Common categories at a glance
| Category | What to understand | Questions to ask |
|---|---|---|
| ACA Marketplace major medical | Comprehensive individual coverage offered through the Marketplace, with plan-specific cost sharing and enrollment rules. | Are you comparing the full premium after any eligible savings? Are your doctors, medicines, deductible, and maximum out-of-pocket costs acceptable? |
| Private individual medical options | Availability, underwriting, benefits, networks, and limitations depend on the specific product and carrier. | Is acceptance guaranteed? What conditions or services are excluded? Is the provider network suitable? |
| Short-term medical | Limited-duration coverage with terms and exclusions that differ from comprehensive Marketplace coverage. | How long can it last? What are the exclusions, renewability rules, and limits? |
| Fixed-benefit and supplemental plans | Pay defined benefits for covered events or services; they are not a substitute for comprehensive major medical coverage. | What triggers a benefit? What is the amount, waiting period, limitation, or exclusion? |
| Health care sharing arrangements | Sharing arrangements are not insurance and do not guarantee payment of medical bills. | What expenses may not be shared? What membership rules or statement of faith apply? |
Compare the documents, not just a headline price. Review covered services, provider network, prescriptions, deductible, copays, coinsurance, exclusions, waiting periods, and the plan’s limits. Actual availability and terms vary by state and product.
A simple checklist for your review
- Write down the monthly premium and any deductible or cost sharing.
- Check your preferred doctors, hospitals, and prescriptions with the plan or carrier.
- Ask whether the option is major medical insurance, limited-duration coverage, a fixed-benefit policy, supplemental coverage, or a sharing arrangement.
- Read the official summary and policy or plan documents before enrolling.
- Ask what is not covered and what could change the price or eligibility.
Want help comparing your options?
Bring your ZIP code, preferred providers, and budget range to a short conversation with Shane.