In-depth Review of Major Medical Insurance Plans

Major medical health insurance is a type of health plan adhering to all of the minimum essential benefits standards of the Affordable Care Act, and providing benefits for a broad range of inpatient and outpatient health-care services. People should know that not all major medical health plans can be purchased with a premium tax credit. It is a type of health insurance covering medical expenses related to hospitalization or illness. This terminology was used to describe comprehensive health plans covering necessary care. In layman’s terms Major medical insurance is the “real” health insurance and does not include limited benefit plans, fixed indemnity plans, dental or vision plans, accident supplements, or critical illness plans and other such plans that are not regulated by the Affordable Care Act.

Major Medical Health Insurance Coverage 

Major medical health insurance is the typical health insurance coverage and these plans comply with the ACA’s regulation for qualifying health plans. Essential health coverage of the Major Medical Health Insurance Plans includes:

  • Outpatient Procedures
  • Hospitalization
  • Preventive Care like immunizations and check-ups
  • Mental health
  • Prescription Medicine
  • Emergency Services
  • Pediatric Services
  • Laboratory Services
  • Maternity and newborn care
  • Rehabilitative and Habilitative Services

Features of Major Medical Health Insurance

The major medical health insurance plan covers the essential care associated with serious illness and hospitalization, along with some additional benefits. Due to the several benefits associated, these plans cost more than the other plans in terms of the monthly premiums. However, a Major medical plan sold during open enrollment or a special enrollment period qualifies for subsidies, thereby reducing the premium cost.

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Buying major medical health insurance on and off the exchange

Individuals looking to purchase Major medical health insurance plan can purchase these plans either through official health insurance exchanges or through licensed brokers, who are eligible to sell qualifying health plans. However, individuals can purchase these plans through exchanges only during an open enrollment period or special enrollment period, if they have a qualifying event such as:

  • Got Married or divorced
  • Change Jobs
  • Have a Child

Individuals looking to buy Major Medical health insurance plan during other times of the year, or wish to purchase a plan that is not available on the exchange, then they have the option to buy these plans off the exchange. Though, they need to know that there may be some drawbacks of buying these plans off the exchange, as they will not be eligible for subsidies that have a great impact on the cost of the monthly premium. The price difference between on and off-exchange plans is huge even if the coverage offered by both is the same.

Major Medical Insurance Differ from Other Types of Insurance

Major medical insurance is different from other types of insurance, as it only covers common and essential medical needs. Like car insurance, this insurance doesn’t become more expensive while filing a claim. However, essential coverage doesn’t mean that Major medical insurance will not cover every medical expense of the insured. For instance, dental or vision care is not considered as essential, so those plans are purchased separately. Different specific plans are available to cover additional costs for accidents, critical illnesses, and disabilities because all these require extra financial and medical help.

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Cost of Major Medical Insurance

Major medical plans come with a deductible amount, which the insured is responsible to pay. It is only after they pay their deductible amount the plan covers the remaining cost of the health care. After the deductible amount, the insured is also required to pay the coinsurance where the insured is supposed to pay a percentage of the bill, which is generally 20%, and the insurance company pays the rest. If the insured share of in-network costs reaches the plan’s maximum out-of-pocket limit, then the plan pays 100% of the patient’s covered in-network care for the rest of the year.

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