Understanding Your Coverage Options
When reviewing your benefit options, you may see both MEC plans and MV plans available.
While both provide access to healthcare services, they are designed differently and generally offer different levels of coverage.
The easiest way to think about it is:
MEC plans focus on preventive care and routine healthcare services.
MV plans provide broader coverage that may include hospital care, emergency services, surgery, advanced imaging, and other major medical benefits.
What Does MEC Mean?
MEC stands for Minimum Essential Coverage.
MEC plans are designed to provide access to preventive healthcare services and, depending on the plan selected, may also include benefits such as:
- Primary care visits
- Specialist visits
- Urgent care
- Prescription benefits
- Virtual care
- Laboratory services
- X-rays
Coverage varies by plan.
What Does MV Mean?
MV stands for Minimum Value.
MV plans include preventive care and routine healthcare services, but also provide coverage for many services that are generally not included under MEC plans.
Depending on the specific MV plan selected, coverage may include:
- Hospitalization
- Emergency room visits
- Surgery
- Advanced imaging (MRI and CT scans)
- Ambulance services
- Maternity benefits
- Mental health treatment
- Physical therapy
- Chiropractic services
- Home health care
Coverage levels, deductibles, copays, and annual limits vary by plan.
Comparing Common Healthcare Services
| Service | MEC Plans | MV Plans |
|---|---|---|
| Preventive Care | ✓ | ✓ |
| Primary Care Visits | Some Plans | ✓ |
| Specialist Visits | Some Plans | ✓ |
| Prescription Coverage | Some Plans | ✓ |
| Virtual Care | ✓ | ✓ |
| Urgent Care | Some Plans | ✓ |
| Lab Work & X-Rays | Higher MEC Plans | ✓ |
| MRI / CT Scans | Generally Not Covered | May Be Covered |
| Hospital Stays | Generally Not Covered | May Be Covered |
| Surgery | Generally Not Covered | May Be Covered |
| Emergency Room Visits | Generally Not Covered | May Be Covered |
| Ambulance Services | Generally Not Covered | May Be Covered |
| Maternity Benefits | Generally Not Covered | May Be Covered |
How Are Costs Different?
Another important difference is how healthcare expenses are shared.
MEC Plans
Most MEC plans use fixed copays or network discounts for covered services.
Examples may include:
- Doctor visit copays
- Specialist visit copays
- Urgent care copays
- Prescription copays
This can make costs more predictable for routine healthcare needs.
MV Plans
MV plans often include:
- Deductibles
- Coinsurance
- Out-of-pocket maximums
For example, some MV plans may require members to pay a portion of healthcare costs until a deductible is met, after which the plan shares costs with the member. Other MV plans may provide first-dollar coverage with copays for many services.
Which Services Are Typically Added With MV Plans?
The biggest difference employees notice is access to major medical services.
Examples include:
Hospital Care
MV plans may provide benefits for:
- Inpatient hospitalization
- Outpatient surgery
- Hospital-based procedures
Emergency Services
MV plans may provide benefits for:
- Emergency room visits
- Emergency transportation
- Ambulance services
Advanced Diagnostics
MV plans may provide benefits for:
- MRI scans
- CT scans
- PET scans
- Advanced imaging
Additional Healthcare Services
Depending on the plan, MV coverage may also include:
- Physical therapy
- Chiropractic care
- Home health care
- Substance abuse treatment
- Mental health treatment
- Maternity services
These services are generally limited, may require preauthorization, and may be subject to copays, coinsurance, annual limits, or other plan provisions.
What Should I Compare When Reviewing Plans?
When comparing a MEC plan and an MV plan, consider:
Doctor Visits
How often do you expect to visit a doctor?
Prescription Medications
Do you take medications regularly?
Specialist Care
Do you currently see specialists?
Hospital Coverage
Would you like benefits available for hospitalization and surgery?
Emergency Care
Do you want coverage for emergency room visits and ambulance services?
Diagnostic Services
Do you want benefits available for MRI, CT scans, and other advanced imaging services?
Understanding these differences can help you compare plan options and choose the coverage that best aligns with your healthcare needs.
Quick Summary
MEC Plans
Typically focus on:
✓ Preventive care
✓ Doctor visits
✓ Virtual care
✓ Prescriptions
✓ Routine healthcare services
Generally do not include:
✗ Hospital stays
✗ Surgery
✗ Emergency room visits
✗ Ambulance services
✗ Advanced imaging
MV Plans
Include preventive and routine healthcare services, plus benefits that may be available for:
✓ Hospitalization
✓ Surgery
✓ Emergency care
✓ Ambulance services
✓ Advanced imaging
✓ Maternity benefits
✓ Additional treatment services
Always review your specific plan's Summary of Benefits to understand covered services, limitations, copays, deductibles, and annual benefit limits before making your enrollment decision.