A major medical health insurance plan generally describes any private individual or family plan sold after 2014 that follows the ACA’s new guidelines.
This means it is a plan that counts as minimum essential coverage, offers the ten essential health benefits, follows guidelines for deductible and out-of-pocket maximum limits, and generally covers “major expenses” associated with serious illness or hospitalization.
All plans sold on the health insurance marketplace are major medical plans, and all employer plans are generally major medical. Limited benefit plans like short-term plans sold off-marketplace that don’t follow ACA guidelines are not major Medical. Off-marketplace plans sold during open enrollment are almost always major medical, but you can double check with the insurer by asking.
There is no strict definition of “major medical”, instead it is typically used in descriptions post-2014 to describe ACA-compliant plans and is used generally to describe comprehensive coverage that isn’t limited benefit, short term, or travelers.
If you have access to Medicaid, CHIP, Medicare, Employer, TRICARE, or non-limited-benefit VA, you have minimum essential coverage and don’t have to worry about the major medical terminology.
TIP: Grandfathered plans that wouldn’t otherwise count as major medicaid today follow special rules. If your plan is grandfathered and counts as minimum essential coverage, then it generally is “major medical”… even though some ACA protections won’t apply. Learn more about grandfathered plans.