Minimal Creditable Coverage/MCC information for individuals

Also see the Connector's webpage on MCC's requirements. (We recommend you print that page out)

It is important to be aware that starting on January 1, 2009, Massachusetts residents 18 years of age or older, who are NOT exempt from the Individual Mandate, will have to have health insurance that is deemed affordable to them at their income level AND meets "Minimal Creditable Coverage" (MCC) standards set by the Connector. It is very important to note that the Minimal Creditable Coverage requirement is being phased in. So for 2007 and 2008, one will only have had to prove they have insurance and the insurance does not have to meet MCC standards for those years. There are also exceptions for the MCC requirement- i.e. some people may be exempt from having to have insurance that meets MCC standards in 2009 and beyond.

No employer has to offer MCC compliant health plans to their employees. The burden is on an individual to make sure their health care plan meets MCC standards. Make sure you get it IN WRITING from your health care insurance carrier that your health plan is or is not MCC compliant.

Also don't be fooled to into keeping or bying a inferior health plan by a health plan insurance broker- by them telling you-"that you won't owe a fine or if you do owe a fine it will only be a very small fine". If they say your "income is under 300 percent of the FPL (federal poverty level) and your fine will be very small" - If you are under 300 percent of the FPL, chances are you will be eligible for a good very affordable comprehensive state subsidized health plan known as Commonwealth Care.

*If you are exempt from the individual mandate, you will not be mandated by the state to buy health insurance and if you choose to buy health insurance it DOES NOT HAVE TO MEET MCC requirements. So what does this mean? Many self-employed people presently buy their own health insurance and many buy health insurance without drug coverage benefits (due to not needing them). If that self-employed person is exempt from the individual mandate, they will not have to buy health insurance and if they do decide to buy health insurance it will not have to meet MCC requirements (i.e. they won't have to buy up/purchase insurance that includes drug benefits and/or other MCC requirements).

If you are not exempt from the individual mandate and can not afford a MCC compliant health plan and are not eligible for a State sponsored plan, you can apply for a waiver from the MCC requirements through the Connector. Note if you do not get a waiver for your health plan that does not meet MCC requirements, you will be penalized for not having health coverage by the Massachusetts Department of Revenue on your State taxes (i.e. you did not comply with the State's Individual Mandate)

It is important to note that open enrollment periods for many health plans occur once a year and there is usualy a one year contract for coverage.

Some plans automatically meet MCC standards and you do not have to worry about whether they include the right benefits. What if your health insurance doesn't meet MCC? "The Health Connector will offer a flexible and generous waiver and appeals process. Tax filers can also file hardship and other appeals with their taxes"

You can also call your health insurance plan directly to see if it meets the State's MCC requirements and/or check with your company's HR department. If you have an out of state employer or health insurance company you may need to ask for detailed information on what your health plan covers and then check with the Connector to see if it meets MCC standards.


A list of plans/programs that meet MCC coverage/are MCC compliant:

* All MassHealth Programs meet MCC requirements (except MassHealth Limited)

*All Commonwealth Care Health Plans/Insurance plans automatically meet MCC standards.

*All Young Adult Plans purchased through the Connector automatically meets MCC standards. However the Young Adult Plan must meet it's own standards.

*Student Health Plans offered by Universities/Colleges are considered MCC compliant

*A health arrangement provided by established religious organizations comprised of individuals with sincerely held beliefs qualifies for MCC standard.

*Any high deductible health plan ("HDHP") that complies with federal statutory and regulatory requirements for Health Savings Accounts (HSA) are considered MCC compliant (Note in 2010-there will some limits on HDHP/HSA-they will have to provide a broad range of medical services and Pre-deductible preventive care benefits- HDHP/HSA plans that do not offer the specifics of MCC will need a determination from the Health Connector.

*Medicare and Medicaid programs/plans are considered MCC compliant (this includes parts A/B).

*All Commonwealth Choice Plans are considered MCC compliant.

*Collectively-bargained plans "in force on 1/1/09 may be deemed MCC compliant for up to 1 year beyond an expired collective bargaining agreement.

*The Health Connector can approve plans that cover a broad range of medical benefits if the relative value of the benefits are comparable to the value of a Health Connector Bronze plan. For information on how to get plans approved under the safe harbor see the Connector's webpage on MCC's requirements.

* VA membership/plans (aka The U.S. Veterans Administration Health System)

*AmericaCorps Insurance (AKA Peace Corps, VISTA or AmeriCorps or National Civilian Community Corps coverage)


*A tribal or Indian Health Service plan


If you do not have one of the listed plans and you are not exempt from the individual mandate, the health plan you do have will have to include certain levels of coverage and benefits as listed below to meet MCC requirements. Your plan will need to meet these requirements by Jan 1, 2009. For more info on the MCC requirements see Community Partner's PDF flyer


"*Primary and preventive care

*Emergency services

*Hospitalization benefits

*Diagnostic surgery

*Prescription drug coverage. Any separate prescription drug coverage deductible may not exceed $250 for an individual and $500 for a family

*Ambulatory patient services

*Mental health services

*No annual or per-sickness benefit maximum

*No per diem limit on in-patent care

*Annual deductibles capped at $2,000 for individual and $4,000 for family coverage

*Annual out-of-pocket spending capped at $5,000 for an individual and $10,000 for a family receiving in-network services, if the plan includes a deductible or co-insurance on core medical services

*Any out-of-pocket maximum must include the upfront deductible, most coinsurance and any service that requires a co-payment of $100 or more

*A minimum of three visits to the doctor for an individual and six for a family prior to any upfront deductible"

QUOTED FROM the Connector's Dec 10, 2007 press release "HEALTH PLANS OFFERED IN 2008 SHOULD MEET NEW STANDARDS"