Frequently Asked Questions About Major Medical Health Insurance
Today, major medical health insurance is a term that has gone by the wayside. In the past, it sometimes described the kind of insurance you might get if you wanted to be protected in case of some type of major medical event, like a car accident or a heart attack. At other times, it meant the same as comprehensive insurance. Comprehensive insurance generally covered doctor visits and other types of routine care as well as major events.
Fortunately, insurance offerings are now much more defined. For example, the type of insurance that you get to cover you in case of a major medical crisis is now simply called “catastrophic.”
Below are answers to five frequently asked questions about major medical and catastrophic health insurance coverage.
- What benefits can you expect with catastrophic health insurance?
Because of the Affordable Care Act, this type of insurance not only covers major medical costs after the deductible, it also covers these 10 essential health benefits (after the deductible) –
- Certain pre- and post-natal services
- Out-patient care (clinic visits)
- Hospital care to cover major medical expenses
- Mental health and substance use disorder services
- Lab tests
- Emergency room care
- Habilitative and Rehabilitative Services
- Preventive services (some with no co-pay before the deductible is met)
- Certain pediatric services
- Prescription drugs on the formulary
Most of these benefits are subject to your deductible and must be provided in-network, so be sure to check that. In 2016, the deductible for a single person is $6,850 and $13,700 for a family.
- How is major medical insurance different than catastrophic health insurance?
Today, all Marketplace plans must fit into either one of the four levels, called Metal Levels – Bronze, Silver, Gold and Platinum – or qualify as a Catastrophic plan. Each plan type offers a different amount of coverage, but all levels provide coverage for the 10 essential health benefits.
In the past, insurance companies offered many types of health insurance, some of which was called “major medical”. You could get coverage for certain types of care, such as hospital care provided for accidental injury, but there was no coverage for any other type of care, even if you reached the deductible. Today, that type of coverage is only possible if it’s purchased as a supplemental plan in addition to your catastrophic coverage.
- Who can buy catastrophic coverage?
Catastrophic coverage can only be purchased by people under 30 years of age or those with hardship exemptions.
- When does it make sense to consider catastrophic health insurance?
It may make sense to purchase catastrophic coverage if you’re younger than 30 and won’t be turning 30 in the next year, are not eligible for health insurance subsidies, don’t expect to visit the doctor (except for no-cost preventive care) and you don’t expect to be hospitalized. Keep in mind that it’s likely that your deductible in 2016 may be as high as $6,850 for a single person and $13,700 for a family.
- Will any clinic or hospital accept my catastrophic health coverage if I have a major medical event?
All health insurance plans must cover emergency care whether you’re in-network or out of network (you’ll have to pay your deductible first, and any co-payments or co-insurance). However, you will be fully responsible to pay any costs that are not part of the emergency care. If you end up in an out-of-network ER, any follow-up care must be done in an in-network clinic or hospital or you may pay the full cost of that care.
Need help deciding if a catastrophic health insurance plan is right for you? Browse plans in Wisconsin that cover major medical events and get a quote right now or give us a call at 800.362.3310. We’ll help you sort through the options and choose a plan that fits your needs.