Limited Medical Insurance

Limited Medical Insurance

An innovative approach for managing basic healthcare costs.

What Is Limited Medical Insurance, also known as Basic Health Insurance?

At Adroit Health Group, we go beyond standard health insurance. We provide options. One of our most versatile options is limited medical insurance. This type of plan is also known as basic health insurance.

Limited medical insurance helps you meet your basic healthcare needs while protecting your financial health. For example, many people today don't have enough in savings to cover high healthcare deductibles. With deductibles as high as $10,000 for a family, this is understandable. Likewise, others don't have access to employer-sponsored plans and don't qualify for government benefits. Others are priced completely out of traditional insurance.

We're committed to bridging this gap. We provide customizable and flexible healthcare options for today's families and working adults. Our supplementary healthcare plans start where others stop.

Limited medical insurance can help protect you from:

  • The financial impact of a major illness or injury
  • Healthcare costs before meeting your insurance deductible
  • Healthcare costs while traveling out of network
  • Limited or non-existent healthcare coverage after losing a job or going through another life event

Here's what you should know about basic health insurance, how much it costs, and how it works.

Limited medical insurance vs. major medical plans

Limited medical insurance is different from major medical insurance.

With major medical insurance, you're generally covered for most healthcare costs after you meet your deductible. It's the type of traditional health insurance you're most familiar with. By paying a set premium every month, your insurance covers all or a portion of covered medical costs.

Limited medical insurance, on the other hand, reimburses you with pre-determined cash benefits after you pay for medical services. What services it reimburses you for, and at what rates, depends on the plan you choose.  Also, limited medical insurance, aka basic health insurance, generally covers everyone, for every healthcare provider. Since reimbursements are generally fixed, the application process and in- and out-of-network details are easier to navigate.

However, limited medical insurance plans must not be confused with "minimum essential coverage" plans that are part of the Affordable Care Act. Our basic or limited medical, health insurance plans are not ACA-compliant.

Instead, these plans supplement your major medical insurance coverage. They can also provide an option when you're priced out of or unable to access traditional health insurance. If you purchase a limited medical insurance plan, and no other ACA-compliant healthcare for the majority of a year, you may be subject to tax penalties.

How Does Limited Medical, aka Basic Health, Insurance Work?

Limited medical insurance provides cash reimbursements for the medical services you use. Limited medical insurance terms are similar to other types of insurance. You apply for them yearly.

These plans can typically help you pay for:

  • Preventative and routine doctor's appointments, for adults and children
  • Emergency room visits
  • Hospitalizations
  • Diagnostic tests
  • Surgery costs
  • Prescription medications

All plans have their own benefit rates for different services. They also differ on what they cover. Reimbursements are paid out to you directly. These plans usually have maximums when it comes to how many days out of the year you can use them, or a maximum benefit amount per plan year. Generally, they don't have in- or out-of-network rules.

When you apply for a plan, you'll receive a quote for your premium. This is the amount you pay each month. Often, however, you'll pay a much lower monthly premium for limited medical health insurance than for traditional plans. However, benefits are typically always less than the total cost of your services.

If you want to learn more about how limited medical insurance works, give our team a call at 1 (800) 269-3563 or send us an email. We're always here to help you make sense of your health insurance options. Adroit Health Group's limited medical plans offer a variety of benefits from several leading insurance carriers, including American Financial Insurance Company, Standard Life and Accident Insurance Company, and Unified Life.

Who Qualifies For Limited Medical Insurance?

For many people, it's actually easier to be approved for limited medical insurance, also known as basic health insurance.

Some plans specify that you'll only receive reimbursements after meeting a six-month waiting period for pre-existing conditions. Many plans don't ask about pre-existing conditions at all.

Beyond that, limited benefit medical insurance is fairly straightforward. Often, there are:

  • No deductibles
  • No out-of-network doctors or clinics, meaning you can see any doctor when you want
  • Pre-negotiated and up-front reimbursement rates
  • No co-insurance or co-payments to keep track of

Again, limited medical insurance should be used as supplementary coverage. Because of this, restrictions on who qualifies and how they can use it are already pre-determined. This makes it easier to apply and get approved.

What benefits aren't covered?

Limited medical insurance, otherwise known as basic health insurance plans, are just that—coverage to meet your basic needs.

It depends on what level of coverage you decide on, but often these plans do not cover long-term, ongoing care. This is because many have maximum benefit amounts and appointments per year.

For example, your plan may cover only a portion of long-term costs related to:

  • Rehabilitative or physical therapy appointments
  • Mental health care
  • Nursing home costs

If you have very expensive treatments, the plan will only reimburse you up to the annual maximum. Make sure to review all aspects of a plan. Consider what healthcare costs you have and if the plan will cover them.

When Should I Get Limited Medical Insurance?

It's best to think of limited medical insurance as a supplement to a major medical insurance plan. It can help you fill the gaps in your current coverage while providing affordable benefits for your family's routine care.

For example, $10,000 deductibles are common now with employer-sponsored insurance plans. But, it's very likely you don't have that amount in savings. A limited medical health insurance plan can help you pay for some of these costs until you meet your deductible.

For others, basic health, or limited medical insurance, provides a lifeline. Realistically, many people simply can't access traditional insurance options. You may consider limited medical insurance if you:

  • Recently lost your healthcare coverage
  • Missed Open Enrollment for an ACA plan (and don't have a qualifying event)
  • Are priced out of ACA-compliant plans
  • Are in-between jobs or recently laid-off
  • Are self-employed
  • Recently retired or are under 65 and waiting for Medicare benefits
  • Are leaving your parent's health insurance plan
  • Frequently travel out-of-network

If you're thinking about limited medical insurance, ask yourself a few questions to see if it makes sense for your situation.

  • Can my current savings cover out-of-pocket costs and deductibles?
  • What does my current health insurance coverage look like?
  • How much is my current deductible?
  • Do I have access to a health-savings account to save for health-related costs?
  • Does my insurance have an annual or lifetime cap? Am I close to reaching it?

Making decisions about you and your family's healthcare is a deeply personal choice. These questions can help you think about your current healthcare needs. Then, they can help you plan for the future.

At Adroit Health Group, we believe that you should have access to the healthcare plans that work best for you and your family. It's important to us that you understand all of your options. Give our team a call at 1 (800) 269-3563 or send us an email to learn more about basic health insurance.

How Much Does Limited Medical Insurance Cost?

As with most types of insurance, the answer depends. How much coverage you choose, where you live, and other factors can affect your cost. For many, though, limited medical insurance premiums are much cheaper than traditional insurance options.

If you're looking for more affordable limited medical insurance plans, you may be able to lower your premiums by:

  • Choosing lower reimbursement rates
  • Selecting a plan with only the benefits you need (such as prescription drug coverage or dental/vision)
  • Picking a plan with a lower maximum benefit or visit amount per plan year

Do remember, though, that limited medical insurance plans are not ACA-compliant. If you have no other major medical coverage during the year you may have to pay tax penalties. In 2017, that penalty was 2.5% of your yearly household income or $695 per adult (whichever is higher).

These rules are always-changing and complicated, so talk to a tax professional for more information.

How Adroit Health Group Is Different

At Adroit Health Group, you save money and we provide peace of mind. If the unexpected happens limited medical insurance plans can protect your family's health—both physically and financially.

Our limited medical health insurance plans can be adapted to fit your family's needs. We also offer other healthcare solutions, like short-term health insurance and disability insurance, to cover other gaps in your coverage.

We provide individual and family healthcare options in over 40 states. Our basic health insurance plans are underwritten by several leading insurance carriers, including American Financial Insurance Company, Standard Life and Accident Insurance Company, and Unified Life.

This information is only the beginning of how we can help at Adroit Health Group. Call our team today to learn more about how we go beyond traditional health insurance. Find the plan that works for you and your family.