Learn more about what major medical insurance is and who qualifies for it in Madison, WI.

What is Major Medical Insurance?

A shift in terminology has occurred over the past few years related to health insurance.


Comprehensive

In the past, major medical insurance was a term used interchangeably with comprehensive or catastrophic coverage. Major medical policies were those that usually covered expenses in and out of the hospital.1


Today, the Affordable Care Act (ACA) ensures that qualified health plans offered in the individual market offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: 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; and pediatric services, including oral and vision care.2

 

Catastrophic

Until the Affordable Care Act, major medical insurance was also called catastrophic coverage, a term that has a very different and specific meaning today. The ACA describes it this way – “Catastrophic plans usually have lower monthly premiums than a comprehensive plan. But they cover your costs only after you’ve used a lot of care. These plans basically protect you from worst-case scenarios like serious accidents or illnesses.”3


A catastrophic insurance plan generally requires you to pay all of your medical costs, up to a certain amount (your deductible), which is usually several thousand dollars. If you have a “major medical event” such as a heart attack or a serious car accident, catastrophic insurance will help cover the major costs of treatment after you have paid all the costs up to the deductible.

 

Who can buy a major medical insurance plan?

Anyone can purchase an individual health plan during open enrollment. However, not everyone can purchase a catastrophic plan. According to the Affordable Care Act, people under 30 and people with “hardship exemptions” may buy a catastrophic health plan.


To find out if you qualify for a major medical insurance plan, contact Unity today!