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comprehensive coverage

What is comprehensive coverage?

Comprehensive coverage – also known as major medical health insurance – refers to plans that cover a wide range of health services (i.e., not a limited-benefit plan or supplemental policy).

All new individual major medical policies sold after January 1, 2014 must be at least as comprehensive as the Affordable Care Act requires, meaning that they cover the ten essential health benefits with no annual or lifetime benefit caps. Major medical plans that predate 2014 are still considered comprehensive (and they count as minimum essential coverage for the purpose of fulfilling the ACA’s individual mandate), but they are generally not as robust as the new policies.

Plans that are not compliant with the ACA are still for sale in most states. These include short-term plans, fixed-indemnity plans, and supplemental coverage like accident plans and critical illness plans. These policies are not considered comprehensive, they are not minimum essential coverage, and they do not fulfill the ACA’s individual mandate if a consumer relies on them without any other coverage in place.