How do different plan designs affect ACA compliance (Minimum Essential Coverage & Minimum Value)?

The Affordable Care Act (ACA) requires large employers (those with 50 or more full-time employees) to offer coverage that meets two key standards: Minimum Essential Coverage (MEC) and Minimum Value (MV). Your plan design determines whether you meet one, both, or neither of these standards, and whether you avoid employer penalties.

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• Minimum Essential Coverage (MEC): The compliance baseline
  MEC satisfies the ACA requirement to offer coverage to at least 95 percent of eligible employees. It includes preventive and wellness services such as annual checkups, immunizations, and screenings, but it does not cover major medical care like hospital stays or surgeries.
  
  • Best for: Hourly, part-time, or lower-wage employees who need affordable, compliant coverage.
  • Important: MEC-only plans meet the 4980H(a) “offer of coverage” requirement but not the 4980H(b) “affordability” standard.
  • Best practice: Pair MEC with $0 primary care access through Vitable to make compliance coverage meaningful and easy to use.
• Minimum Value (MV): The standard for comprehensive coverage
  MV requires plans to cover at least 60 percent of expected healthcare costs and to include major medical and physician services. Most PPO, HMO, EPO, and HDHP plans meet this standard.
  
  • Best for: Employers that want to offer full coverage to core full-time staff.
    Affordable coverage threshold (2024): Self-only coverage must cost less than 8.39 percent of an employee’s household income.
  • ‍ Combine MV-level plans with built-in primary care to reduce claims and stabilize renewal costs.\

How common plan designs fit ACA compliance:

• MEC (Preventive-Only): Meets MEC but not MV. Best for part-time or hourly employees.
• HDHP: Meets both MEC and MV. Balances affordability and full coverage.
• Traditional PPO/HMO/EPO: Meets both MEC and MV. Ideal for comprehensive coverage for full-time employees.
• ICHRA: Employees choose their own ACA-compliant individual plan, which typically meets both MEC and MV.
• Vitable Primary-Care-First Plan: Meets MEC when paired with a compliant partner plan but is not major medical coverage on its own.
  
  

Combining compliance with affordability:
Many employers use blended strategies to stay compliant while controlling costs:

• MEC + Vitable: For hourly or part-time employees.
• HDHP + Vitable: For full-time teams needing full coverage.‍
• ICHRA + Vitable: For flexibility across multiple locations or employee types.

Vitable’s primary-care-first model helps employers meet ACA requirements affordably while keeping care accessible. Every member receives $0 access to virtual and in-home primary care, mental health support, and prescriptions. This improves engagement and satisfaction while maintaining compliance.

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• MEC provides baseline compliance and prevents 4980H(a) penalties.
• MV ensures comprehensive coverage that meets affordability rules.

The most effective approach blends both, using MEC-based options for affordability and MV-level plans for full coverage. With Vitable as your foundation, you can stay compliant, control costs, and deliver benefits that employees truly value and use.

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