Why Minimum Essential Coverage (MEC) is Not Enough

The concept of Minimum Essential Coverage (MEC) is a relatively new one in the insurance industry, brought into being by the Affordable Care Act (ACA).  In a nutshell, it encompasses the services that are considered preventive such as a yearly physical and standard blood work; it also stipulates that no co-pay, coinsurance or deductible is charged to the patient for these preventive services.  In other words, preventive care is ‘free’ on the plans.  As we all know, this care comes at a cost – higher premiums and deductibles that are shouldered by both businesses and individuals

The Society for Human Resource Management states, “…46 percent of employers will take steps to reduce cost growth in 2018, (by) offering lower-cost, high-deductible health plans.”  Many employers have had no choice but to turn to high-deductible plans that keep premiums steady but ultimately cost their employees more.  A hidden consequence of MEC plans is the reimbursement stipulation that makes primary care inconvenient for people that want to go for a yearly preventive visit and also discuss other health concerns.

For example, many healthcare providers now inform their patients during yearly preventive visits that they need to come back if they want to discuss anything outside the scope of a standard health screening, like a sore knee.  Providers have been forced into this position because if a patient mentions something that requires a diagnosis, the visit will likely no longer be considered preventive (and consequently no longer ‘free’) and the patient could be charged for the visit.  

Visits involving a diagnosis often require a co-pay, with the overall charge going toward the employee’s deductible.  This situation is frustrating for the employee because 1) they are charged for a visit they have been told would be ‘free’ and 2) they will need to schedule a second appointment to come back and discuss whatever is ailing them.

The financial set-up of MEC plans can also discourage individuals from seeking care when they are sick.  Rather than visiting the doctor, appointments are put off because the plan only covers preventive visits, not sick visits.  Consequently, illnesses can become more complicated and costly to treat. Some employees avoid taking time off work for an appointment because many businesses don’t differentiate between sick paid time off and paid vacation.  Understandably, many employees are reluctant to give up vacation time to visit the doctor.

The Role of Direct Primary Care with MEC plans

Direct Primary Care (DPC) works in tandem with MEC plans by keeping the costs related to doctor visits predictable, while also making them convenient to both the employee and employer.

DPC offers appointments that don’t need to take into consideration if the visit is preventive or for an illness.  So, patients get the care they need without co-pays or the worry about how the visit will affect their deductible, making DPC an ideal addition for people suffering from chronic conditions such as diabetes.

DPC is accessible, with same-day appointments often available.  In addition to seeing a doctor in a traditional office setting, DPC offers virtual visits (where the patient communicates with the doctor via phone, text, email, or video conference) that allow the employee to stay at work.  Not only is this good for the employee who is now able to manage his/her health conveniently, but it is also good for the employer who does not have an interruption in productivity due to office visits or absences that could have been prevented by better management of medical conditions.

Although MEC plans have undoubtedly created benefits for patients by making preventive health services available, for many the plans just don’t go far enough.  DPC helps fill the void left by MEC plans with affordable, dependable and convenient everyday care, making it an excellent incentive for employee recruitment and retention.