What Is and Isn't Covered
How Health Insurance Coverage Works
Health insurance coverage is the package of services that an insurance company has agreed to pay. To understand what may or may not be covered, it's helpful to look at a few basics.
- Your doctor may decide you need certain tests, treatments or procedures out of medical necessity.
- A medical benefit is something your plan has agreed to cover, either partially or fully.
Health Insurance Coverage Limits
Knowing your health insurance coverage limits ahead of time is important. Some expenses may not be covered, and some may only be partially covered. Just a few of these limits may include:
- Care that your receive outside your plan's network
- Plan restrictions or maximum limits for certain types of care
- Preventive treatments, such as flu shots or annual check-ups
- Over-the-counter drugs
- Alternative therapies, such as massage and acupuncture
- Mental health therapy
- Cosmetic surgery
There are plans available that may cover some of these types of expenses. For example, plans that include preventive care may cover annual routine doctor's visits. Some plans offer at least partial health insurance coverage for treatment from doctors and hospitals outside their network. On the other hand, over-the-counter drugs are rarely covered.
So it's a good idea to look at a plan carefully to see what is fully, partially, or not covered at all. Then you can plan for and budget your out-of-pocket expenses.
The Right Balance of Health Insurance Coverage
Balancing what you can afford and the health insurance coverage you need is the key to finding the right plan. Here are a few tips for finding the right plan.
- It's best to choose a plan that covers services you'll use frequently — even if it means a higher premium — because it will save you money in the long run.
- If you now have a primary care physician, make sure your doctor is within the plan's network.
- Take the time to read the details about the plans you are considering — ask for the Outline of Coverage.
- If you have any questions about your health insurance coverage, contact a customer service representative.
Be proactive and learn about the coverage of plans that you are considering. It will help ensure the best health care for you and the ones you love.
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