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What is a comprehensive health insurance plan?

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A brief overview...
  • Comprehensive coverage is called Minimum Essential Coverage under the Affordable Care Act
  • Plans that satisfy the Affordable Care Act’s individual mandate must offer certain benefits to subscribers
  • Supplemental plans, such as vision, dental and medical management plans can be purchased to supplement an individual plan based on anticipated need

A comprehensive health insurance plan, or comprehensive coverage, is what most people think of when they think of insurance. Comprehensive coverage is a person’s main health insurance plan, which can be supplemented with other, more targeted insurance plans.

With the passing of the Affordable Care Act in 2014, comprehensive health insurance plans had to meet certain requirements to satisfy the individual mandate, or the law stating that all American citizens must have health insurance.

Read on to find out more about comprehensive health insurance plans and how to find a plan that qualifies as coverage under the Affordable Care Act.

Find private comprehensive health insurance with free quotes using our zip code tool above!

The History of Comprehensive Coverage


The system of employer-based health insurance, where a person’s employer is expected to sponsor their medical insurance plan (at least for employees with benefits) is unique to the United States. This model of insurance provision developed in the early 20th century when, because of world wars and the Great Depression, employers had to find non-financial incentives to attract employees.

Still, coverage was not regulated or mandated to meet specific standards until the late 1960s. Because of laws and competition, as well as the passage of Social Security, Medicaid, and Medicare, insurance became increasingly comprehensive over time.

The health care paradigm shifted as Americans began to think about health insurance less as a perk and more as a right. Insurance companies expanded the breadth of coverage to satisfy these new demands.

Today, comprehensive health insurance covers preventative care, emergent and urgent care, hospital visits, doctor’s visits, required lab and imaging tests, substance abuse treatment, mental health coverage and more. The Affordable Care Act passed in 2014 outlines criteria an insurance plan must meet to be considered comprehensive and to satisfy the individual mandate.

Comprehensive Coverage Under the Affordable Care Act


The Affordable Care Act refers to comprehensive coverage as Minimum Essential Coverage. To qualify for Minimum Essential Coverage under the Affordable Care Act, a plan must offer at least the following benefits:

  • Outpatient care like doctor’s visits, urgent care, and preventative visits
  • Emergency room visits
  • Hospitalizations for both surgery and overnight visits for observation, critical illness, etc
  • Pregnancy, maternity and newborn care along with benefits that support lactation and breastfeeding
  • Mental health counseling, behavioral health treatments, and substance abuse treatment
  • Prescription drugs, including birth control
  • Rehabilitative devices that might be prescribed by an occupational or physical therapist
  • Lab tests ordered by your MD
  • Preventative care and wellness visits
  • Chronic disease management
  • Pediatric dental, vision, emergent and wellness care

That means that every plan accessed through a state or through the federal Marketplace offers at least these benefits. In an effort to stay competitive, some insurance plans may offer benefits in excess of these minimum requirements. No plans will offer fewer benefits. In fact, if your insurance plan does not meet these minimum standards, you may not satisfy the Individual Mandate requirement and may be asked to pay a fine along with your taxes.

You can research and compare what benefits different plans offer by contacting an agent, a company’s website, the Marketplace or by contacting insurance companies on the phone.

Non-Comprehensive Plan Types


Some benefits you want or need may not be included in the Affordable Care Act’s list of requirements for Minimum Essential Coverage or comprehensive coverage. You can purchase these plans to supplement your main, comprehensive plan as you require.

– Vision Coverage

While plans that satisfy the criteria for Minimum Essential Coverage all cover pediatric vision, some do not cover adult vision. As a consumer, you have two options to ensure you have vision coverage.

First, compare plans carefully as you shop for coverage. Some plans offer limited or full vision benefits that cover eye exams and some or all of the cost of glasses or contacts. To easily access this information, simply call the insurance company to inquire about different plans they offer.

If you cannot find a plan you like that offers vision coverage, or if your employer-based plan does not offer vision benefits, you can choose to purchase a separate, standalone vision policy. This kind of policy typically offers more than what is offered through a comprehensive plan and is a good choice for individuals who expect to see the optometrist several times throughout the year.

– Dental Coverage


As a general rule, dental insurance plans must be purchased or provided independently of your main, comprehensive health insurance plan. Unlike vision plans, dental health insurance plans can be purchased on the exchanges in the Marketplace. There are two forms of dental plans, high and low.

A high coverage plan will have lower copayments and deductibles than a low coverage plan. It will also have higher premiums.

Typically, individuals who anticipate seeing the dentist often, or with more complex issues, should choose a high coverage plan. Those who anticipate visiting the dentist for simple cleanings or fillings can likely get away with a low coverage plan with lower monthly premiums.

– Medical Management Programs

Individuals with complicated conditions that require extensive treatment may choose to subscribe to Medical Management Plans, which offer more extensive, specific benefits for certain conditions. These policies may offer extended coverage like cancer policies, inpatient hospital coverage, weight management or bariatrics, accidental death, or international policies that cover medical costs in foreign countries.

For individuals who anticipate exceeding their coverage limits for their main, comprehensive policies, these supplemental policies can offer peace of mind.

Frequently Asked Questions about Comprehensive Health Insurance Plans

Hand writing FAQ on chalkboard

– Do I still have to pay for benefits offered by comprehensive plans?

Yes, you still have to pay for benefits offered by comprehensive plans. Health insurance is merely the cost sharing of risk among pools of individuals and insurance companies. Unless you qualify for government-subsidized insurance or receive an excellent employer-based policy, you will likely be required to pay:

  • Monthly premiums: A monthly bill that allows you to maintain health insurance coverage
  • Deductibles: Minimum out-of-pocket costs before your insurance benefits kick in
  • Copayments: Small fees at the time of service

Some preventative care, such as wellness visits with your primary care physician (PCP) or prenatal care may be completely free under a plan that meets the requirements of Minimal Essential Coverage.

– What if my comprehensive plan still does not offer a benefit I need?

First off, it’s important to compare plans to find the one that best fits your needs. You can also decide to purchase supplemental coverage plans, such as the ones described above.

– How can I find out more information about my current or a potential comprehensive plan?

Most insurance plans will publish information about covered benefits on their websites. You can compare these to decide which plan most suits the level of coverage you require. You can also contact an insurance agent, customer service of individual insurance companies and Marketplace customer service for more detailed information on plan benefits and coverage.

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