Major Medical Insurance

Comprehensive, ACA-qualifying healthcare coverage

What is Major Medical Insurance?

Major medical insurance is comprehensive, "qualifying" healthcare coverage. You may know it by a different name, “Obamacare.”

Since the Affordable Care Act (ACA) went into effect in 2014, all medical insurance plans being sold as major medical coverage are required to meet a set of minimum coverage standards (see the next section).

Any health insurance plan that does not meet that minimum requirement is not considered a major medical plan.

What Does Major Medical Insurance Cover?

ACA health insurance plans are required to cover the following healthcare services, often referred to as the 10 essential health benefits:

  • Ambulatory patient services

  • Emergency services

  • Hospitalization

  • Maternity and newborn care

  • Mental health and substance use disorder services, including behavioral health treatment

  • Prescription drugs

  • Rehabilitative and habilitative services and devices

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services, including oral and vision care

Have a coverage question?

Speak with a health insurance agent today.

Major Medical Insurance is Guaranteed Issue

ACA major medical insurance is required under law to be “guaranteed issue.” That means you cannot be denied coverage based on health status (including pre-existing conditions), age, gender, or other factors.

However, you can be charged more for some things such as age, tobacco use, family size and geographic location.[1]

Do You Need Major Medical Insurance?

As of 2019, the ACA individual mandate is no longer being enforced with a federal tax penalty for adults 26 and older that opt out of coverage without qualifying for an exemption. However, some states have individual mandates and tax penalties for going without qualifying coverage.

Even though you can't be penalized for not having major medical coverage under federal law, you should still consider these more comprehensive plans if you:

  • Aren’t already covered on a parents’ or employer’s major medical plan
  • Have a pre-existing condition – major medical plans are guaranteed issue so you can’t be turned away because of past health conditions
  • Qualify for a subsidy – you may be able to get a better ACA plan at a more affordable rate than you think
  • Rely on prescription drugs – major medical plans are the only plans that require drug coverage
  • Live in a state with an ACA tax penalty

Find Answers to Affordable Care Act Questions

Choosing health insurance coverage can definitely feel overwhelming, and the temptation can be to focus on monthly premium rather than the big picture. To find the best health insurance plan for you, start by considering your healthcare needs and budget for the year to come. Also, be sure to consider what your healthcare expenses were in the past year and if your current coverage was adequate. Did anything change, or do you expect it to change in the year to come? Learn how to choose the best health insurance option for you.
There are many places to purchase ACA-compliant health insurance, alternative health insurance, supplemental insurance and health insurance add-ons such as telemedicine. If you want to buy an Obamacare policy that qualifies for a subsidy, you’ll want to shop or a state-based health insurance exchange. There are other places to buy if you don’t qualify for a subsidy or want to explore off-exchange options. Learn more about:
Obamacare, which is a nickname for the Affordable Care Act (ACA), remains law. As such, individual major medical insurance policies must be guaranteed issue. All individual major medical insurance must also include the 10 essential health benefits and no-cost preventive care as specified in the ACA. However, the ACA’s individual shared responsibility payment will be repealed Jan. 1, 2019.[2] That means you will not owe a tax penalty if you go without minimum essential coverage in 2019. If you were uninsured in 2018 and did not qualify for an exemption from the individual mandate, you could owe the penalty when you file your 2018 federal taxes. Learn more about the tax penalty repeal and what it could mean for you in 2019.

When Can You Get Major Medical Insurance?

Individual major medical coverage can only be obtained during the annual ACA open enrollment period (typically Nov - Dec) unless you qualify for a special enrollment period due to losing your coverage through a qualifying life event like getting married or divorced, moving to a new state or area where your plan isn’t available, having a child or losing your job.

Find out how to get health insurance now, or call 888-855-6837 to speak with a health insurance agent to discuss your options.

Have Questions? Speak to an Agent

Speak to a licensed health insurance agent during business hours for help understanding your options and enrolling in coverage.

Call 888-855-6837