Health insurance policies come in various forms. Two of the most common policies are major medical and short term (interim) major medical. These policies cover basically everything from doctor visits, prescriptions to hospitalizations and surgeries.
Major Medical Policies
These policies are offered by many insurance companies with various options and exclusions. The typical policy covers you for doctor visits, (well or sick), prescriptions (RX card), urgent care facilities, x-ray, imaging, surgeries and hospitalizations (inpatient and outpatient).
There are three basic types of major medical policies. They range from basic indemnity (go anywhere) plans; Preferred Provider Organization (PPO “network”) plans to Health Maintenance Organizations (HMO “must” stay in network) plans. They all protect you financially but how you are covered and what choices you have can vary greatly.
Preferred Providers Organizations (PPO’s)
PPO policies offer you the ability to choose providers, facilities and hospitals but give you incentives to choose within a “PPO” network of providers. The policy gives you more coverage when you choose providers within their designated networks. Only Blue Cross/Blue Shield is currently offering ACA compliant plans using STATEWIDE PPO network. There are no carriers offering compliant health plans using a national PPO network.
Health Maintenance Organizations (HMO’s)
HMO’s allow you to choose your primary care physician from their limited physician list. Some plans are REFERRAL based, meaning your primary care physician will direct your care within the HMO system, some do not require the referral. You DO NOT have the ability to go outside their system except for emergencies ONLY.
2026 ACA (Obamacare) Health Plans
Every policy written since 1/1/2014 is compliant with the Affordable Care Act (Obamacare). It does not matter if it is written direct with a carrier or ON the exchange (healthcare.gov). To get a quote, click on the link below.
ACA Alternatives
SHORT TERM medical policies will still be available for purchase to those who can medically qualify (do not have pre-existing conditions). These plans cover you in the case of an illness or injury, but do NOT cover pre-existing conditions, well visits, preventative care, etc. As of today, the maximum policy term is 4 months and the coverage cannot be renewed.