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.

The Breakdown:
What Does a Major Medical Insurance Policy Provide?
Post - What is a Major Medical Health Insurance Plan

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 include:

♦ Laboratory services

♦ Emergency services

♦ Prescription drugs

♦ Mental Health and Substance Use Disorder services

♦ Maternity and newborn care

♦ Pediatric services (including vision and dental care)

♦ Rehabilitative and habilitative services and devices

♦ Ambulatory patient services

♦ Preventative and wellness services, as well as chronic disease management

♦ Hospitalization

Major medical insurance plans are designed to cover medical services that the average person could need in their lifetime once their out of pocket maximum has been met.  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 on a dime.  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


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.

Read More: Health Insurance in Las Vegas, Nevada

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