Limited Medical Benefit Plans: Affordable Basic Coverage

Limited medical benefit plans — sometimes called fixed indemnity plans — can help cover common healthcare expenses like routine doctor visits, minor procedures, or diagnostic tests. These plans pay a set cash benefit for specific covered services, helping you manage out-of-pocket costs if you don’t qualify for subsidies or need extra protection outside of open enrollment. Many also come with a network which allows members to get in network repricing on services offered by in network providers

A limited medical benefit plan is not the same as major medical insurance. Instead of covering every healthcare cost, it pays you a fixed amount per covered service. You can use this cash benefit toward doctor bills, lab tests, or even everyday living expenses during recovery 

This type of plan may be a good option for you if:

• You’re between jobs or can’t afford major medical coverage right now 
• You missed the open enrollment window for ACA plans
• You’re self-employed or don’t qualify for subsidies
• You want to supplement your high-deductible plan with extra cash for everyday medical visits

•  Not major medical insurance
• Do not cover all essential health benefits
• May exclude pre-existing conditions
• Not a substitute for ACA minimum essential coverage
• Do not cap your total medical bills — benefits have fixed dollar limits