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Why Choose Major Medical Health Insurance Plans?

Major medical health insurance plans provide comprehensive coverage for individuals and families, ensuring access to essential health benefits and protecting against high medical costs. These plans are designed to make healthcare accessible and affordable for everyone.

Benefits of Major Medical Health Insurance Plans

Essential Health Benefits

Major medical health insurance plans cover ten essential health benefits, including:

  • Preventive care and wellness services
  • Emergency services
  • Hospitalization
  • Prescription drugs
  • Mental health and substance use disorder services
  • Maternity and newborn care
  • Pediatric services, including dental and vision care
  • Laboratory services
  • Ambulatory patient services
  • Rehabilitative and habilitative services and devices

No Pre-existing Condition Exclusions

These plans cannot deny coverage or charge higher premiums based on pre-existing conditions, ensuring everyone has access to necessary care.

Subsidies and Financial Assistance

Depending on your income, you may qualify for subsidies or premium tax credits, making major medical health insurance plans more affordable. These financial assistance options can significantly reduce your monthly premiums and out-of-pocket costs.

Annual Open Enrollment Period

The marketplace offers an annual open enrollment period where you can compare different major medical health insurance plans and choose the one that best fits your needs and budget. Special enrollment periods are also available for qualifying life events.

Getting Health Coverage Outside Open Enrollment

Special Enrollment Periods

Outside of Open Enrollment, you can only enroll in or change Marketplace plans if you qualify for a Special Enrollment Period based on certain life changes or your estimated household income.

Life Changes

Special Enrollment Period details vary based on the life change:

Changes in Household

You may qualify for a Special Enrollment Period if in the past 60 days you or anyone in your household:

  • Got married: Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Had a baby, adopted a child, or placed a child for foster care: Your coverage can start the day of the event – even if you enroll in the plan up to 60 days afterward.
  • Got divorced or legally separated and lost health insurance: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Died: You’ll qualify for a Special Enrollment Period if someone on your Marketplace plan dies which causes you to lose your current health plan.

Changes in Residence

You may qualify for a Special Enrollment Period if you move to:

  • A new home in a new ZIP code or county
  • The U.S. from a foreign country or United States territory

Or, move to or from:

  • A place you attend school (if you’re a student)
  • A place you both live and work (if you’re a seasonal worker)
  • Shelter or other transitional housing

Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period. You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

Loss of Health Coverage

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days.

Select the type of coverage you lost for Special Enrollment Period details:

  • Job-based coverage
  • Individual health coverage
  • Medicaid or the Children’s Health Insurance Program (CHIP) coverage (or were denied Medicaid/CHIP)
  • Eligibility for Medicare
  • Coverage through a family member

An Employer Offer to Help with the Cost of Coverage

You may qualify for a Special Enrollment Period if you (or anyone in your household) were offered an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days or expects to in the next 60 days. Your employer may refer to an individual coverage HRA by a different name, like “ICHRA.” Get details about offers for individual coverage HRAs and Qualified Small Employer HRAs.

If you qualify to enroll in Marketplace coverage through this Special Enrollment Period, fill out our form or contact us to complete your enrollment.

More Qualifying Changes

Other situations that may qualify you for a Special Enrollment Period:

  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • Leaving incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

View other Special Enrollment Periods

Notice: You may have to submit documents: When you apply, you must attest that the information you provide on the application is true, including the facts that qualify you for a Special Enrollment Period. You may have to submit documents that confirm your life event.

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Important Information about Major Medical Health Insurance Plans

Major medical health insurance plans provide comprehensive coverage, including ten essential health benefits. Be sure to review your policy carefully to understand the coverage, exclusions, and limitations. Subsidies and premium tax credits are available based on income and household size. Coverage availability and terms may vary by state.

Need Assistance? Our licensed critical illiness insurance agents are here to help you choose the right critical illness insurance plan and answer any questions you may have.