What is a Major Medical Health Insurance Plan?

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 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 major medical. Limited benefit plans like short-term plans sold off-marketplace that don’t follow ACA guidelines are not major Medical. For those who are interested, we discuss the differences between major medical plans and short-term plans on a separate page. 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, the term is typically used in descriptions post-2014 to describe ACA-compliant plans and is used 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 medical today follow special rules. If your plan is grandfathered in and counts as minimum essential coverage, then it is classified as “major medical” even though some ACA protections won’t apply. Learn more about grandfathered plans.

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...

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