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Major Medical Health Insurance

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What is major medical insurance?

Individual Major Medical

The main idea of major medical is providing insurance coverage for illness, hospitalization and preventive health care. These plans must comply with Affordable Care Act (ACA) regulations for qualifying coverage and are designed to help pay health-related costs for enrollees. These “ACA Qualified Plans” must provide minimum essential coverage.

Major medical could be purchased through the Health Insurance Marketplace “ObamaCare” or directly through an insurance company. You can also qualify for coverage through your employer. Major medical plans can provide full coverage with low out-of-pocket “subsidized” costs, but they also can be Catastrophic and other high-deductible health plans as defined by the ACA.

Major medical does not include limited benefit plans, fixed indemnity plans, accident supplements or critical illness plans, which none of these are regulated nor qualified by the ACA.

What does major medical health insurance cover?

This insurance provides coverage for illnesses and injuries, along with preventive care. The Affordable care Act requires all major medical plans to cover an extensive list of preventive services for 3 categories of insureds including adults, women and children. This includes services for immunizations and screenings.

Along with preventive services, all major medical plans, per “ACA requirements” must provide at least these 10 categories of essential health benefits:

Ambulatory patient services

Emergency services

Hospitalization

Maternity and newborn care

Mental health and substance use disorder services

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services, including oral and vision care

Some major medical insurance policies will have added coverage such as dental, vision or medical management programs. How your major medical plan covers these benefits will depend on the number of different programs available. 

How are preexisting conditions treated?

All ACA compliant major medical insurance plans do cover preexisting conditions. Under the ACA, health insurance companies can’t refuse to cover you or charge you more due to a preexisting condition, which would be a condition you had prior to applying for new health coverage.

All “ObamaCare” / Marketplace plans must cover treatment for pre existing conditions . Insurance plans can not reject you, charge extra or refuse to pay for essential health benefits for any condition you had before your coverage started.

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