Major Medical Insurance
for Individuals
As healthcare costs continue to rise, having comprehensive health insurance coverage is more important than ever before.
In this article, we will examine major medical plans for individuals, what they cover, how they work, and provide quotes from five top health insurance providers.
What is Major Medical Insurance?
Major medical insurance, sometimes called comprehensive medical insurance, is a type of health plan that provides extensive coverage for a broad range of services. Unlike basic plans that mainly cover preventive care and limited sickness benefits, major medical plans include wider coverage for hospitalization, surgery, emergency care, prescription drugs, and other services associated with serious medical events.
The hallmarks of major medical insurance are its high deductible and out-of-pocket maximum limits. Deductibles typically range from $1,000 to $10,000 depending on the plan. The out-of-pocket maximum, which includes the deductible, copays, and coinsurance, can be as high as $20,000 for an individual and $40,000 for a family. Once the out-of-pocket maximum is reached, the plan pays 100% of covered expenses.
Major medical plans utilize various cost-sharing features including:
- Deductible: the amount you pay out-of-pocket before insurance kicks in
- Copay: a flat fee per medical service, such as $30 per office visit
- Coinsurance: the percentage of costs you share with the insurer, like 20% of hospital charges
- Out-of-pocket maximum: the most you’ll pay in a year before your insurance covers 100%
Who Needs Major Medical Insurance?
Major medical coverage is designed for individuals who do not have health insurance from an employer or government program. This includes:
- Self-employed persons
- Part-time and hourly workers
- Early retirees not yet eligible for Medicare
- Young adults no longer covered by parental plans
- Americans who lost employer coverage
- Low-income individuals above Medicaid thresholds
Having comprehensive major medical coverage protects these individuals from potentially ruinous medical bills in the event of a serious accident, illness, or hospitalization. It provides vital financial security when you need healthcare the most.
What Does Major Medical Insurance Cover?
Major medical plans provide extensive coverage for medically necessary care at in-network hospitals, clinics, doctors’ offices, surgery centers, and other healthcare facilities. Some of the key services covered include:
- Hospitalization
- Surgery (inpatient and outpatient)
- Doctor visits and services
- Emergency room and urgent care
- Lab tests, x-rays, and diagnostic imaging
- Preventive care and cancer screenings
- Prescription drugs
- Physical therapy and rehab
- Mental health and substance abuse treatment
In addition to covering wide-ranging services, major medical plans have high annual or even lifetime limits on covered benefits – typically $2 million or more per insured. This ensures ample protection against the costs of severe injuries, long hospital stays, or chronic critical illnesses.
How Major Medical Insurance Works
Major medical plans work by combining a high deductible with coinsurance and copays to share costs between you and your insurer. Here is a step-by-step overview:
- You pay routine medical expenses out-of-pocket until reaching the annual deductible. Preventive services like physicals may be covered before the deductible.
- Once the deductible is reached, you share additional costs with the insurer via coinsurance and copays up to the out-of-pocket max.
- If your out-of-pocket expenses hit the annual limit, the plan pays 100% of covered costs for the rest of the year.
- Charges beyond what is considered reasonable and customary or not covered by the plan are your responsibility.
- At the end of the year, the cost-sharing resets – you’ll pay out-of-pocket again until meeting a new deductible for the next year.
Major medical plans contain exclusions and limitations. Services often not covered include: vision, dental, hearing, long-term care, cosmetic procedures, infertility treatment, alternative medicine, and more. Be sure to understand what is and isn’t covered before enrolling.
How to Choose the Best Major Medical Insurance
When selecting major medical insurance as an individual, keep the following factors in mind:
- Your budget – Find a plan with premiums, deductibles, and out-of-pocket costs you can afford. Balance premium price with cost-sharing amounts.
- Covered services – Pick a plan that covers all the medical services important to you, such as mental health benefits or physical therapy.
- Doctor networks – Choose an insurer with a provider network suitable for your healthcare needs and preferred hospitals and clinics.
- Prescription drugs – Verify the plan includes your medications in its formulary to receive optimal coverage.
- Exclusions – Pay attention to the plan’s fine print for any exclusions that may impact you.
- Customer service – Evaluate each insurer’s reputation for service and efficiency in claims payment.
The right major medical plan provides peace of mind you’ll be covered in the event of serious illness or injury. Taking the time to find affordable, comprehensive coverage is a smart healthcare move.
Major Medical Insurance Quotes from Top Providers
To give an idea of typical costs and coverage options, here are sample major medical plan quotes from five highly-rated health insurers:
UnitedHealthcare – MyHealthcare Comprehensive Plan
– Deductible: $5,000 individual/$10,000 family
– Out-of-pocket max: $8,500/$17,000
– Coinsurance: 30%
– Monthly premium: $430 individual/$980 family
BlueCross BlueShield – Comprehensive Choice PPO
– Deductible: $2,500/$5,000
– Out-of-pocket max: $7,500/$15,000
– Coinsurance: 20%
– Monthly premium: $510/$1,290
Cigna – Open Access Plus Plan
– Deductible: $7,900/$15,800
– Out-of-pocket max: $8,550/$17,100
– Coinsurance: 40%
– Monthly premium: $380/$950
Aetna – Balanced Choice PPO
– Deductible: $3,000/$6,000
– Out-of-pocket max: $8,500/$17,000
– Coinsurance: 30%
– Monthly premium: $460/$1,060
Humana – Copay Select PPO
– Deductible: $1,500/$3,000
– Out-of-pocket max: $5,000/$10,000
– Copay per visit: $25 primary, $60 specialist
– Monthly premium: $510/$1,180
These examples illustrate the range of options and costs for major medical insurance from leading national carriers. Premiums vary based on factors like age, location, and health status. Getting quotes from multiple insurers is the best way to find coverage that fits your medical needs and budget.
Critical Gap for Individuals
Major medical insurance fills a critical gap for individuals who lack health coverage from an employer or government program. It will protect you from ruinous medical debt in the event of a serious illness, injury, or hospital stay.
When choosing a plan, focus on affordability, sufficient coverage for your needs, provider network adequacy, and strong customer service from the insurer. Although premiums and deductibles may be higher than other insurance types, major medical plans give individuals essential peace of mind.