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What is a buy-up medical plan?

“To sum it up…”

  • A base medical plan is the basic minimal coverage offered to every member of an insured group, but a buy-up plan has selected changes and additions to allowable coverage for a slightly higher premium
  • Fully explore what the medical insurance needs are for your household and know when any needed changes can be done to your existing policy
  • Adding or expanding coverage for things like disability, dental and vision are some of the more common buy-up plan changes
  • The market for supplemental coverage options is great, but this type of insurance alone will not allow you to be ACA compliant
  • Plan any major changes to your policy, switching plans, or companies carefully to ensure you are really getting the best deal for your budget

The term “buy-up” might sound like a mystery purchase option carried out by the insurer, but it is describing the action of covered individuals when switching to, or adding coverage to existing medical plans for increased value and usability. This is a process that normally results in a better health insurance experience for the consumer.

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What are the differences in a base and buy-up medical plan?


A company that offers group medical insurance is helping pay for these plans with earned business revenue. Like employees, they also have to keep an eye on the bottom-line and try to stick within a given budget.

A group health insurance policy will contain the basics, which is usually the necessary services that meet the minimum essential coverage stipulations of the ACA health insurance reforms. Most group policies allow for an employee to “buy-up,” or add extra coverage at a slight increase in premiums each month.

The difference between a base medical plan and buy-up is the extent of coverage that you end up having at your access.

Explore Medical Insurance Options for You and Your Family


Finding the best health insurance plan for you and your family requires taking a close look at a few of the details that are important for your lifestyle and medical needs.

Group plans do try to include as many features as possible to cater to the masses, but there may be parts of the coverage that you have to buy-up in order to have the coverage you need.

– Budget

How much money do you have in the budget to devote to health insurance? The premiums are only a small part of the costs. There will also be a deductible to meet and what is becoming an increasingly higher out-of-pocket limit.

– Copay, Prescriptions, and Other Costs

If you or family members need to see a doctor frequently for chronic conditions, need to take prescription medications and testing, it is wise to find out how much of these basic costs are covered. How much will it cost each time you have to see the doctor?

– Health Savings Account

Adding pre-tax dollars to an HSA account is a nice option to have, especially if you are having to cover numerous members of a household.

– Costs of COBRA Coverage

Will you be able to handle 100 percent of the premium costs of your health insurance plan if you lose your job? It is a good idea to consider this scenario before making a final decision for coverage.

Changes and Open Enrollment Periods


Being able to switch medical plans, companies, or make changes in the marketplace requires waiting until the open enrollment periods each year unless you have a life event that allows you to utilize a special enrollment period.

Qualifying events like losing your health insurance, having a baby, or getting married will allow you to make needed changes for a special 60-day period.

You will have to check with your employer as to the specific open enrollment period for their group health policy. Their open period can be very different from the November 1 to December 15 dates of the ACA Marketplace.

Disability Coverage Buy-Up

An excellent example of buy-up options for medical insurance is to add long-term or short-term disability coverage to your existing health insurance plan.

Even if a base plan comes with basic disability coverage, it is limited and ineffectual if you are hurt, or get seriously ill. Adding long-term disability will provide as much as two years of coverage, earn a higher continued salary, and keep you adequately protected.

There is a low premium increase for adding long-term disability coverage and it benefits far outweigh the small adjustment in price.

Dental and Vision Buy-Up


Offering the basics of vision and dental coverage with group health insurance can cost companies more than they are willing to pay. Depending on the want and need of their employees, some will go the extra mile to provide these types of coverage or help make it an affordable option.

The ability for employers to offer current and future employees better buy-up options provides a way to be the more desirable employment choice. Delivering specialty buy-up insurance products is a way for a company to seem more progressive than the competition.

The Supplemental and Plan Buy-Up Product Demand

There is an increasing availability of insurance products that are limited in coverage but can be useful in conjunction with concurrent health insurance coverage.

Not all supplemental products are buy-up, as they have to be purchased outside of the policy you have and there is a danger of confusion about whether that type of coverage is ACA compliant. As a stand-alone product, they do not fulfill minimum essential coverage laws.

Increased Basic Services


ACA Marketplace insurance plans are divided into four categories:

  • Platinum
  • Gold
  • Silver
  • Bronze

Many feel that the categorization has everything to do with particular plans offering better services over another. This may be true in some sense, depending on the company, but the designation is more in line with what you will be paying, versus what the insurer pays.

You should a deeper search into each company to find out where the best deals are in regards to the amount of basic services offered before deductibles.

Plan Your Next Medical Insurance Move


With all of the hazards financially of being without minimum essential coverage health insurance, great care should be taken in planning changes, switching plans, and other major strategic moves.

Unless you qualify for a special enrollment period, you cannot make changes to your policy until the next open enrollment period.

Be sure and check with your employer if you currently have group coverage through your job.

Mark down the dates for open enrollment. This is when you can better plan to make changes by incorporating all of the experiences learned over the past year.

Finding the right medical plan for you is often more than the bottom-line cost. It needs to offer the services, copay, deductible amounts and out-of-pocket limits that make sense for your particular budget.

The process of buy-up with health insurance is not new. Contact an insurance expert today and see how your current coverage can be improved. Click here and enter your zip code to review local providers best health insurance plans and deals with free quotes!

  1. http://www.huffingtonpost.com/christina-lamontagne/do-i-need-to-upgrade-my-health-insurance_b_6101270.html
  2. http://health.usnews.com/health-news/managing-your-healthcare/insurance/articles/2010/11/01/how-to-choose-a-health-insurance-plan-12-helpful-tips
  3. https://www.healthcare.gov/glossary/open-enrollment-period/
  4. https://www.amherst.edu/offices/human_resources/benefits/vltdb/ltdnewhire
  5. https://www.forbes.com/2010/08/17/best-benefits-package-for-small-business-entrepreneurs-human-resources-growth-lessons-10-benefits.html
  6. https://www.washingtonpost.com/business/economy/health-insurance-industry-markets-supplemental-policies-to-cover-medical-costs/2014/02/05/f57eb606-8d25-11e3-95dd-36ff657a4dae_story.html?utm_term=.0348b898a68c
  7. https://www.healthcare.gov/choose-a-plan/comparing-plans/