In choosing health insurance, some individuals may not want, or be able to afford, traditional comprehensive medical insurance coverage.
For example, younger adults – who on average are the least likely to need routine medical care – often have financial priorities that make them more willing to have less medical insurance coverage in order to pay a small premium.
In addition, some individuals want coverage above and beyond their existing basic policies, so that they can have greater financial security in the event they are faced with a significant medical issue that exceeds the limits of their standard health care policy.
For these consumers, there is a type of insurance that provides excellent coverage for the most serious medical expenses, but no coverage for routine or relatively minor medical issues. This is known as major medical health insurance, and is also sometimes called “catastrophic coverage.”
Major medical health insurance policies work by providing a layer of coverage above and beyond a traditional policy. This type of coverage kicks in once the fairly significant deductible and coinsurance obligations have been met. For example, some major medical policies provide for a $50,000 deductible. This means that in event of a serious accident or illness, after the first $50,000 of medical expenses has been paid (either by your basic health insurance policy, or by you if you have no other insurance), the major medical policy would kick in and cover all customary medical expenses (often 100% of those charges) up to a maximum payable amount. The maximum payable amount is usually quite high – it’s not uncommon to have a policy that covers up to $1,000,000 or $2,000,000.
If you have a basic plan, you can try to find major medical coverage with a deductible that matches up with the payment benefits of that plan. This can help you ensure that you are covered for nearly all types of medical problems or issues that may occur.
Major medical policies can cover significant medical expenses associated with significant accidents or health problems, but there are generally exclusions for certain times of equipment that may not be related solely to treatment. For example, some policies exclude coverage of air conditioners, transportation equipment (such as a van equipped to transport a wheelchair), in-home elevators or escalators, and swimming pools that might be useful for rehabilitation purposes.
Furthermore, if you are not covered by a basic health insurance plan, there will be additional exclusions from the scope of a major medical policy. Many times these exclusions are for charges incurred for a certain number of days of hospital care, a certain amount of charges of doctor care, and a certain amount of charges for prescription medications. Sometimes these excluded amounts can be fairly significant. This is because major medical is not intended to be the first line of protection against medical expenses, but rather to supplement your existing basic coverage.
In addition, “pre-existing” medical conditions are generally not covered by a major medical health insurance policy, unless certain thresholds are met. Often times, these thresholds include that you not have incurred any charges or medical treatment for such a condition during the past year, or that your major medical coverage has been in place for a year or two before seeking treatment for the condition.
There are risks in relying solely on major medical insurance as your only coverage, but it’s certainly better than having no insurance at all.
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