What is Limited Medical Insurance?
Limited medical insurance provides basic healthcare insurance coverage not within the boundaries of major medical insurance. Individuals who obtain a limited medical policy will use this type of insurance to meet the needs of pre-deductible payments, out-of-network costs, and other incidents where the major medical insurance won’t provide the necessary coverage.
Limited Medical vs. Major Medical
When comparing limited medical insurance with major medical insurance it is the extent of coverage that is the main difference between the two. Whereas major medical insurance offers comprehensive coverage for many healthcare issues and comes with a deductible and co-pay, limited medical insurance is one that fills in the gaps and provides a cash out payment to help pay for certain medical bills. Major medical insurance is your main insurance coverage whereas limited medical is useful for paying for bills that are not covered by the major medical insurance plan.
How Does Limited Medical Insurance Work?
A Limited medical policy will pay the insured a specific amount of money under the coverage plan. In order to have this plan in place, the individual will pay a monthly or annual premium throughout the life of the plan to ensure proper coverage. The premium will be lower than the premium paid for major medical insurance but so will the benefits. This limited medical plan is ideal for covering incidents that major medical insurance is unable to cover for one reason or another.
Some of the services that a limited medical plan will pay for include the following:
- Wellness visits for adults and kids
- Emergency room visits
- Hospital stays
- Diagnostic testing
If you pay your premium continually, your coverage will continue to stay in effect. You may have a maximum number of times that you can use your annual benefits. Each plan will dictate how much the premium is, how much the payout is, and what the limited medical coverage can be put towards.
Who Qualifies for Limited Medical?
In general, it’s often easier to apply for and obtain limited medical insurance than it is major medical insurance. With major medical insurance, there is a lot of paperwork involved and perhaps even a physical exam by a doctor to determine your current health status. With a limited medical plan, as the premium and benefits are both often less than with major medical insurance, there will be less requirements to meet prior to obtaining this insurance coverage.
Many people are able to qualify for limited medical insurance. Some plans will require a waiting period for the purpose of determining any pre-existing conditions whereas other plans don’t focus on pre-existing conditions at all.
In fact, limited medical insurance is quite easy to understand. There are no deductibles, no out-of-network issues to deal with, pre-negotiated rates for reimbursement and no co-payments. This plan is ideal for filling in the gaps in coverage of your regular medical health insurance.
What Benefits Aren’t Covered?
Limited medical won’t cover each healthcare issue and medical need. It is a basic health insurance policy to provide financial assistance in certain instances.
The level of coverage that the limited medical policy will provide depends on the exact plan you choose, as all limited coverage plans are different. It’s important to note that limited medical insurance does not cover ongoing care where many appointments and treatments are needed. There is usually a maximum amount of visits listed in the plan and you can only have a certain amount of treatments or visits before the coverage runs out for the year.
With that said, a limited medical policy may cover partial payments for ongoing care in the form of physical therapy visits, mental healthcare appointments and costs associated with nursing home stays.
Knowing up front what benefits won’t be covered with limited medical insurance will help you to choose a specific plan wisely. Review your current treatment needs and decide if a specific limited medical plan will adequately serve your insurance coverage needs.
When Should I Get A Limited Medical Policy?
Limited medical offers the perfect way to fill in openings in your current major medical coverage plan. It’s a good idea to get a limited medical plan when you have a high deductible attached to your major medical insurance plan. As many medical costs will not reach certain high levels of deductibles, this means that you will be paying out of pocket to deal with the costs not handled by your main insurance coverage plan. If you have a high deductible, signing up for a limited medical plan is a wise idea.
Other times when you should obtain a limited medical plan include the following:
- Currently have no major medical insurance plan
- Missed the enrollment period for an Affordable Care Act (ACA) plan
- Can’t afford the ACA plan
- Have been laid off from work
- You are self-employed
- Awaiting Medicare benefits
- Were recently a dependent on your parents plan
- Need to often use out-of-network providers
Before you sign up for a limited medical plan you should consider the following:
- Ability to afford out-of-pocket costs and deductibles
- State of current health insurance coverage
- Current deductible
- Prior healthcare visits and ongoing medical issues
When you consider all of the previously-mentioned items you can determine if limited medical coverage makes sense in your individual situation.