Individual Limited Benefit Plans

Supplement individual health plans with fixed payment protection.

What are Limited Benefit Plans?

Individual limited benefit plans, also called limited medical, fixed indemnity, or mini-med plans, provide basic financial support for routine healthcare needs. Instead of covering a percentage of medical costs like major medical insurance, these plans pay a fixed dollar amount for specific services.


These plans do not replace comprehensive health insurance. They work best as a supplement, helping reduce out-of-pocket costs for everyday care. When evaluating a plan, focus on more than just the monthly premium.


When considering a limited benefit plan, it's important to ask not just, "What does it cost?" but also, "What does it actually protect me from?"

How We Can Help

Limited benefits plans provide simple, affordable coverage for routine care. They help manage everyday expenses but do not protect against major medical risks. For most individuals, they work best as a temporary solution or as a supplement to comprehensive coverage.


Contact us to learn more about your options.

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How Limited Benefit Plans Work

Limited benefit plans pay set amounts for covered services. Each benefit is predefined, so you know exactly what the plan will pay.


For example:

  • $50 for a doctor visit
  • $1,000 per day for a hospital stay
  • $500 for outpatient surgery


If your provider charges more than the benefit amount, you pay the difference. These plans do not include coinsurance structures or out-of-pocket maximums, which means your total financial exposure is not capped.

Key Advantages

Predictable Cash Payments

Plans pay fixed benefits directly to you or your provider. You can use the funds for medical bills or everyday expenses.


No Deductibles

Coverage starts immediately. You do not need to meet a deductible before receiving benefits.


Lower Monthly Premiums

These plans cost less than ACA-compliant major medical coverage, making them a practical option for budget-conscious individuals.


Simplified Enrollment

Many plans offer guaranteed issue or minimal underwriting, which helps individuals with health conditions secure coverage.

Important Limitations

Limited benefit plans offer affordability, but they come with clear limitations:

  • They do not meet Affordable Care Act minimum essential coverage requirements
  • They do not include an out-of-pocket maximum
  • They do not cover catastrophic or high-cost medical events
  • Coverage for prescriptions, maternity care, and mental health is often limited or excluded
  • Pre-existing conditions may not be covered


Because of these gaps, these plans can leave you exposed to high costs during serious medical events.