Health Insurance

Major Medical

Major medical health insurance is a specific kind of healthcare coverage. It’s comprehensive, it sometimes costs more and it is available to people regardless of health history or pre-existing conditions.

Major Medical insurance is, well, major.

It’s what we call comprehensive coverage, “Obamacare” plans, ACA-compliant coverage, and “traditional” health insurance.

In short, it’s what you probably think of when you hear the phrase “health insurance.”

Major medical plans cover a broad range of benefits and services that vary based on company and plan type. All health insurance works like this.

But with major medical, certain types of benefits must be covered by the plan, by law, even if you don’t have any intention of using those benefits.

These must-be-covered benefits are known as the “10 essential health benefits.” They include things like preventive care, maternity services, mental health care, prescription drugs, and more.

Thanks to the same law that guarantees these essential health benefits, major medical plans also guarantee lots of consumer protections. That means insurance companies have rules they have to play by, and you, as a consumer and patient, have protections against nefarious practices. (Nefarious is a fun word, isn’t it?)

Case in point?

Under the law (the Affordable Care Act, a.k.a. “Obamacare”), insurance companies can’t charge you higher rates or deny you major medical coverage because of your medical history. Even if you have a “pre-existing condition” — a health problem that exists before you sign up for medical coverage — insurers aren’t allowed to use that as a factor in your application. You’re treated the same as someone without any medical issues.

Major medical plans are the top tier of health insurance coverage.

You’ll pay a monthly premium for major medical coverage, which varies based on the company and plan you choose. On top of that, you’ll have “cost-sharing” amounts, like coinsurance, copays, and deductibles. These are set amounts that you pay for your care.

If you buy private major medical insurance — in other words, you don’t get it through your job — you may qualify for a tax credit to bring some of these costs down.

You can buy private health insurance:

  • Directly from an insurance company;
  • Through an agent or broker who represents a company (or a bunch of companies);
  • From a private marketplace, like ours, that helps you compare rates across different companies in your area; or
  • Via the state- or federal-run marketplace in your state created under the Affordable Care Act

No matter where you get your private plan from, though, you can only do it during a specific time of year. It’s called the Open Enrollment Period, and it runs from November 1st through December 15th in just about every state.

(States with their own marketplaces may have a different enrollment period.)

Outside this enrollment period, you won’t be able to get major medical insurance unless a major life event happens. A Special Enrollment Period lets you sign up if something big happens, like you get married, have a baby, get out of jail or become a citizen.

Bottom line? You’ve got a lot of options for health insurance these days.

But not every plan type covers the same level of benefits.

When we’re talking about “major medical insurance,” we mean a specific kind of coverage. It’s comprehensive, it costs more and it’s available to people regardless of health history or pre-existing conditions.

Ready to Get Started?

You can create the kind of health insurance coverage that works for you, with limited benefits and lower premiums or with top-tier comprehensive benefits. The choice is yours.

Concierge Services

Schedule your one-on-one insurance consultation with a coverage team member, privately and at your convenience.