What is Major Medical Insurance?

Major medical insurance refers to health insurance that covers medical illnesses. “Major Medical” is a term that was previously used to describe what many considered to be standard medical insurance coverage. With the passing of the Affordable Care Act, major medical insurance as we knew it ceased to exist. Today, the term minimum essential coverage is now what is used to describe the modern health insurance plans that were formed under the ACA that go beyond the scope of what was historically covered by major medical insurance.

Minimum essential coverage plans now include many benefits that were only available through riders in the past.  Mental health benefits, specialist care, chiropractic services, maternity care, and physical therapy are included in medical health insurance plans that meet minimum essential coverage standards under the Affordable Care Act. These benefits were not previously covered by most major medical insurance plans prior to the passing of the ACA.

Two benefits that continue to be excluded from coverage are vision and dental care. These benefits were generally excluded from major medical insurance and continue to be excluded by minimum essential coverage insurance today.  The plans offered by Blue Cross and Blue Shield of North Carolina® do provide pediatric vision and dental benefits, though they may be subject to additional copays or deductibles.

As a result of the Affordable Care Act, all medical health insurance plans must cover certain health care needs in order to be considered compliant. If a person retains a major medical insurance policy that is not considered compliant under the new federal law, the insured person will remain subject to the ACA’s Individual Shared Responsibility Payment.

The services that must be covered by medical health insurance providers under the Affordable Care Act are:

  1. Pediatric Services
  2. Maternity Care
  3. Preventative and Wellness
  4. Rehabilitative and Habilitative Services
  5. Laboratory Tests
  6. Prescription Drugs
  7. Mental Health and Substance Use Disorders
  8. Outpatient Care
  9. Hospitalization
  10. Emergency Room Visits

Today’s health insurance plans must cover all of the above services in order to be considered compliant with ACA’s minimum essential coverage requirements.  However, these plans can differ greatly in the extent to which they cover each benefit. For example, different insurance plans may cover different types of prescription drugs.

A knowledgeable and authorized agent at WNC Health Insurance can help you determine which of the many compliant versions of health insurance plans may be most beneficial to you and your family.