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What is a Buy-Up Medical Plan?

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What is a buy-up medical plan?

What is a Buy-Up Medical Plan?

Just the Essentials...

  • A base medical plan is the basic minimal health insurance coverage offered to every member of an insured group.
  • A buy-up medical plan features certain changes and additions to allowable coverage for a slightly higher premium.
  • You should fully explore the medical needs for your household and know when changes need to be made to your health insurance policy.
  • Adding or expanding coverage for items such as disability, dental, and vision is a common change made to a buy-up medical plan.
  • Plan any major changes to your policy, such as switching plans or companies, carefully to ensure that you’re getting the best deal for your budget.

Learn More About Buy-Up Medical Plans

What is a buy-up medical plan? Sounds kind of odd, doesn’t it? Almost like some buying option that makes you tack on more health insurance coverage than you need for twice the price.

That is a major misconception about buy-up medical plans. A buy-up medical plan is not a way to get you to tack on health insurance coverage that you do not want or need. It’s a health insurance plan that allows you to take certain actions on your own.

Buy-up” describes a type of health insurance plan that allows you to switch your coverage, or add coverage to an existing health insurance plan, for increased value and usability. As a result, you’ll get a better experience with your health insurance plan.

Let’s take a deeper look at the buy-up medical plan.

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Base Medical Plans vs. Buy-Up Medical Plans

When you initially purchase a health insurance plan, or you choose a health insurance plan from your employer, what you’re buying is called a “base” plan. Base medical plans cover core healthcare services, such as:

  • Visits to your Primary Care Physician (PCP)
  • Hospitalization
  • Preventive & wellness services
  • Mental health services
  • Laboratory services

These are known as “essential health benefits”. If you’re looking to engage in certain elective procedures, such as weight loss treatment or plastic surgery, you’ll have to pay out of pocket if you have a base medical plan. Elective services are typically not covered by base medical plans.

Buy-up medical plans are less restrictive, and allow you to extend your options. If you’re willing to increase how much you pay for health insurance premiums each month to get access to care you may not have with your base medical plan, then a buy-up medical plan is your best option. Buy-up medical plans are designed to allow you to expand or completely switch your health insurance coverage so that you have better access to the services that you need most.

Medical Plan Options: Exploring the Fine Details

A key part of researching and comparing health insurance plans is exploring the fine details of what’s available to you. If you want to find the health insurance plan that’s best for you and your family, you’ll need to take a closer look at what’s most important for your lifestyle and medical needs. While base medical plans try to offer as many features as possible to meet everyone’s needs, you may still have to buy-up to get what you need the most.

Here are a few things to consider while you’re deciding between sticking with a base medical plan and choosing a buy-up medical plan:


This is probably one of the most important things to consider, as health insurance premium costs can quickly eat up your budget if you’re not careful. Something else to consider is that premiums are only a portion of the cost. You’ll also have to meet a deductible, and to meet your deductible, you’ll have to pay an ever-growing out-of-pocket limit.

Co-Pays, Prescriptions, and Other Costs

Do you or other family members on your plan frequently see a PCP or Specialist? Are you regularly needing to renew prescriptions or have medical testing performed? If so, it’s in your best interest to see how much your health insurance plan, or potential health insurance plan, covers these costs. Doing the research beforehand will save you a great deal of money on these costs in the long run.

Health Savings Accounts

A Health Savings Account (HSA) can be a major money-saver if you incur a great deal of medical expenses over the year. When you opt into a HSA account, a certain amount of your pay is set aside per pay period to go into that account. This allows you to accrue money that can help you cover a variety of medical expenses. It’s a wonderful option to have, especially if your health insurance is covering multiple dependents.

COBRA Coverage

Unfortunately, life happens sometimes, and you may find yourself out of a job. If you lose your job, you’ll have the option to continue your employer-sponsored health insurance coverage for a time through COBRA. Before you opt into COBRA coverage, consider this: opting into COBRA means that you’ll have to take on 100 percent of the cost of your health insurance coverage, as your former employer no longer pays a part of your premium. Will you be able to handle that cost?

What is a Buy-Up Medical Plan?

Making Changes During Open Enrollment

No matter what type of medical plan you have, you’ll have to wait until an Open Enrollment Period (OEP) comes along to make changes or switch plans. If you have a qualifying life event, you may be able to take advantage of a period outside of the OEP known as Special Enrollment. Those qualifying life events include:

  • Losing your health insurance
  • Having a baby
  • Getting married

Times for Open Enrollment can vary depending on your provider. Always be sure to check with your employer or health insurance provider to find out when they hold Open Enrollment each year. If you purchased your plan through the ACA Marketplace, your Open Enrollment period begins in early November and typically runs through the middle of January.

Buy-Up Medical Plans for Specific Features

When you purchase a health insurance plan, you have several different buy-up medical plan options. Below, we’ve listed a few of the different types of buy-up coverage that are typically available to you.

Disability Coverage

One great buy-up medical plan option is long-term or short-term disability coverage. Adding it to your base health insurance plan can be a lifesaver if you find yourself out of work due to any potential life-changing injury or illness.

Some base medical plans may come with basic disability coverage, but that coverage is not as comprehensive as a buy-up package will be. Adding long-term disability coverage to your plan will provide as much as two years of coverage, earn you a higher continued salary, and keep you adequately protected.

There is a premium increase for adding short or long-term disability coverage, but it’s very low. Besides, the benefits far outweigh any adjustment in price!

Dental & Vision Coverage

Offering dental and vision coverage as a part of group health insurance would be extremely costly for any company. This is why companies offer vision and dental buy-up packages for those of you who may want or need to take advantage of such coverage.

Demand for Buy-Up Packages

Buy-up medical plans are being seen more and more by employers and health insurance providers as perfect ways to deliver services that they do not already provide. As interest in these types of plans increases, so does the availability of the plans themselves.

While some see buy-up medical plans as limited in scope, they still serve a positive purpose. Many buy-up medical plans can be very useful alongside your current base health insurance plan.

The ACA “Metal” Plans

Plans found in the ACA Marketplace follow a strategy that’s somewhat similar to the buy-up model. Marketplace health insurance plans are divided into four different categories, named for types of metal, and the premiums are priced according to their tiers:

  • Bronze: Least expensive, highest deductible (Insurance pays 60 percent, you pay 40 percent)
  • Silver: Insurance pays 70 percent, you pay 30 percent
  • Gold: Insurance pays 80 percent, you pay 20 percent
  • Platinum: Most expensive, lowest deductible (Insurance pays 90 percent, you pay 10 percent)

While the tier types may make it seem as if certain plans offer better health insurance coverage over others, the designations are actually related more to what you pay vs. what your insurer pays. As always, it’s important to do your own research to find out which health insurance plans will work best for you and your family.

What is a Buy-Up Medical Plan?

Planning Your Next Move

As with any major life decision, you should take plenty of care when planning to make changes to your current health insurance plan. The same can be said for considering switching health insurance plans. Having health insurance is important, but having health insurance that works the best for you is more important than simply buying a plan just to have it.

Remember that you cannot make changes to your health insurance policy any time of the year. In order to make changes, should you wish to do so, you’ll have to wait until Open Enrollment* comes around. Only if you’ve experienced a qualifying life event can you sign up for a Special Enrollment period.

*Remember to note the dates for Open Enrollment. They’re often different if your health insurance plan goes through an employer than if you choose a plan through the ACA.


Finding a health insurance plan that works for you is more important than looking at cost. It’s important to find something that offers the benefits that make the most sense for you and your budget, including::

  • Services
  • Co-pay and deductible amounts
  • Out-of-pocket costs
Buy-up medical plans are not new to the world of health insurance. Chat with one of our experts today to see how your coverage can be improved! Also, look around to find a health insurance plan that works for you. Enter your zip code into our free tool below to discover free quotes for plans in your area.

Key Resources:

Do I Need to Upgrade My Health Insurance During the Open Enrollment Period?

Information on Essential Health Benefits (EHB) Benchmark Plans

What is a deductible?

Co-Pay vs. Deductible: What’s the Difference?

What is a Health Saving Account (HSA)?

What is Continuation of Health Coverage (COBRA)?

What is the Open Enrollment Period?

Managing Disability Benefits

The Best Benefits Package for Small Businesses

The ‘Metal’ Categories: Bronze, Silver, Gold & Platinum

Changing Plans After You’ve Enrolled