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Glossary > Major Medical (Minimum Essential Coverage)

Major Medical (Minimum Essential Coverage)

What Is Major Medical Insurance?

Major medical insurance, or minimum essential coverage is a broad type of insurance that includes every essential medical expense you may incur. There are fewer gaps in the insurance for both inpatient and outpatient services, making it a common healthcare option for those who cannot get insurance through a public program or through their employer. 

 

Types of Major Medical Insurance

There are two different types of major medical insurance offering specific coverage plans to those who have major medical insurance:

 

Comprehensive -

This is the more common form of major medical insurance, and it's designed to cover all medical costs after the deductible is satisfied. The deductible is different from person to person and is largely dependent on the monthly premium you pay. In some instances, your deductible will be zero, meaning the coverage will take place as soon as the costs are incurred. This type of comprehensive major medical coverage is called first-dollar coverage. There is no deductible. 

 

Supplemental -

The other kind of major medical insurance, supplemental, acts as a boost for your existing health insurance plan. It serves to cover expenses that your employer-provided insurance does not. Once the benefits of your comprehensive plan run out and the deductible is paid, the coverage of the supplemental insurance kicks in to help cover further costs. 

 

When Do You Need Major Medical?

This type of coverage is ideal if you want long-term health coverage but don't feel your company's current health plan's coverage is enough. It is also an appropriate form of coverage if you are self-employed because of the wide range of services and expenses it covers. 

In the ACA marketplace, there are four different levels of coverage referred to as metal tiers.  These tiers do not affect your quality of healthcare, they just determine how much you will pay for coverage, and how much your health insurer will pay for coverage.  The tiers from least expensive to most expensive: 

  • Bronze
  • Silver
  • Gold 
  • Platinum 

What Major Medical Insurance Covers

Major medical insurance covers a wide array of different medical needs. Each company has a different plan, so you should check with your insurer before going forward with any medical procedure. 

 

What It Covers

Individual major medical coverage should cover at least a portion of any medical expenses you incur either in a hospital or an outpatient facility. This includes services such as ambulatory, home healthcare, diagnostic visits, X-rays, and lab tests. 

 

What It Doesn't Cover

While it covers most of the essential health services you need, there are a few things that major medical does not cover. It does not cover elective surgeries in most cases, such as plastic surgery. It also does not cover dental services. 

 

Who Should Consider Major Medical Insurance?

If you feel that your employer's coverage is not enough for you or your family, major medical could be right for you, especially the supplemental version. It is also the ideal type of coverage for someone who is not offered insurance by their employer or is self-employed.

Talk to an agent 858-771-4087, or enter your zip code here to see if major medical is right for you!