7 Things Not in Most Health Insurance Covers

Updated on August 31, 2020

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Having a health insurance cover is vital for you and your family, especially now medical costs are proving to be expensive. Therefore, if you have a current health plan, ensure you are aware of the details it offers, as some you may think they are within the plan, and may not be part of it. Also, if you want to select a new health insurance policy for your family or a Medicare supplement plans 2021 for your aging parents, ensure you know what the cover entails to avoid surprises when you need the insurance cover the most. So it is best to consult the services you will have to make smart choices for your health. Thus, have a list of what you will want to be covered and inquire to know if the cover is partial or full. Below are some of the things that most health insurance companies do not cover.

1. Travel vaccines 

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When you consider travel vaccines, they are different from health vaccines generally. For instance, if you need a flu vaccine or tetanus shot as preventative care. Most insurance companies will cover them as part of your health maintenance. However, if you are traveling abroad and you need a yellow fever vaccine or an oral typhoid vaccine. Most of them do not cover for these vaccines, including Medicare. This is because most health insurance companies, cover medically necessary things, and somehow travel vaccines are not medically necessary. So, since the trip is done willingly, you have to pay for the vaccine.  

2. Nursing home care 

When you have a loved one that needs regular nursing home care, in most instances, it is not part of most health insurance plans. However, most covers are short term care in a skilled nursing facility. Such as, if you break a hip and you need surgery, the assistance you get in a skilled nursing facility or rehabilitative facility will cover the recovery process. In comparison to long term nursing home care. However, the former is part of the cover as they are short term, and it is because of a medical incident. Importantly, you will have to check with your insurance cover if it has limits with the length of time they cover you in a skilled nursing facility. 

3. Preventative tests

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This can be a little bit questionable, as other tests are within the cover of the insurance, but still, others are not. For instance, cholesterol screening, mammograms, and colonoscopies are on the cover. While others like prostate-specific antigen screenings are not part of most health insurance covers. Hence, it is wise to consult with your health insurance cover what preventive care is part of your plan, and if it is full cover or not. Others like Vitamin D testing are also not covered in many, and the reason in most insurance companies deny it for the value of the test is insufficient. So, consult the preventative care cover you get for you, your family, and also for your aging parents if you are searching for one. 

4. Alternative therapies 

Depending on your state and plan, alternative therapies are covered. However, acupuncture and other alternative therapies, are not with most health insurance. In the under 65 years of age bracket, acupuncture, massage therapy, or chiropractic care are not under the cover. However, in some states, they may be covered according to how they define essential health benefits. As an example, there are times chiropractic care falls under the essential health benefits of ambulatory care or rehabilitative care. If you need to receive this treatment from a chiropractor, it will be part of the coverage. However, if you often visit the chiropractor for back issues or to feel better, it is not in the coverage. 

5. Vision, dental and hearing 

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When it comes to coverage for dental, vision, and hearing, you will have to buy a separate cover that includes them as most insurance plans do not cover these. Alternatively, you can get one that covers all of these. Plus, many people feel that it may also not be worth having this insurance as it can lead to being much more. For instance, if you have dental cleaning twice a year, it can cost at most $120 that may be cheaper in comparison to paying the monthly fee for dental insurance. Consult on this is you have a Medicare cover to see if they are eligible or not. 

6. Medications 

When it comes to prescription medication, it is under the essential health benefits, and so medication is covered by the insurance. However, you need to know the details of this cover as sometimes there are medications that are not part of the cover. Therefore, inquire about the list of covered medications known as formularies. Hence, through this, the insurers have a lot of flexibility in choosing their formularies. So depending on the classes available, the insurance companies do not cover all drugs and instead choose one drug in each class. Plus, generic drugs are covered more in comparison to a brand name. Thus, if you have a list of the medication that you take, confirm if it’s part of your plan.  

7. Weight loss surgery

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In terms of weight loss surgery, bariatric surgery is under cover of most Medicaid programs and Medicare. However, most of the other insurance covers do not cover weight-loss surgeries. So, while some are part of the cover and others are not, consult as most of the above. Plus, it is not a guarantee that the coverage pays for all the costs that are part of the surgery. So, if you plan to have bariatric surgery, compare the plans and check through the details for what is exactly covered. Again this applies to cosmetic surgery as well. It is what is medically necessary, and a facelift or nose job is not part of the cover. However, if you had a mastectomy and you need reconstructive breast surgery, it is deemed medically necessary, and it will be part of the cover.  

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The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.