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Comprehensive Health Insurance: What Is Included?

Comprehensive health insurance, sometimes referred to as major medical insurance, covers everything from inpatient stays to outpatient care and consults. A plan must meet Affordable Care Act (ACA) standards and be considered comprehensive. Basic (or limited) medical insurance does not have to meet these same standards. While comprehensive health insurance covers various services, it does not cover everything.

Key takeaways:

Keep reading to discover what comprehensive health insurance is, what it covers, and why it may be a good fit for you.

What is comprehensive health insurance?

Comprehensive health insurance is insurance that covers a wide range of medical costs. This contrasts with basic health insurance, such as limited coverage, short-term, or supplemental plans that only cover a few needs. Basic health insurance plans are not regulated by the ACA, whereas comprehensive health insurance plans are.

Comprehensive health insurance must cover 10 essential health benefits and 60% coverage for average medical costs. Comprehensive health insurance plans can be purchased through an employer or the healthcare marketplace. Other comprehensive health insurance options include Medicare, Medicaid, COBRA, and student health plans.

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Comprehensive health insurance coverage – what is included?

Comprehensive health insurance provides coverage for inpatient and outpatient services. This includes any needed testing, such as blood work or X-rays. They also cover needs such as emergency services and pediatric care. According to the ACA, a health insurance plan must cover 10 essential health benefits to be considered comprehensive. These benefits include:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalizations.
  • Maternity and newborn care.
  • Mental/behavioral health and substance use disorder services.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventative and wellness services and chronic disease management.
  • Pediatric services, including oral and vision care.

Comprehensive coverage does not mean you won't incur healthcare costs. With comprehensive insurance, you will still have monthly premiums, deductibles, copays, and co-insurance costs.

What is not included in comprehensive health insurance?

While comprehensive health insurance covers a wide range of healthcare needs, there are a few services not covered. Every plan is different, so it’s important to contact your health insurance provider for coverage details. Services typically not covered by comprehensive health insurance include:

  • Cosmetic procedures such as Botox or plastic surgery
  • Health supplements such as protein shakes
  • Osteopathy/Homeopathy
  • Acupuncture

Why you should consider a comprehensive health insurance plan?

You should consider a comprehensive health insurance plan because of the number of services they cover. No one plans to become sick, have an emergency, or be hospitalized, but it happens. Knowing you have health insurance for these unplanned events can help provide financial peace of mind.

Comprehensive care will also make it more affordable for you to see a provider for preventive care, such as annual wellness exams and vaccinations. Preventative care is an important step in long-term health. Opting for comprehensive coverage will provide you with more options for your healthcare.

What is the difference between comprehensive and limited coverage?

To be considered comprehensive, a health insurance plan must cover the 10 essential health benefits as outlined by the ACA. Limited health insurance coverage is not held to this standard. Limited coverage is more restrictive and may have a time limit. For example, a short-term coverage plan usually only provides coverage for a few months to a year.

Short-term plans are commonly used to bridge gaps between coverage with comprehensive plans. Limited coverage plans typically have lower premiums but less coverage than comprehensive health insurance plans.

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Comments

Cesar Lopes
prefix 1 month ago
I would like to know how new surgical techniques or new medications are incorporated into medical plan coverage. Is there a regulation for this?
Laurie A York
prefix 8 months ago
I have high cholesterol, severe fatty liver disease, non-alcoholic cirrhosis of the liver -stage one, Alfa -1 good protein deficiency and I have a BMI of 30. I also have serotonin syndrome which really reduced the types of medication I can take safely. I am very limited on what medications I can take safely. My insurance will not cover my Wegovy. What can me or my Dr. do to help get coverage for this medicine?