What Health Insurance Doesn’t Cover: Your Guide

  • Health Insurance

Insurance of any kind can be confusing, but when it comes to medical insurance, it’s really tricky to tell what’s covered and what isn’t. Whether you’re shopping around for a new plan or recently just got on a new health insurance plan, it’s good to know the ins and outs of your health insurance coverage before you end up with a large stack of medical bills that you can’t afford. In this article, we’ll discuss the things that medical insurance surprisingly doesn’t cover so that you can make better decisions about your medical expenses. 

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What health insurance does cover

In accordance with the Affordable Care Act (ACA), the Health Insurance Marketplace must now cover a specific set of services at little or no out-of-pocket expense to you. They are also required to cover at least 10 essential health benefits. These essential health benefits (EHBs) include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization and surgery
  • Maternity and newborn healthcare
  • Mental health treatment and substance abuse disorders including counseling and psychiatric treatment
  • Pharmaceutical drugs
  • Rehabilitation services that provide care for those suffering from disabilities and injuries. 
  • Laboratory services (blood and urine testing, etc.)
  • Preventative and wellness services
  • Pediatric services

In short, a lot of the basic care that you will get on a regular basis should be covered by your health plan. Most of the time your doctor won’t suggest treatments that are not covered by your insurance. In a lot of cases, they will try to familiarize themselves with your health insurance plan so that they can lead you in the right direction. However, don’t leave the all the responsibility in the hands of your doctor. It’s important that you make time to read through your health insurance policy and look for any holes before getting services. 

What health insurance doesn’t cover

If you have a good insurance plan, most of your basic medical needs will be covered, but you might be surprised to know the services that generally are. Here is a list of services that health insurance does not cover:

  • Nursing home services: Most nursing home services are not covered by standard health insurance or even Medicare. However, nursing home care is covered by Medicaid. Many people are confused about this, because they confuse short-term care from a skilled nursing facility with long-term nursing home care. These two things are very different. For example, if you were to suffer from a fall or some other type of injury that required you to get surgery, you would need short-term care in a rehabilitative facility to help you get back on your feet. That kind of care is covered. Full-fledge nursing home care on the other hand, wouldn’t be covered because most health insurance providers place time limits on how long they will cover nursing home services. That being said, Medicare will only cover skilled nursing if the patient stayed for at least three days before staying in the skilled nursing facility. Additionally, the patient must be admitted to the facility for the purpose of seeking treatment for a short-term illness or injury as opposed to a chronic one. 
  • The shots you get before traveling abroad: At some point, health insurance companies decided that they would only cover services and procedures considered to be medically necessary, and travel vaccines didn’t make the cut. Now, we’re not talking about your standard health vaccines like the tetanus or flu shot; those are covered. But for those of you who like to travel, the cost of your Typhoid or Yellow Fever vaccine is coming out of your own pocket. This rule of thumb goes for the vast majority of health insurance policies, including Medicare.
  • Cosmetic surgery: Once again, health insurance policies will usually only cover what is “medically necessary.” It’s safe to say that Botox and lip injections will not be covered by your health insurance policy. However, there are certain surgeries that dance on the line between medically necessary and cosmetic. For example, if you wanted plastic surgery on your nose because you thought it was too big, that’s considered cosmetic. But if you had to get work done on your nose due to issues with your sinuses, then that’s probably going to be considered medically necessary. 
  • Acupuncture & alternative therapies: The rules surrounding acupuncture and other types of alternative therapies such as chiropractic care aren’t as black and white. Coverage for such services like massage therapy, acupuncture, and chiropractic care aren’t part of the requirements for most individual health care plans. However, depending on what state you live in, your health insurance plan might cover chiropractic costs. Say you are involved in a car accident that caused you to suffer from back injuries as a result. There is a good chance that your health insurance plan will cover these services. However, if you are a regular at the chiropractor just because you enjoy it, then it probably won’t be. While the standard Medicare plan does not cover acupuncture, there are some Medicare Advantage cans that can. Keep in mind that with most plans who do cover these types of services, there is usually a limit on how many visits you get. 
  • Dental, Vision & Hearing: If you are shopping around for health insurance plans with your employer, note that dental, vision and hearing services are not covered under a regular health insurance policy. If you want to get insured for these services, you will have to buy separate insurance plans for each one. Keep in mind that a lot of times, these insurance policies don’t have any limits on how much they can charge you in out-of-pocket expenses, so research different dental offices before receiving services. Some people choose to not include a dental plan at all. If you wear glasses or contacts, however, it’s probably worth looking into your options for vision insurance.
  • Weight loss surgery: If you’re considering having weight loss surgery, you might be in luck if you have Medicare or Medicaid. While there is currently not a requirement at the federal level for health insurance plans to cover bariatric surgery, Medicare and many Medicaid plans do cover it. Aside from those two plans, more than half of the states in the U.S. do require there to be at least partial coverage for bariatric survey as an essential health benefit (EHB). Remember that even if the state you live in mandates coverage for this procedure, you may still be responsible for some of the medical bills related to your weight loss surgery. 
  • Preventative screenings: Before we go any further, there are A LOT of preventative tests that are covered by your health insurance policy, but there are some that aren’t. This is where things get confusing for a lot of people. For example, mammograms, cholesterol screenings, and colonoscopies will be covered. But if you need to get Prostate Specific Antigen (PSA) screening, it most likely will not be covered.
  • Certain medications: Once again, there are a ton of prescription medications that are covered by most health insurance plans, since pharmaceutical services are one of the essential health benefits (EHBs). However, health insurers get to choose what to cover and what not to cover. Most healthcare insurance plans will choose to cover the minimum. This means that they will pick a drug from each class to cover, and not cover the rest. Many times, the generic version of the drug you are prescribed will be covered by your health insurance, while the name brand will not.

Source: pocketyourdollars.com

A Beginner’s Guide to Insurance Premiums

Deductibles can reduce your insurance premiums, as well. An insurance deductible is the cost you pay before the insurance company pays anything. If your car is insured and you have a $1,000 deductible, you have to pay $1,000 before the insurance company will begin to cover any costs. If there are $3,000 in damages to your vehicle, you would have to pay $1,000 and the insurance company would pay the other $2,000. As a general rule, the higher your deductible, the lower your premiums.

In the case of health insurance, taking on a higher deductible, higher co-pays or longer waiting periods may lower your costs. However, if you can afford a plan with a lower deductible, you may want to take that. Lower deductible health plans offer customers more predictable prices for higher amounts of coverage.

Your homeowners insurance premium may be affected by the coverage limits you choose, your deductible amount, optional coverages you select, your home’s age and condition, your claims history and your credit rating.

Car insurance premiums may be affected by your age, your credit score, your driving record, the age of your car, the type of coverage you chose, coverage limits you select, where you live and drive, and how often you drive.

Your life insurance premium may be affected by the amount of life insurance coverage you buy, the type of life insurance policy you select, the length of your policy, and your age, health, and life expectancy.

Insurance Limits

Some companies, specific policies or types of coverage have insurance limits. An insurance limit is the maximum amount of money the company will pay. Typically, the higher your insurance limit, the higher your premium. It’s also the inverse of a deductible. You pay the part of the claim or claims that’s more than the limit on your policy.

Insurance limits can be on a per occurrence basis or on an aggregate basis. For example, a per occurrence basis could be a $20,000 insurance limit on bodily injuries per person, per car accident. An aggregate insurance limit might be a $100,000 limit on construction costs in the event of a natural disaster.

Car Insurance

Car insurance laws and policies typically list liabilities as a set of three numbers that stand for the coverage limits when you’re responsible for an accident. If your numbers were 22/66/15, your insurance would cover $22,000 for bodily injuries per person, $66,000 in total bodily injury coverage per accident and $15,000 for property damage per accident. For personal injury protection, collision and comprehensive coverage, the numbers are listed as a single amount for each type of coverage. Your state may have specific minimum limits for certain coverages, so make sure you’re getting a fair rate.

Health Insurance

Healthcare laws often change, and many lifetime and annual health insurance limits are illegal. However, some health insurance policies still list annual limits or limits on the number of times certain treatments will be covered, such as acupuncture, chiropractic services and orthotics. Companies may also place limits on prescription medication to keep costs down. There may be policies such as “step therapy,” which requires you to try less expensive drugs first, or quantity limits, such as only covering 30 pills in 30 days.

Homeowners Insurance

Your homeowners insurance policy will often list separate limit amounts for different types of coverage. The limit amounts for liability coverage – in case you’re sued by someone for property damage or injuries that occur on your property – may be different than the limit amount for damage to your home and personal property. Make sure you review all of your homeowners insurance coverage limits, such as the amount it may cost to rebuild your home (dwelling coverage), liability coverage and personal property coverage.

Shopping Around

It’s important to shop around for insurance because different companies have different target clients. You may be the target client for one company, but not for another. That means your premium may be lower with one company than another. The price you pay for your insurance may include taxes or fees, as well. And these could differ from company to company. Before shopping around, call your insurance company and see if they’re willing to lower your premium.

In addition, insurance companies may decide to pursue a new market segment. That can lower rates on a temporary basis, or on a more permanent basis if that works for the company. In either case, you can get a better deal on your insurance if you are part of the demographic that insurance company wants to attract.

The best insurance company for you may not be the best insurance company for your parents or your best friend. It all depends on your age, location and many other factors.

Source: smartasset.com

5 Affordable Healthcare Tips That Will Change Your Life

This post may contain affiliate links. Please read my disclosure for more information.

Healthcare is something I’m thinking more and more about these days. I’m not the sprightly 22-year-old I once was and now I don’t just worry about my health but my husband’s too.

As an acupuncturist by day, I see the effect of poor health management and the toll of high healthcare costs every day and it breaks my heart. I don’t wish that stress on anyone.

But there’s so little information on ways to combat the rising price of healthcare that we just sit back and keep paying.

Here are some affordable ways to save on necessary medical costs and prevent small things from becoming very expensive problems.

Healthcare Sharing

Travis and I don’t have health insurance from our jobs so the decision was easy for us to go with a healthcare sharing program. These not-for-profit programs are popular because they offer protection from large medical expenses at a fraction of the cost of insurance and they count towards coverage under national healthcare law.

Another plus is I know my money is going to people who need it, not to the extravagant lifestyles of shady people.

We are members of Christian Healthcare Ministries and have been really happy with it. I pay half of what I would’ve through the marketplace. Like the name implies they do require proof of practicing Christianity but if that’s off-putting there’s Liberty HealthShare which I’m not very familiar with but I know doesn’t have that requirement.

Acupuncture

I’m a little bias on this one. But I’m not just another blogger telling you the benefits of acupuncture from an outside perspective. I’ve treated thousands of patients for everything from the common cold to serious chronic disorders. Most people think acupuncture is expensive and some places it is, but there are affordable options all over the world. Community acupuncture clinics through the

Most people think acupuncture is expensive, and in some places it is, but there are affordable options all over the world. Community acupuncture clinics through the People’s Organization of Community Acupuncture offer treatments on a sliding scale of $15-$40.

You only pay what you can afford so you can get the number of treatments you need to feel better. Whatever your health concern is from stress and anxiety to digestive troubles or neuropathy, acupuncture is an affordable method of treatment for most people.

Buy Prescriptions Online

If you have a recurring prescription look into seeing if you can get it online. As a cash payer, I saved $40 on a prescription I’d been getting from a traditional pharmacy by switching to online.

It’s as easy as searching for your prescription to see what your options are and filling in your doctor’s name and number at checkout so they can confirm on their end. I’ve used HealthWarehouse.com and had a great experience.

Wear Your Glasses

I’ve been in glasses since I was 8 and contacts since I was 12. Those things add up quick and once you’re in them there’s no going back unless you’re fortunate enough to afford Lasik. This year I vowed to wear my glasses at least 1 day a week to save money on contacts. I discovered

This year I vowed to wear my glasses at least 1 day a week to save money on contacts. I discovered Eyebuy Direct when a friend posted about them on Instagram. Their frames start at $9 and their premium line starts at $49 (and includes lenses!) Whatever your style is they have an affordable frame for you. I love my

Whatever your style is they have an affordable frame for you. I love my Stanfords, they make me feel like I went to a prestigious private university. My favorite part about

My favorite part about Eyebuy Direct is the digital screen protection lens options, and how affordable they are! I spend a lot of time on the computer or looking at my phone and I have seen a major decrease in eye-strain since getting my new specs. Needless to say, I’m wearing my glasses more than one day a week now and cutting back on how often I buy contacts.

Diet & Exercise

“Wealthy people think long term while the middle class think short term.” Keith Cameron Smith said that in his book The Top 10 Distinctions Between Millionaires and the Middle Class. What’s true about wealth is true about health. The best way to prevent a major medical emergency down the line is to be intentional today. There are a ton of free and thrifty ways to stay active like running, walking, biking, or

The best way to prevent a major medical emergency down the line is to be intentional today. There are a ton of free and thrifty ways to stay active like running, walking, biking, or online fitness classes. It takes little extra effort to commit to cooking healthy meals at home and avoid overindulging in rich foods. Just think, every effort now is a dollar saved in the future.

It takes little extra effort to commit to cooking healthy meals at home and avoid overindulging in rich foods. Just think, every effort now is a dollar saved in the future.

Disclosure: This post contains affiliate links. Using these links helps me add more waffle makers to my already extensive collection. Cheers!

5 Healthcare Budget Hacks

5 Healthcare Budget Hacks

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If you’re on a buget and want to save on healthcare costs, read this. Tips and tricks to for affordable healthcare for millennials. #moneytipsformillennials #healthcaretips #healthcaretipsformillennials

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Jen Smith is a personal finance expert, founder of Modern Frugality and co-host of the Frugal Friends Podcast. Her work has been featured in the Wall Street Journal, Lifehacker, Money Magazine, U.S. News and World Report, Business Insider, and more. She’s passionate about helping people gain control of their spending.

Source: modernfrugality.com