For years, major medical health insurance plans were the norm for Americans. These plans provided comprehensive coverage for major medical expenses, like hospital visits and doctor visits. They were offered by major employers and government organizations and were often the only way that many people could afford to cover their major medical costs. But in the last few years, major medical health insurance plans have all but disappeared from the market. Regardless, let’s look at what major medical health insurance plans are and which are still available.
What is Major Medical Health Insurance?
Major medical coverage focuses on providing coverage for preventive health measures, illness, and hospitalization. Individual major medical plans must comply with today’s ACA regulations in terms of paying health-related costs and qualifying coverage. The ACA refers to these as “qualified plans,” which means they offer minimum essential coverage.
As we mentioned, major medical plans are not as prevalent as they once were, and the only place you can really get them today is via the Health Insurance Marketplace or from an individual insurance broker. Most major medical plans offer full coverage with lower out-of-pocket costs, but Catastrophic and other high-deductible plans can also be considered major medical under the ACA.
It’s worth noting that major medical insurance does not include insurance programs such as fixed indemnity plans, benefit plans, critical illness plans, or accidental supplements, as the ACA provides no regulation for these.
What’s Covered by Major Medical Health Insurance Plans?
Major medical insurance basically provides coverage for injuries, illness, and preventative care. Under the ACA, all major medical policies must cover a sizable list of preventive services for three categories of insureds, including women, children, and adults. This includes health screenings and immunizations, but along with preventative measures, all of these plans must also provide no less than ten categories of essential health benefits. These benefits include:
- Outpatient procedures or Ambulatory services
- Preventative care
- Laboratory services
- Prescriptions drugs
- Pediatric care
- Addiction counseling and mental health
- Emergency services
- Maternity and Newborn care
Just keep in mind that federal and state insurance marketplaces are not the only place you can purchase major medical plans. In fact, you can do so through any licensed private broker.
Who Should Use Major Medical Insurance?
Major medical insurance is the best choice for those looking to minimize their expenses for emergency services, preventative care, and the management of chronic illnesses. These plans are comprehensive and provide an excellent way to cover a full range of ordinary medical care while also ensuring that any emergencies are also covered. Though these plans will not help you in every case, they provide coverage for various health-related care and services.
What are the Drawbacks and Benefits of Major Medical Health Insurance?
One of the most significant advantages is that major medical covers most required care for hospitalization and severe illness, with many additional benefits.
The drawback is that these plans often cost more in monthly premiums than other choices because they offer so many benefits and services. The other thing to keep in mind is that these plans are only available for purchase during open or special enrollment periods. Also, be sure to see if you qualify for any subsidies, as these will help drastically reduce the price of your premiums.
Where can you buy Major Medical Health Insurance?
As we briefly mentioned, major medical plans can be purchased through the health insurance marketplace or via a licensed broker. The key factor here is that you can only buy one of these policies on the exchange during specific times of the year, with the most common time being during the open enrollment period. However, some people can qualify for a special enrolment period, expressly, if you have one of these events:
- Getting married or divorced
- Change in employment
- Birth of a child
If you’re looking to buy major medical insurance during other times of the year or want a plan that’s not offered on the exchange, you can always purchase policies off the exchange. However, buying a plan that’s not from the marketplace does have drawbacks, with the biggest being that those not purchased from the exchange are not eligible for subsidies. Since subsidies can significantly reduce monthly premiums, the monetary differences between buying on and off the exchange are often significant, even if coverage is comparable.
Are there Alternatives to Major Medical Plans?
There are a few viable options in terms of alternatives for major medical health insurance. The first option is called Catastrophic coverage, and these plans differ from major medical in that they offer only limited benefits. Catastrophic plans typically cover surgery, hospitalization, injury, or major illness expenses. However, they do not help with minor conditions or preventative care. The good news is that the premiums for these plans are usually much lower than those of major medical policies.
Another great option is short-term insurance, which allows people to purchase plans for up to 12 months. This insurance is an excellent option for those in transition periods such as a job change or relocation.
Choosing the Right Major Medical Plan for You
The choices are staggering whether you wish to purchase a major medical health insurance plan on or off the exchange. For this reason, it’s best to seek the advice of a licensed broker who can help you select the right plan for your medical needs and budget.
The major medical health insurance plans on the exchanges are an excellent option for those who need extensive medical coverage. The plans provide access to a vast network of health care providers, including hospitals and doctors’ offices. They also offer a great deal of preventive care and allow you to visit the doctor without worrying about the cost. Above all, major medical plans offer a great deal of flexibility, which is especially appealing to those in transition periods such as a job change or relocation.