Major medical coverage forms the foundation of serious health protection. These plans cover a wide range of essential medical services — hospitalization, surgery, specialist care, diagnostic testing, and emergency services — while helping protect you from catastrophic costs.

Private major medical PPO options are typically medically underwritten. Premiums and eligibility are based in part on health history. Healthy applicants often receive more competitive rates and broader network access compared with many community-rated Marketplace plans (especially when subsidies are not available).

Key Features

• Nationwide or broad PPO networks — See specialists without referrals in many cases
• Year-round enrollment — Apply any time
• Structured cost-sharing — Deductibles, copays, coinsurance + annual out-of-pocket maximum
• Core medical benefits including hospital care, physician services, and emergency care

Who this may be right for

• Self-employed individuals and families who do not qualify for significant ACA subsidies
• People who want broad doctor choice and no-referral specialist access
• Those who need coverage to start quickly outside Open Enrollment
• Applicants in generally good health

Most private health plans cover recommended preventive services at no cost when received from an in-network provider (following USPSTF A/B recommendations and other federal guidelines).

Preventive Care at $0 Cost-Sharing

• Annual wellness visits and many routine screenings
• Recommended immunizations
• Certain preventive medications (when prescribed)
• Well-child visits and pediatric preventive services

Prescription Drug Coverage

Plans typically use a formulary organized into tiers:

• Tier 1 — Preferred generics (lowest cost)
• Tier 2/3 — Preferred and non-preferred brand drugs
• Specialty tiers — Higher-cost specialty medications

Mail-order options for 90-day supplies of maintenance medications are commonly available.

Supplemental insurance (excepted benefits) works alongside your primary health plan. These policies pay cash benefits directly to you when a covered event occurs. You can use the money for medical bills, deductibles, rent, groceries, or any other expense.

Common Types

• Accident Insurance — Benefits for injuries from covered accidents
• Critical Illness — Lump-sum payment upon diagnosis of covered conditions (certain cancers, heart attack, stroke, etc.)
• Hospital Indemnity — Fixed dollar amount per day or per confinement in the hospital

Short-term limited-duration insurance (STLDI) provides temporary medical coverage during gaps (between jobs, waiting for new benefits, or outside Open Enrollment).

Current Rules (2026)

Federal rules from 2024 generally limit new short-term policies to an initial term of no more than 3 months and a maximum total duration of 4 months. In 2025 the federal Departments announced they would not prioritize enforcement of those limits while considering further rulemaking. State rules vary significantly — some states ban or further restrict these plans. Always verify current rules for your state.

Important Limitations

• These plans are not comprehensive health coverage
• They do not meet ACA minimum essential coverage requirements
• Pre-existing conditions are frequently excluded
• Many essential benefits may be limited or excluded
• Medical underwriting is common

Adult dental and vision benefits are generally considered supplemental (excepted) benefits and are not required essential health benefits for adults under the ACA.

Typical Dental Benefits

• Preventive — Cleanings, exams, X-rays (often 100%)
• Basic — Fillings, simple extractions (commonly 70–80%)
• Major — Crowns, bridges, root canals (commonly 50%)

Typical Vision Benefits

• Annual comprehensive eye exam
• Allowance for frames and lenses or contact lenses

Life insurance pays a tax-free death benefit to your chosen beneficiaries. It can replace lost income, pay off a mortgage, cover final expenses, or fund education.

Term Life Insurance

• Coverage for a set period (commonly 10, 20, or 30 years)
• Most affordable option for a given death benefit
• No cash value
• Ideal for temporary needs (mortgage, young children)

Permanent (Whole / Universal) Life

• Designed to last your entire life
• Builds cash value on a tax-deferred basis
• Higher premiums than term
• Useful for lifelong coverage or estate planning