Most Americans have health insurance in place, be it a private plan or employment-based cover. While many take up this precaution and benefit, the individual types available can, at times, be confusing.

This article looks into the difference between basic health insurance and major medical plans. It explains these options in more detail, so you’ll be able to make an informed decision before you select yours. 

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Basic Health Insurance 

Basic plans offer indemnity and usually include the direct costs of medical treatments. They can be used for hospital stays, some elective surgeries, and in the event of an emergency. 

A policy of this nature will pay for the total bill when it’s deemed to be essential medical care. However, it will have a predetermined limit, and you’ll have to settle the balance.

Major Medical Insurance

Major Medical Insurance is a comprehensive option and often more expensive. The elements included match a basic plan and cover preventative care, your prescriptions, and general wellness management.

The broader range of services can include x-rays, tests, out of hospital services, and specialized treatment for different life stages. 

It may have a pregnancy and maternity benefit, which provides care for newborns. It could also help you manage chronic conditions and the required medication to help you cope with such diseases and rehabilitation programs. 

You also have the option to add dentistry and optometry aid to your plan, but it comes at an added cost, as it’s often not listed as an essential service for adults. We’ll unpack this in the next section. 

Essential Benefit Categories

The Affordable Care Act (ACA) aims to offer fair and low-cost health plans to all Americans. It identified ten essential benefits that an insurance plan should cover. The list is as follows: 

Emergencies

In the event of an accident or trauma, when you need urgent and immediate care, you can visit any ER. 

Hospital Admissions

Once you’re admitted to a hospital, the cover includes your stay and all treatments you receive while you’re an inpatient. Limits or thresholds will apply depending on the type of plan you opt for. 

Prescriptions 

A government-approved list of prescription medication has to be included in the cover. It contains some chronic illness treatment drugs. 

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Preventative Care and Wellness Screenings 

Under this category, a list of screenings and counseling services are included. It covers select vaccines, type two diabetes, nutrition and dietician services, and colon cancer checks. 

Maternity Benefits 

This includes pregnancy and newborn care, so both mother and child are covered before and immediately after birth. 

Pediatric Care

This includes a range of medical services for children, as well as vaccinations and immunizations. It also has annual dental and vision coverage for kids under 18.

Mental Health

This encompasses service providers offering counseling, psychotherapy, as well as treatment for addictions.

Outpatient Care

Sometimes referred to as ambulatory care, this covers treatment outside the hospital. At times, it may include rehabilitation and diagnostic tests, for when you’re not admitted nor staying in a medical facility. 

Lab Services

Testing and screenings are done in a medical laboratory, such as blood tests are covered. It’s for diagnostic services to determine the nature of care required. 

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Rehabilitation

This covers the care you need to recover from injuries or help you adapt to a chronic illness or disability. Physiotherapy, occupational or speech therapy, and the tools you require will be included.

In Closing 

Understanding the different health care options is vital to help you get the right cover to match your medical needs and budget. Consider the ten essential services to help you evaluate any plan on offer. 

However, keep in mind that limits and conditions still apply. You may need to settle for the government-approved medication and facilities or pay extra to enjoy the comprehensive cover.