Major Medical Insurance: Definition, Coverage & More | eHealth
If you’re looking for health insurance, you need to make sure your insurance offers comprehensive coverage. this includes preventive care, emergency room visits, urgent care visits, surgical procedures, and hospital stays.
Fortunately, that is precisely what major medical insurance offers. When someone talks about typical health insurance coverage, they are usually referring to major medical insurance. But how does health insurance work and what does it cover?
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Keep reading to learn more about major medical insurance, including what this health insurance covers, benefits, drawbacks, and more, to make sure you select the right policy for your needs.
major health insurance covers all minimum essential benefits and meets Affordable Care Act (aca) standards for individual and family coverage. Many individuals and families select major medical coverage to ensure that all of their medical expenses are covered regardless of health problems that may arise during the year.
major medical expense insurance explained
Elderly medical insurance is a specific type of health insurance plan that will help you cover your medical expenses. It often covers preventive care services, urgent care visits, emergency room visits, prescription drugs, and other routine medical expenses. however, this type of plan will not cover cosmetic procedures. it also has a longer duration than a short-term insurance plan. the goal of this plan is to minimize out-of-pocket expenses for the policyholder.
When people talk about typical health insurance coverage, major medical plans are the type of insurance they’re thinking of. Major health insurance plans are comprehensive, comply with Affordable Care Act (ACA) regulations for qualifying health plans, and are designed to minimize out-of-pocket costs for individuals and families.
For example, your primary health insurance plan must cover your annual wellness exam. if you catch a cold and have to go to the emergency room due to complications, the plan will often cover that expense as well.
what do major medical plans cover?
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Major health insurance plans offer the 10 essential benefits:
- hospitalization
- outpatient procedures (also called ambulatory care)
- preventive care like checkups and shots
- prescription drugs
- mental health and addiction counseling
- laboratory services
- emergency services
- pediatric care
- maternity and newborn care
- preventive care coverage
- easier to obtain than other health insurance policies, specifically for those with pre-existing medical conditions
- qualifies for the aca, so fines can be avoided in states with tax penalties
- can be difficult to understand due to legal jargon
- Terms are usually longer, so you’ll have to wait to change plans
- change jobs
- marry or divorce
- have a child
- income change
These plans are not only sold through official state and federal marketplaces. they can be sold off-exchange through licensed private brokers. For example, ehealth is a private marketplace that sells major health plans along with other insurance options, small business health insurance, and alternative coverage options like short-term health insurance.
Who is Major Medical Insurance suitable for?
Major medical coverage is a good option for almost anyone who wants to minimize expenses for preventive care, emergency services, and management of chronic conditions. These comprehensive plans are the best way to cover a full range of your day-to-day health care, while ensuring that any unexpected medical needs do not cause significant financial concern. Although these plans will not cover all medical services, they will provide coverage for the widest range of services and care.
How is major medical insurance different from other health plans?
The insurance for major medical expenses differs from other health plans because it is more complete. The terms for this type of health insurance plan are typically longer than a short-term one and provide more extensive coverage than a catastrophic one. for example, a major health insurance plan will cover preventive care visits, but catastrophic health insurance will not. Plus, major health insurance plans provide better coverage for chronic health conditions like diabetes and heart disease.
benefits and disadvantages of insurance for major medical expenses
It is important to consider the benefits and drawbacks of major medical expense health insurance.
pros of insurance for major medical expenses
major medical expense insurance covers the most necessary care associated with serious illness and hospitalization, along with many additional benefits, including:
A major health insurance plan sold during open enrollment or a special enrollment period may also qualify for subsidies that significantly reduce the cost of premiums.
disadvantages of major medical insurance
On the other hand, there are some drawbacks of major health insurance plans. include:
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more expensive than other options in terms of monthly premiums as they offer many additional benefits.
ways to sign up for major medical insurance
Major health insurance can be purchased through official health insurance exchanges and through licensed brokers like ehealth, which may also sell qualified health plans. you are limited to buying on an exchange during certain times of the year. The most common time to buy a plan is during the open enrollment period. You may also qualify for what’s known as a special enrollment period if you have a qualifying event. these include:
If you want to buy major medical insurance at other times of the year, or if you want to buy a plan that isn’t offered on the exchange, you also have the option of buying a policy outside the exchange. buying a policy outside the market can have certain drawbacks. for example, plans purchased off-exchange are unlikely to qualify for subsidies. Since these subsidies can have a significant impact on the cost of the monthly premium, the monetary difference between plans in and out of the market can be significant, even if the coverage is similar.
alternatives to insurance for major medical expenses
When the law here was first enacted, it included a requirement that all Americans have a health insurance plan or pay a penalty. in April 2020, the penalty was lifted, allowing individuals to explore alternatives to major medical coverage.
An alternative that some people choose is catastrophic health insurance. Catastrophic plans differ from major health insurance in that they offer a very limited range of benefits. These plans will generally cover expenses associated with a hospital stay, surgery, serious illness, or injury. however, they will not cover preventive care or minor health problems. The premiums for these plans are much lower than the premiums for major health insurance because they offer less coverage.
Short-term health insurance is another option that allows people to purchase coverage that lasts up to 12 months or less. Short-term health insurance may be a good option if you’re in a transition, like moving or changing jobs.
choosing the major medical coverage that’s right for you
Major medical insurance can help you pay for a wide range of health care expenses, including emergency room visits, preventive health services, and surgical procedures. however, there are many plans to choose from, so finding the best policy for your specific needs can be challenging. Fortunately, our team is available to help.
Whether you’re shopping for major health coverage in or out of the Marketplace, the choices can seem overwhelming. That’s why it’s helpful to work with a licensed broker like ehealth. our experienced agents can help you select the best plan for your needs and budget. our services are free and we offer 24/7 support after you sign up to help you manage your plan. With licensed agents in every state, you can shop for the best plans no matter where you live, all from the comfort of your own home. Check out all individual and family health insurance plans in your state to learn more about your options in major medical coverage and find the right plan.
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