What is a Major Medical Health Insurance Plan?

A major medical health insurance plan is a comprehensive medical plan that can help you pay for doctor’s visits, hospitalization, and prescription drugs if you should become sick or injured. It also helps you pay for preventative care.

While there’s no set definition of what “major medical insurance” is comprised of, the term is generally used to refer to health insurance plans that were sold after 2014 and follow the minimum essential coverage guidelines and practices outlined in the Affordable Care Act.

The Ten Essential Health Benefits

that every plan must have included

• Hospitalization
• Prescription drugs
• Laboratory services
• Emergency services
• Ambulatory patient services
• Maternity and newborn care
• Mental Health and Substance Use Disorder services
• Pediatric services (including vision and dental care)
• Rehabilitative and habilitative services and devices
• Preventative and wellness services, as well as chronic disease management

Covered Services

Major medical insurance plans are designed to cover medical services that the average person might need in their lifetime. The health insurance plans that are sold on the health insurance marketplace, as well as all employer plans, are major medical insurance plans and are required to meet the ACA guidelines. Limited benefit plans, like short-term health insurance, are not required to offer the same benefits as major medical insurance and generally should not be considered good options for the long-term.​

Who Needs Major Medical Insurance?

If you think that because you’re reasonably healthy and lead an active lifestyle that you don’t need insurance, think again; regardless of how healthy you are, your situation could change in an instant. Because the cost of medical care (especially if you find yourself with a serious or chronic condition) can quickly eat away at the most respectable nest eggs, having an insurance policy is a necessity.

Employer-Based Plans
vs.
Individual Major Medical Health Insurance Plans

More than half of working Americans acquire their health insurance through their employer. For most, this is an ideal situation, as they can enjoy relatively low premiums that come out of their paychecks automatically. However, many Americans don’t have this option. For example, if you work for a small business that has less than 50 full-time employees, your employer can opt out of offering insurance without facing a tax penalty. In some cases, even if your employer does offer insurance, you may decide that it doesn’t fit your needs.

For those who are unable or uninterested in getting insurance through their employer, individual major medical health insurance plans are available. Talk to your health insurance agent to learn what types of plans are available and get advice on choosing one that will meet your needs.

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Major Medical vs Other Types Of Health Insurance Coverage

A serious illness or injury can have a lasting impact on more than just your health; it can take a significant toll on your finances as well. Too many Nevadans spend years saving to pay off a home or to enjoy a comfortable retirement, only to watch their hard-earned savings and future earned income disappear because of a medical emergency. Very few people are wealthy enough to be self-insured; the rest of us rely on major medical health insurance to protect us from financial hardship.

One of the goals of the Affordable Care Act was to do away with skimpy health insurance plans that don’t provide adequate coverage. For example, short term insurance plans, mini medical plans, indemnity plans, etc. have limits, and many have underwriting qualifications to get them. Desperate Nevadans and sometimes income strapped Nevadan’s who are searching for budget-friendly health insurance options may be drawn to these plans because of their low monthly premiums.

Know What You Are Buying!

While these plans may look and sound like major medical health insurance, they do not provide the coverage that many customers expect. Sometimes you may speak with agents that sell these products in a deceitful manner, making them sound like they have coverage of an ACA (Obamacare) plan, but they do not offer the full benefits of one.