Major medical insurance is comprehensive, "qualifying" healthcare coverage. You may know it by a different name, “Obamacare.”
Since the Affordable Care Act (ACA) went into effect in 2014, all medical insurance plans being sold as major medical coverage are required to meet a set of minimum coverage standards (see the next section).
Any health insurance plan that does not meet that minimum requirement is not considered a major medical plan.
ACA health insurance plans are required to cover the following healthcare services, often referred to as the 10 essential health benefits:
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
Pediatric services, including oral and vision care
Learn more about the 10 Essential Health Benefits required by ACA health plans.
ACA major medical insurance is required under law to be “guaranteed issue.” That means you cannot be denied coverage based on health status (including pre-existing conditions), age, gender, or other factors.
However, you can be charged more for some things such as age, tobacco use, family size and geographic location.[1]
As of 2019, the ACA individual mandate is no longer being enforced with a federal tax penalty for adults 26 and older that opt out of coverage without qualifying for an exemption. However, some states have individual mandates and tax penalties for going without qualifying coverage.
Even though you can't be penalized for not having major medical coverage under federal law, you should still consider these more comprehensive plans if you:
Individual major medical coverage can only be obtained during the annual ACA open enrollment period (typically Nov - Dec) unless you qualify for a special enrollment period due to losing your coverage through a qualifying life event like getting married or divorced, moving to a new state or area where your plan isn’t available, having a child or losing your job.
Find out how to get health insurance now, or call 888-855-6837 to speak with a health insurance agent to discuss your options.
Speak to a licensed health insurance agent during business hours for help understanding your options and enrolling in coverage.
Need health insurance? You may qualify for a $0 Premium Bronze or Silver ACA plan as part of expanded subsidies under the 2021 American Rescue Plan Act.
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