The Affordable Care Act has several mandates. It requires that all primary insurance plans must cover the 10 “essential services” while it also directs states to create marketplaces where the financially disadvantaged can get access to affordable insurance. A major medical insurance plan, however, is not for the financially disadvantaged. This type of insurance plan is not available in the state marketplace, and it can’t be purchased with a government subsidy.
Like the other insurance plans available in the market for those who normally couldn’t afford insurance, a major medical insurance plan covers all the Obamacare mandated benefits. But there’s usually more:
- Once you start paying premiums and you get covered health services, your insurance provider can then negotiate with the doctors on your behalf to cut down the costs. Usually, this negotiation can result in a reduction of 20 to 50 percent of the bill.
- You also get free preventive care screenings. These aren’t just for major health conditions like cancer. They also include dietary counseling for weight loss, tobacco and alcohol counseling, and you won’t have to pay for any out of pocket costs.
- Your application for the health insurance cannot be declined because you have a pre-existing health condition.
- The plan also includes an “out of pocket maximum.” This is the amount of money you have to pay as a share of your medical bills. In 2016, this maximum was at $6,850 for individuals and $13,700 for family coverage.
- Many of these plans come with copays. The copay is a flat rate you pay for a specific medical service. Let’s say that a typical visit to a doctor’s office normally costs $125. But your plan states that you only pay $30 for each visit. That means your insurance company will have to cover the other $95. These copays may also apply when you see a specialist or for prescription medicine.
- Most of these plans also come with a cost-sharing feature with deductibles. The deductible is the amount you need to pay out of your own pocket, before the insurance company pays its share of the bill. Typically, when you opt for lower premiums the deductibles are higher.
- Many plans also include coinsurance. Once the deductible amount has been met, you pay a certain percentage of the bill until you reach the out of pocket maximum.
The cost of major medical insurance can vary, depending on your insurance provider and your circumstances. But on average, individuals pay $273 per month for premiums while family coverage costs $698 per month.
The deductibles will also determine your expenses. The average deductible is $3,989 for individual coverage and $7,657 for family coverage.
A major medical insurance plan can be customized to meet your particular insurance needs. It’s a good idea to shop around so that you can find the plan that offers premiums you can afford and benefits you can use.