Major & Short Medical
Major Medical Health Plans & Affordable Care Act (ACA): A major medical health coverage is a type of long-term medical insurance that meets the mandate essential health benefits(EHB) standard regulated by the ACA. Most of its plans are sold on the healthcare insurance marketplace through private or public insurance carriers or off-exchange through a licensed broker allowed to sell qualifying health plans or directly from an insurer as long as they’re fully compliant with the ACA.
The best option is to purchase your Major Medical plan on-exchange during the open-enrollment. Purchasing your plan on-exchange may qualify you for premium subsidies, which keeps your premiums more affordable. You could also choose to purchase your health plan, not offered on-exchange, off-exchange through licensed brokers with no subsidies. Be aware that a qualifying event like changing jobs or getting married could also allow you to qualify for a special enrollment throughout the year.
Major medical plans are designed to cover most individuals’ and family’s expenses associated with serious illness or hospitalization once their deductible is met. Most of the on-exchange plans are either health maintenance organizations (HMO) or exclusive provider organizations (EPO) depends on the insurer. They both cover preventive services, including check-ups, immunizations, and screenings, at no additional cost to the insured. Below are the ACA ten minimum essential health benefits for any insurance carriers operated in the marketplace:
- Prescription drugs
- Pediatric services
- Preventive and wellness services and chronic disease management
- Emergency services
- Hospitalization
- Mental health and addiction services
- Pregnancy, maternity, and newborn care
- Ambulatory patient services
- Laboratory services
- Rehabilitative and habilitative services and devices
But if you’re in need of any other types such as preferred provider organizations (PPO) or point-of-service (POS), or even health savings accounts (HAS), you might want to consider off-exchange plans.
Short Term Medical: Whether you’re in need for temporary medical coverage for an emergency, you missed open enrollment period, or you are ineligible for the on-exchange insurance coverage or job-based health insurance plan, or unable to afford private insurance plans, short term medical is the answer to your prayer.
The short term is designed to help bridge gaps from one life event to another without a comprehensive health care plan. A short-term plan is not considered major medical coverage and it’s not regulated by the Affordable Care Act (ACA). But it’s still a type of medical health insurance providing short term medical type benefits for unexpected accidents and illnesses.
Short-term plans are sold outside the exchanges and they’re not required to meet the same standards as medical plans sold on the exchanges. Their coverage varies depending on the plans and the insurer, so it’s important to read and understand the exclusions and limitations before buying the plans.
Short term plans’ premiums tend to be lower than unsubsidized major medical plans. They are based on many factors, including your health status and the benefit level you select. Their deductibles are significantly higher. Limited coverage for most services like preventive care, doctor visits, urgent care, emergency care, prescriptions, and no coverage for pre-existing conditions.