You already know that medical insurance is crucial in order to protect yourself and your loved ones in the case of injury or illness.
But what exactly is “major medical?”
And how do these plans affect you personally, or your business?
Being aware of all the types of coverage available to you can help you make smart choices for your family or company.
This guide will share all of the information you need to know about what major medical insurance is, how it works, and if you should consider getting it for you and your family.
What is major medical coverage?
Major medical coverage, also called comprehensive medical insurance, includes all health insurance plans that meet the minimum benefit standards, in compliance with the Affordable Care Act.
Between 2010 and 2018, the federal government required that all Americans be covered by major medical insurance whether it was provided by their employer, Medicare, or Obamacare.
There is no longer an individual health insurance mandate by the government, but most people agree that being insured is very important!
In the event of serious illness or injury, you should have protection from financial debt by purchasing some type of health insurance for yourself, your loved ones, or your employees.
Major medical plans are likely to have higher deductibles, so many people opt for different types of plans.
Even if you are in great health and do not require a comprehensive plan, you may consider a personalized plan for your individual needs.
Is major medical the only health insurance that exists?
No. There are many options for individualized plans.
You can get insurance with varying coverage levels or catastrophic insurance.
Catastrophic insurance is low-cost and low-benefit, but it can prevent bankruptcy in the event of serious accident or illness. It is important to have this type of insurance, at the very least, in order to protect you and your loved ones from incurring major costs.
Major medical plans don’t always include dental, vision, and critical illness benefits so many people will opt to purchase supplemental insurance for this type of coverage.
What does major medical mean for my business?
For business owners who are looking to provide coverage for their employees, major medical standards are important to consider.
The government has different regulations on benefits for small businesses and large businesses.
- Fewer than 50 employees is considered a small business.
- 50 + full-time staff is considered an ALE (applicable large employer). How to determine if an employer is an ALE.
ALE’s must offer minimum essential coverage to their employees, defined by the Affordable Care Act. Large companies may be fined on their tax return if they do not offer major medical plans. This law does not necessarily apply to small businesses.
There are tax credits that apply as well. For example:
According to the IRS website, there is a small business health care tax credit that benefits employers who meet the following standards:
- Have fewer than 25 full-time equivalent employees
- Pay average wages of less than $50,000 a year per full-time equivalent (indexed annually for inflation beginning in 2014)
- Offer a qualified health plan to its employees through a Small Business Health Options Program Marketplace (or qualify for a limited exception to this requirement)
- Pay at least 50 percent of the cost of employee-only – not family or dependent – health care coverage for each employee
Laws regarding insurance coverage for employees can get complicated, as you can see by the Employer Shared Responsibility Provisions Under the Affordable Care Act.
Luckily, the experts at Nevada Benefits can help you understand the legalities of what benefits you need to include in health plans you offer your employees.
How much does major medical insurance cost?
Cost can depend on your age, income, family size and the type of plan you choose.
Insurance coverage prices will vary based on what benefits you require.
If you have dependent family members to add to your health insurance plan, the cost may go up. However, based on these factors, you may also qualify for tax credits and subsidized coverage which can make your health plan more affordable.
With Nevada Benefits, you can personalize a health insurance plan to suit your own financial needs. Reach out to one of our Health Professionals for more information.
What does comprehensive medical insurance cover?
Major medical policies include coverage for the minimum health benefits which include these 10 essentials:
- Ambulatory services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse treatment
- Prescription drugs
- Lab tests
- Chronic disease management, “well” services and preventive services recommended by the U.S. Preventive Services Task Force
- Pediatric services for children, including dental and vision care
- Rehabilitative services
Major medical policies do not always offer vision, dental, critical illness, or other benefits.
Deductibles may be higher in major medical policies, which makes some individuals and businesses require different types of coverage.
Should I get major medical insurance?
There are several reasons to purchase major medical insurance, or to consider other similar options. Major medical insurance may work well for people who need a standardized plan and don’t require very low deductibles.
Some people qualify for major medical coverage through their employer, but they may also need to find supplemental coverage for vision or dental.
Or, they may wish to purchase individualized health insurance in order to have lower deductibles and more options.
If someone is self-employed or unemployed, they may require a more personalized policy.
Nevada Benefits can help put together a plan that makes the most sense for you and your family.
Reason #1 To Get Major Medical Insurance: If You Are Unemployed Or Self Employed.
Individuals who do not qualify for medical benefits from their employer may want to consider a personalized plan through Nevada Benefits.
Even if you are in excellent health, and have no dependents, you should still have low coverage or catastrophic insurance in case of an emergency.
In the case of serious illness, people who have no health insurance may end up with large medical bills that they are unable to pay. Insurance is important to protect you and your loved ones against burdensome financial debts.
With new government subsidies and tax breaks, individual health insurance is more affordable than ever.
Reason #2 To Get Major Medical Insurance: If You Own A Business.
If you’ve ever wondered, “how do I offer health insurance to my employees?” Nevada Benefits can help.
You may wish to offer one plan, or multiple options for your staff. You can completely customize the benefits by including dependents, and deciding how much of your employees’ premiums you want to pay.
Offering health insurance benefits is a great way to retain your employees long-term, keep your staff happy and healthy, and grow your business.
There are also tax benefits to offering health insurance for your business.
We can help you decide which health plan is best for your company.
Reason #3 To Get Major Medical Insurance: If You Are Unhappy With Your Current Policy
Even if you have a medical plan that is offered through your employer, you may wish to explore other options.
There are many options that have more benefits and lower deductibles that may be better suited to your family and financial situation.