Individual & Family · Major Medical
Health coverage that actually covers you.
Major medical is the real thing: comprehensive health insurance for routine care and the expensive surprises alike. Here’s what it must cover, the plan types you’ll choose between, and where to get it.
The baseline
Ten benefits every real plan must include
Since the ACA, every true major medical plan covers the ten essential health benefits — no exclusions for pre-existing conditions, no lifetime dollar limits.
- Ambulatory (outpatient) services
- Emergency services
- Hospitalization
- Maternity & newborn care
- Prescription drugs
- Laboratory services
- Preventive & wellness services
- Mental health & substance use care
- Pediatric services
- Rehabilitative & habilitative services
The alphabet, decoded
HMO, PPO, EPO, POS — which shape fits you?
HMO
Health Maintenance Organization
In-network care coordinated through a primary doctor. Lowest premiums; referrals required; prevention-focused.
PPO
Preferred Provider Organization
See any provider, in or out of network, usually without referrals. The flexibility costs more each month.
EPO
Exclusive Provider Organization
Network-only coverage (except emergencies) without referral requirements — a middle path on price and freedom.
POS
Point of Service
Lower costs in network, referrals to see specialists, partial out-of-network coverage. A blend of HMO and PPO.
Three doors
Where major medical coverage comes from
Marketplace (ACA)
Individual and family plans bought on healthcare.gov — with income-based savings for most shoppers.
The ACA guideEmployer coverage
Group plans through work, with the employer sharing the premium. If you have access, it’s usually the first option to weigh.
Public programs
Medicaid and CHIP for qualifying incomes — and Medicare at 65 or with qualifying disabilities.
The Medicare guideFika makes it easy
Private plan or Marketplace? We’ll do the math.
We compare your real options side by side — Marketplace plans with whatever savings you qualify for, private coverage, and everything in between — and give you the yearly cost, not just the premium. Free, no pressure, no spam.
FAQs
Coverage questions, answered
Through the Marketplace: premium tax credits for households between 100% and 400% of the federal poverty level, and cost-sharing reductions on Silver plans below 250%. The larger pandemic-era subsidies ended after 2025, so the math changed for many households — but most shoppers still qualify for real help. The ACA page covers the 2026 numbers →
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