Think that your every health care need is covered by your insurance plan? It may not be so. Taking the time to read all the material associated with your health care package may keep you from being surprised later.
Here are the top 10 treatments that your health insurance plan may not cover:
- Maternity expenses. Pre-natal and delivery expenses may not be covered in all plans. If you are planning on having a child, be sure to check your current health care plan to find out what it will pay for. If your company offers several choices for health care, you may need to switch to a plan that covers these expenses.
- Eye doctors. Routine visits for an eye exam, even if you go to an ophthalmologist, typically are not covered unless you have a medical condition, such as glaucoma. Low-cost vision insurance can help pay for eye exam costs, glasses and contact lenses. Surgery to improve eyesight is generally not covered by health care insurance.
- Treatment for drug addiction or alcoholism. If treatment is included in your plan, what is covered can vary greatly. Some plans will cover in-patient treatment but not out-patient programs.
- Nursing home or home health care. With shorter hospital stays a goal in saving health care costs, even patients too young to retire may require a stay in a long-term facility or home health care. Find out what your plan will cover and for how long.
- Cosmetic surgery. You most likely are on your own if a facelift or liposuction is in order.
- Treatment for weight loss. Prescription medication, surgery, dietitians and exercise trainers may be what the doctor ordered, but check with your plan to find out what costs you will be responsible for.
- Mental health. Trips to the therapist may be limited, or may not be covered at all. Some plans restrict therapy to a particular group of counselors, or offer an Employee Assistance Program. In-patient psychiatric treatment may be covered in some instances, but not always.
- Any treatment related to an accident. If you are hurt on the job or in an auto accident, your health care provider may not cover you.
- Preventative care. Your annual physical or flu shot may not be covered. Most plans that have a network of health care providers cover at least some of these expenses, but be sure to check, especially if your physician is out-of-network.
- Chiropractic, acupuncture or other types of alternative care. Read your plan closely or call your human resources department to determine if you will be covered. A chiropractic visit for a sore back may be covered, but not a visit to cure asthma.
So you’ve determined that your current health care plan does not cover treatment you need. What can you do? If your company offers a more expensive health care plan that covers the services you need, consider switching to it. You may be able to purchase supplemental coverage, such as vision insurance, to help defray the costs. Another option is a Medical Spending Account (MSA), which allows your employer to deduct a pre-tax amount of your pay for medical expenses that aren’t covered by your plan.
If your benefits guide isn’t clear about whether a particular treatment is covered, don’t assume that it is. Call your benefits administrator to find out.