What is fixed indemnity insurance?
"Indemnity" means a payment for a loss. A fixed indemnity plan pays a fixed amount per period (like per day in the hospital) or per service (like per office visit), regardless of how much the care costs. Hospital indemnity plans are one common type.
Under federal law it's an "excepted benefit." That means it doesn't have to follow ACA rules, and it isn't counted as health coverage.
When a fixed indemnity plan can be the right choice
- You have an ACA or job-based plan with a high deductible, and you want money coming in if you're hospitalized.
- A hospital stay would also cost you income. A daily benefit can help with bills while you're out of work.
- You want to choose your own doctors or hospital. Payments usually don't depend on networks.
- You want a predictable, limited benefit at a premium you can plan around, and you understand it won't pay your full bill.
When an ACA plan, or a different ACA plan, is the better fit
- You don't have a health plan. A fixed daily benefit can be much less than what a hospital actually charges, and you'd owe the rest. Get an ACA plan or job-based coverage first.
- You have health conditions, are pregnant, or take regular medicines. An ACA plan covers that care and caps your yearly costs.
- You may qualify for premium tax credits or cost-sharing reductions. Those only apply to Marketplace health plans.
- You have an HSA. A plan that pays per day in the hospital usually doesn't affect HSA eligibility, but plans that pay per office visit or service may. Ask the agent, and check with a tax professional.
What it pays
Each policy has a schedule of benefits. Depending on the plan, it may pay a fixed amount for:
- Each day in the hospital, or each hospital admission
- Intensive care days
- Doctor or urgent care visits
- Some tests, surgeries or emergency room visits
Benefits often have limits, such as a maximum number of days per year.
What it doesn't pay
- The rest of your bill. If your care costs more than the benefit, you owe the difference.
- Services not on the schedule.
- Pre-existing conditions during the plan's exclusion period, if it has one.
- Anything above the plan's daily, per-event or yearly limits.
- Care during any waiting period after the policy starts.
How it compares to an ACA plan
| Fixed indemnity plan | ACA plan | |
|---|---|---|
| How it pays | Set amount to you, per day or per service | Pays providers based on the actual bill, after your share |
| Essential health benefits | Not required | Required |
| Yearly out-of-pocket limit | None | Yes |
| Pre-existing conditions | May be excluded for a time | Always covered |
| Premium tax credits | No | Yes, if you qualify |
| Minimum essential coverage | No | Yes |
Many people use both: an ACA plan for medical bills, and a fixed indemnity plan for a set payment during a hospital stay.
Costs and how it's priced
Premiums usually depend on your age, where you live, who's covered, and the benefit amounts you choose. Higher daily benefits cost more. Some plans ask health questions. Ask whether the premium can go up at renewal. An agent can show you exact prices.
How to enroll with a licensed agent
1. Tell us what coverage you have now. We'll make sure you have, or can get, a health plan first. 2. Pick benefit levels that match your deductible and your budget. 3. Compare plans from the insurance companies we represent in your state: benefit schedule, limits, waiting periods, and exclusions. 4. Apply. You'll see the required notice on the application. 5. File claims with the insurance company after a covered event.
Frequently asked questions
Is fixed indemnity insurance the same as health insurance?
No. It pays set amounts for covered events. It doesn't have to cover essential health benefits or pre-existing conditions, and it doesn't count as minimum essential coverage.
Does the payment depend on my bill?
No. You get the amount listed in the policy, whether your bill is higher or lower.
Can I use it with my ACA plan?
Yes. Many people use it alongside an ACA or job-based plan.
Does it use a provider network?
Usually not, because it pays a set amount. Check your policy.
Can I use my premium tax credit for it?
No. Tax credits only apply to Marketplace health plans.
Important information
This policy provides limited benefits. Benefits are paid in fixed amounts regardless of actual charges and may be less than your costs. It has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. It is not comprehensive health insurance and does not count as minimum essential coverage. For costs and complete details of the coverage, call a licensed insurance agent at 1-877-861-3558.
Offered by First Health Solution, LLC d/b/a Health Enrollment, a licensed insurance agency (NPN 17718619). Insurance is underwritten by the insurance companies we represent. Not a government agency. Not available in all states.
Last reviewed October 2026. Not available in all states. This page is general information; see the policy for complete terms.