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What is a Major Medical Health Insurance Plan?

by | Oct 14, 2024 | Health Insurance

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What Does Major Medical Provide?

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.

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What is a Major Medical Health Insurance Plan?

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.​

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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.

 

Does Health Insurance Cover Hair Loss?

Does Health Insurance Cover Hair Loss?

If you are experiencing hair loss due to an underlying medical condition, then there is a good chance that your health insurance will cover treatment for the condition, either completely or at least a portion of the cost. To be sure, you’ll want to check your “Agreement of Coverage” document.

Health Advice From Centenarians

Health Advice From Centenarians

Gardening has been shown to positively impact our moods, reduce stress and alleviate symptoms of anxiety and depression. However, studies have shown that the benefits of this hobby may extend even beyond promoting a sense of contentment and well-being.

Signs You Should Go See Your Doctor

Signs You Should Go See Your Doctor

Sometimes, deciding whether to see a doctor is a gray area, but it’s better to err on the side of caution. If you are experiencing a serious injury or illness, it is easy to justify making a call to your local medical office. However, it is important to remember that early detection generally leads to better outcomes.

Health Insurance Quotes

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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.

 

 

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Alternatives to Health Coverage

There are two main alternatives to major medical health insurance:

1). Fixed Benefit Indemnity Plans

Nevadans with fixed benefit indemnity plans are reimbursed a set sum for medical services. Despite the skinny coverage, these plans can cost as much as a major medical health insurance plan. In most cases, reimbursed sums are too low, potentially leaving customers who experience major health problems with medical bills sending them into bankruptcy. For example, a popular fixed benefit indemnity plan that costs $450 per month pays $100 for up to five doctor’s visits per year, $50 per year for screening tests and $1,000 a day for up to 30 days in the hospital. On average, hospital stays costs THOUSANDS per day. In all, the average expense for a hospital stay is over $9,000, and that number soars to almost $23,000 if surgery is performed. Fixed benefit indemnity plans may pay a set dollar amount for costs like surgery, tests, and prescription drugs. They pay their fixed amount, and that’s it.

2). Medical Discount Cards

Another type of health coverage that masquerades as major medical coverage is in the form of medical discount cards. As the name suggests, this type of coverage provides discounts on medical services in exchange for a monthly fee. Unfortunately, in many cases, customers have a hard time finding providers that offer the promised discounts, meaning that their monthly payment went towards nothing more than lining the pockets of those peddling these “plans.”

 

Finding Quality Health Insurance with Nevada Insurance Enrollment

If you’re shopping for health insurance with a tight budget, then you may believe that a cheap, bare-bones plan is your only option. However, for most people, major medical coverage is still within reach. One of our agents can help you find a health insurance plan that provides real protection in the event of an injury or illness, ensuring that if the unexpected happens, your situation won’t be worsened with financial troubles. These plans are all ACA approved and may have Government assistance depending on your household income.

By page visits (this month)

 

#1) Health Insurance Subsidy Chart

#2) Health Insurance

#3) Health Insurance WITH a Subsidy

#4) Insurance Blog Posts

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Are Ambulance Rides Covered By Health Insurance?

If you have a qualified health plan (QHP) the answer is yes, ambulance rides are covered. A QHP is an insurance plan that is certified by Nevada Health Link in Nevada that covers “10 essential health care benefits” including emergency transportation. You may need to pay a deductible, co-payment, or co-insurance for your ambulance trip.

Does My Auto Insurance Policy Cover My Trailer?

You have an auto insurance policy that covers damage to your vehicle, but what if you regularly use your vehicle to pull your trailer? Does that trailer have the same coverage as your car or truck?

What To Do After Closing On Your House

Closing on your home can feel like the end of a long journey, and while it is definitely a reason to celebrate, the work is not quite done. There are a few jobs to tackle before getting fully settled.

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