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We can’t stress the importance of knowing your health insurance coverage enough.
If you’re not well-versed in your health insurance coverage, you can get too complacent. Obviously, this isn’t a good thing, as it can result in a monumental bill for a medical procedure that you thought would be covered.
At the same time, you may spend thousands of dollars for a medical procedure that your policy actually covers.
Suffice it to say, you need to know about your policy coverage to make the most out of it. But if you’ve never used your insurance policy before, you may not know what’s included in it and what’s not.
What’s Included in Health Insurance Coverage?
We’re not going to lie: navigating your health insurance coverage can be tedious and complex. No wonder many people can’t take the time to know exactly what they’re paying for.
Medical insurance can vary a great deal, depending on the provider, plans, and specific policy limitations.
That said, the Affordable Care Act (ACA) sets a standard for all the policies you can buy from the ACA Marketplace. Although different policies might vary widely, there are ten standard benefits that all ACA Marketplace policies offer.
- Ambulatory care. Also called outpatient service, these are medical services that don’t require your overnight admittance to a hospital room.
- Emergency room. This refers to services done when you wind up in a hospital emergency room treatment.
- Inpatient care. Contrary to outpatient care, inpatient care is when you’re admitted for one or more nights in the hospital.
- Pre and post-natal services. Medical services afforded to a mother before and after delivering a baby.
- Psychological treatment. Treatment for psychological needs, including substance use treatment and mental health treatments like counseling, psychotherapy, etc.
- Prescription drugs. Any drugs you take, whether regularly, semi-regularly, or even just temporarily, will most likely be covered by primary benefits.
- Physical recovery services. Services that help the patient recover from a disability, physical trauma, or chronic condition, which can include psychiatric rehabilitation and physical therapy.
- Lab tests. Any laboratory examinations and consultations are conducted on-demand or routinely.
- Preventive services. These are regular doctor’s appointments, vaccinations, counseling, screenings, and other services you undergo to maintain your health.
- Pediatric services. Healthcare services that are afforded to infants and young adult children, including dental and vision care.
These are the basic insurance coverages, but that doesn’t mean there won’t be more. The only way to say what your policy covers is by consulting your insurance provider.
Keep in mind that while most insurance policies cover these services, that doesn’t necessarily mean that you won’t be shelling out additional expenses. Depending on the services, there are multiple out-of-pocket costs, such as deductibles, co-payments, and more.
What Does Health Insurance Not Cover?
Like the previous section, exclusions to your medical insurance coverage can vary greatly. Thus, the only way to know for sure is to talk to your insurance agent or provider.
There are the standard services that are typically not included in most insurance policies, which are the following.
- Off-label prescriptions. Insurance providers are not obligated to cover medicine prescribed for a certain condition if it’s not proven to treat the said condition.
- Cosmetic medical procedures. Services that alter someone’s physical appearance such as liposuction, implants, botox, laser hair removal, etc.
- Fertility treatments. This case can vary depending on the state’s insurance laws, but most insurance companies can decline to cover fertility treatments, although they can cover testing services required for fertility treatments.
- New medical technologies. Products or services that are new to the market and haven’t been proven yet can be refused coverage.
How to Know Your Health Insurance Coverage
The surest way to know what your policy covers is to ask your insurance providers. You can also talk to your employer if you get your insurance through your job.
Here at Magnum Insurance, we provide a free consultation about the coverage of health insurance policies that you’re thinking of getting.
Understanding Your Coverage With Magnum Insurance
You must understand precisely what your health insurance covers because doing so allows you to maximize your benefits to the last dollar.
If you still don’t have health insurance or are looking to switch policies, Magnum Insurance is ready to provide the assistance you need. Be sure to reach out to us today!
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