The MEC Choice plan is a Minimum Essential Coverage (MEC) limited benefit plan. It’s designed to meet ACA preventive requirements while also offering a modest set of office visits, urgent care, labs, and generic prescriptions. Unlike traditional major medical insurance, MEC Choice does not provide unlimited coverage for hospital or surgical services — instead, it focuses on preventive care and a limited number of outpatient benefits, all with predictable copays and no deductible. This makes it a step up from MEC Classic, giving members more practical access to everyday healthcare needs while keeping costs low.
- Plan type: MEC limited benefit plan (not major medical)
- Network: PHCS PPO — national access; plans are not insured by PHCS
- Deductible (individual/family): $0 / $0
- Out-of-pocket maximum (individual/family): $8,700 / $17,400
- Preventive care: $0 copay for non-hospital based preventive services (routine screenings, immunizations, wellness visits)
- Primary care visits: $35 copay
- Specialist visits: $75 copay (includes mental and behavioral health)
- Urgent care: $85 copay
- Telemedicine: Unlimited $0 copay visits
- Labs & radiology: $50 copay (non-hospital based)
- Advanced imaging (CT/MRI/PET): $500 copay, up to 3 times per year (prior authorization required)
- Hospitalization, surgery, ER, anesthesia: Not covered
- Pregnancy benefits: Not covered
- Pharmacy: Preventive generics $0 copay; non-preventive generics $5 copay; brand and specialty drugs not covered
How MEC Choice Differs from MEC Classic
- Expanded coverage: MEC Choice adds limited office visits, urgent care, labs, and imaging, while MEC Classic only covers preventive care and telemedicine.
- Pharmacy benefits: MEC Choice includes a $5 copay for non-preventive generics, whereas MEC Classic excludes them entirely.
- Out-of-pocket maximum: MEC Choice caps member costs at $8,700 individual / $17,400 family, while MEC Classic has no out-of-pocket maximum.
The MEC Choice plan is best for individuals who want ACA compliance plus affordable access to basic outpatient services. It’s not designed for hospital or surgical coverage, but it helps reduce out-of-pocket costs for preventive care, primary care, urgent care, labs, and generic prescriptions. If you’d like to confirm whether your doctor participates in the PHCS PPO network, check which medications qualify under the formulary, or compare MEC Choice against other limited benefit options, contact Fage Financial today — we’ll walk you through the details and help you decide if this plan is the right fit for your needs.