on total benefits for a particular illness or for a single year.
  • No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
  • For policies that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family.
  • All services must be provided to all of those covered (for example, a plan that covers dependents must extend maternity services to them)
  • No cap on prescription drug benefits.

*Other ways of Meeting MCC

You automatically meet MCC if you're enrolled in:
  • Medicare Part A or B;
  • Any Qualified Health Plan purchased through the Massachusetts Health Connector or directly through a carrier, including ConnectorCare plans and catastrophic plans;
  • MassHealth (including temporary coverage);
  • A federally-qualified high deductible health plan (HDHP) offered with a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) if it meets the requirements above;
  • A Student Health Insurance Plan (SHIP) offered in Massachusetts or another state;
  • A tribal or Indian Health Service plan;
  • TRICARE;
  • The U.S. Veterans Administration Health System;
  • A health insurance plan offered by the federal government to federal employees or retirees; or
  • Peace Corps, VISTA or AmeriCorps or National Civilian Community Corps coverage;
  • A Pre-Existing Condition Insurance Plan (PCIP).

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