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3: Analyze Your Circumstances

Recognize Limited Benefit Plans

SAM tips

Minimum Essential Coverage
ACA exchange (marketplace) plans must meet minimum essential coverage (MEC) guidelines. This is not a requirement of other insurance plans. Be aware of essential services covered in these plans before selecting your own.


hospital sceneThough legislation changes regarding the following plans as to whether they are considered “qualified health coverage,” there are limited benefit plans that can provide coverage for particular health care settings, ailments and diseases. Often these plans offer lower premiums but more restricted benefits than major insurance coverages. They can serve as supplements to a regular medical plan, if desired.

  • Basic Hospital Expense covers continuous in-hospital coverage and some hospital outpatient services for a period (usually not less than 31 days).
  • Basic Medical-Surgical Expense covers costs of surgery, including a certain number of days of in-hospital care.
  • Hospital Confinement Indemnity to cover a fixed amount for each day that you are in a hospital.
  • Accident Only covers death, dismemberment, disability or hospital and medical care caused by an accident.
  • Specified Disease coverage pays for the diagnosis and treatment of a certain disease, such as cancer.
  • Other Limited coverage can include only dental, vision or other care.
  • Medical Cost Sharing offers a group of individuals a way to “share” medical costs. To participate, you must meet all requirements which may include dietary and exercise requirements as well as religious views.

According to Health care.gov, plans offering discounts on medical services do not qualify as coverage. You can find lists of qualifying health coverage plans from the IRS.

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