What is typically covered with my health insurance plan?
UPDATED: Apr 29, 2013
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Asked April 29, 2013
Health insurance will vary somewhat from one carrier to another, but most health insurance policies include coverage for specific things, such as doctor visits, surgery, and other outpatient care. Most health insurance policies will also cover the cost of hospitalization, but the length of your hospital stay may be impacted by the policy you have.
As a rule, medical expenses as a result of disease, injury, illness or accident are all covered. That means you would be covered for a broken bone, pneumonia, cuts and burns, and such things as heart disease or chickenpox in children. Currently not all insurance companies will cover treatment for preexisting conditions such as diabetes, but that will change in January of 2014 when all insurance companies will be required to accept preexisting conditions under the Affordable Care Act.
The amount of coverage will almost certainly change according to the plan you are on, the insurer you are using, and even the state you live in. In most cases, the amount of coverage available is based on statistical data regarding the cost, length of treatment, and the seriousness of the injury or treatment. Your policy should provide you with more detailed information on what is covered, and for how much.
Some health insurance plans include coverage for psychological or psychiatric care as well. Since this type of coverage is determined by each insurer independently, you should contact your insurance company if you need to know exactly how much coverage is available for a particular treatment plan. Drug and alcohol rehabilitation is not covered by all insurers, but it is covered by some. The amount of coverage available will vary by insurer and policy type.
Keep in mind that you can pick up supplemental insurance to cover any items not included in your basic health care plan. This might include a supplemental plan to cover medical equipment, prescriptions, or incidental treatments such as physical therapy. Check your health insurance policy or speak with your local agent to determine where there are gaps, and then look for a supplemental plan that fills those gaps without creating too much duplicity in your basic coverage.
Answered April 29, 2013 by Anonymous