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.
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.
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.
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Medicaid Basics To Know
Medicaid is a health insurance program administered by the state and federal government, to provide health coverage for those who meet income restrictions or have qualifying medical needs. Medicaid can also be used alongside other health insurance coverages such as private health insurance, Medicare, etc.
What is Tier Pricing With Prescription Medications?
Your health insurance company’s formulary is a list of all the different drugs that their plans cover. Within the formulary, there are drug tiers. These tiers determine the level of coverage your prescription drug plan offers for a specific type of medication.
Health Insurance with a Preexisting Condition
You may assume that since you have a preexisting condition, you’ll pay a higher premium than someone who is in perfect health. However, an insurer cannot reject you, refuse to pay for health benefits pertaining to your illness or injury, or charge you a higher premium because of your condition.
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.
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Recent Posts
Medicaid Basics To Know
Medicaid is a health insurance program administered by the state and federal government, to provide health coverage for those who meet income restrictions or have qualifying medical needs. Medicaid can also be used alongside other health insurance coverages such as private health insurance, Medicare, etc.
What is Tier Pricing With Prescription Medications?
Your health insurance company’s formulary is a list of all the different drugs that their plans cover. Within the formulary, there are drug tiers. These tiers determine the level of coverage your prescription drug plan offers for a specific type of medication.
Health Insurance with a Preexisting Condition
You may assume that since you have a preexisting condition, you’ll pay a higher premium than someone who is in perfect health. However, an insurer cannot reject you, refuse to pay for health benefits pertaining to your illness or injury, or charge you a higher premium because of your condition.
Is Physical Therapy Covered Under Health Insurance?
Whether you have recently been injured or you are experiencing chronic pain or limited mobility, going to a physical therapist can greatly improve your quality of life. For many people, concerns about how much regular sessions cost is a big roadblock to getting much needed care. Fortunately, if you have an ACA-compliant health insurance plan, rehabilitative services like physical therapy are listed among the essential health benefits.