Choosing between major medical and major non-medical health insurance relies on what an individual can afford as well as what are their needs. Major medical health insurance can protect against severe injury or illness through referrals to various inpatient and outpatient services. Besides, such plans meet the minimum essential benefit standards of the Affordable Care Act (ACA) and also provide benefits for a broader scale of both inpatient and outpatient services. Non-major plans usually have a limited area of coverage and focus on specific treatments and illnesses, allowing the insured to get protected against unforeseen incidents and conditions without the high price tag.
It should be noted that not all major medical health insurance plans can be bought with a premium tax credit. Nevertheless, enrollment in such programs does offer protection from tax penalties for being uninsured under the ACA. Many factors impact the costs of health coverage, including the type of plan in which a person enrolls, the kind of services they need and how often they need them, as well as whether prescription drugs are taken regularly to manage chronic health conditions. Frequently, the major plans of insurance that have lower premiums may be offset by other costs, like higher deductible cost-sharing or higher maximum limit paid out-of-pocket.
Major medical plans tend to have a set amount (deductible) that the insured is responsible for paying. Once the deductible is paid, the plan entails the coverage of the remaining cost of care. In addition, there is also usually coinsurance after meeting the deductible, involving the patient paying a percentage of the bill, usually 20%, with the insurance company covering the rest (Montgomery, 2022). Once the patient’s total share of in-network costs, such as the deductible, coinsurance, and any applicable copays, reaches the maximum out-of-pocket limit, the health plan can pay 100% of the patient’s covered in-network care for the rest of the year (Montgomery, 2022).
In addition, in 2022, all plans compliant with the ACA must cap in-network costs paid out of pocket at no more than $8,700 for a person and $17,400 for a family (Centers for Medicare & Medicaid Service & Department of Health & Human Services, 2021). In 2023, the upper limit for costs paid out of pocket will reach $9,100 for an individual and $18,200 for a family (Centers for Medicare & Medicaid Service & Department of Health & Human Services, 2021). Major medical plans can be highly robust while out-of-pocket laws are low; however, they are also concerned with high deductible plans that are HAS-compliant, including catastrophic plans defined by the ACA.
Non-major health insurance plans, or basic plans, offer a lower scope of coverage compared to major medical insurance. In a perfect scenario, such plans should function as a supplement to traditional medical insurance, but the reality is that they are sometimes all that an individual can afford (JM Brassill Group Inc., 2017). The subscribers of the plan pay a low coverage premium and receive certain sums of money to reimburse their doctor visits, laboratory tests, and surgeries. However, the cash being refunded will, in the majority of cases, be lower than the total costs of services provided to the insured.
There are also instances in which individuals should consider non-comprehensive health issues ranging from disability insurance to domestic partner coverage and other types of insurance. These types of coverage entail the services that are often necessary to consider for individuals that have some health complications. For example, disability insurance and policy can offer income protection to help cover monthly expenses if an individual is unable to work because of a total disability due to injury or illness. Another instance is a critical illness, and cancer insurance can help the insured bridge the gap between conventional disability and medical coverage, offering protection against potential financial services.
Oral and vision health insurance can also be considered essential because they entail the regular assessment and monitoring of dental and oral care. This is because many diagnoses of chronic illnesses are possible through oral assessments. After all, 90% of chronic diseases have oral symptoms (Montgomery, 2022). For individuals wearing glasses or lenses, regular vision care is necessary to identify critical issues as early as possible with subsequent management. Therefore, any type of non-comprehensive health insurance can help facilitate preventive care and the identification of illnesses at their early stages. Besides, they can contribute to the accessibility and affordability of care as individuals will know that there are enough resources for them to seek preventive healthcare services without having to worry too much about the high expenses that go along with it. While not all costs are covered in non-comprehensive health issues, the lowered costs encourage the insured to seek preventive care. Since adequate health care entails preventive care, it may be a good idea for individuals and families to consider insurance for non-comprehensive services.
Centers for Medicare & Medicaid Service & Department of Health & Human Services. (2021). Patient protection and Affordable Care Act; HHS notice of benefit and payment parameters for 2022 and pharmacy benefit manager standards. Web.
JM Brassill Group Inc. (2017). Difference between basic insurance & major medical insurance | New York benefit advisors. Web.
Montgomery, K. (2022). Major medical health insurance overview. Web.