Learn about what medical insurance is and about ACA-compliant coverage in Madison, WI.

What is ​Medical ​Insurance?

Not sure what medical insurance is? Medical insurance is also known as health insurance. It is designed to protect people from large medical bills should they become injured or sick and need extensive medical care. It works the way other insurance works – it manages risk by pooling the resources of a group to pay for the costs of those in the group who need to draw on those resources.


Because of the Affordable Care Act (ACA), most medical insurance has a stricter definition than in the past. In order to be ACA-compliant, medical insurance must –


  • Offer essential health benefits
  • Not cancel existing policies (except for non-payment of the premium or fraud)
  • Be offered to those with pre-existing conditions
  • Not charge women more for coverage (you can be charged more for coverage depending on your age, where you live, how many people are on the plan and if you use tobacco)

 

Can I buy a plan that is not ACA-compliant medical insurance?

You can find plans that offer limited health coverage or only cover certain things, such as –

  • Coverage limited to vision care or dental care
  • Workers' compensation
  • Coverage limited to a specific disease or condition
  • Plans that offer only discounts on medical services

It’s very important to note that these plans do not meet the definition of ACA-compliant insurance. People that have these types of coverage (without an additional ACA-compliant medical insurance plan) may be liable to pay a fee for not having medical insurance.


For example, plans that offer discounts on medical services usually issue a “medical discount card” that is valid when you pay a monthly fee. You are required to see specific providers and you pay the cost yourself, but at a discounted price. Discount plans are not regulated by the Wisconsin Office of the Commissioner of Insurance – you need to carefully research the discount plan to make sure it’s legitimate.


Some people buy supplemental health insurance policies in addition to their ACA-compliant plans. Supplemental policies will provide money to live on if you are in the hospital, receiving rehab or other circumstances. If you are interested in this type of additional coverage, be sure to carefully review the plan to make sure it offers the extra coverage you want.

 

Ready to find a plan? Shop medical insurance plans and get a quote now. Have questions about what kind of medical insurance is right for you? Talk to our knowledgeable and friendly customer service representatives available from 7 a.m. to 7 p.m. Monday through Friday at 800.362.3310.