Major Medical Plans – What Is Universally Covered?

There are three basic types of major medical plans. In terms of comprehensive coverage, consumers have the choice of first dollar coverage or standard coverage. Alternatively, consumers may elect only supplemental major medical plans. These plans only cover a percentage of medical expenses after certain limits are met. However, regardless of the type of major medical plan, there are some expenses that are, for the most part, universally covered. The following list is neither definitive nor all-inclusive. Instead, the list is intended as a general rule of thumb guideline as to what you can expect to be covered for under your policy.

1. Hospital expenses. These include necessary emergency room care, inpatient services, intensive services such as cardiac care or ICU, medicinal supplies and medications, surgical procedures, emergency transportation services, and doctor’s care while in the hospital.

2. Doctor’s care outside of hospitalizations. These services include preventative care, sick visits, regular check-ups, and lab tests. Also included are specialists such as physical therapists, orthopedic doctors and surgeons, as well as anesthesiologists and radiologists.

3. Nursing care. Nursing care encompasses services provided both inpatient and outpatient. Included in most major medical plans are private duty nurses, home healthcare service providers, convalescent care, and nursing home care.

4. Auxiliary services. Additional medical expenses such as prescription medications, casts, splints, prosthetic devices, crutches, durable medical equipment such as wheelchairs or hospital beds, and some adaptive devices are commonly covered under a standard health insurance plan.

While these covered expenses vary in terms of limitations from one insurance provider to the next, in general all major medical plans cover these routine medical expenses. One provider may limit the number of emergency transportation calls they will cover in a calendar year. Another provider may cover the cost of prosthetic devices on a sliding scale, paying 100% on devices up to a certain dollar amount and only 75 or 80% above and beyond those limits.

In terms of comparing major medical plans, issues such as deductibles, coverage limitations, and other specifics will have different meaning in different situations. Families may be more concerned with deductible requirements in order for a policy to pay for routine checkups and sick doctor visits. A single adult under 25 may be more concerned with coverage for preventative care. Older couples may be more concerned with prescription drug coverage and nursing care benefits. These diverse concerns are what prompts different coverage levels and benefits so that each company can meet a variety of consumer needs.

Sean L Johnson is a journalist for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. Get a free reduce quote today at