Seven Surprising Things that Aren’t Covered by Your Health Insurance Plan

Almost all Americans have health insurance nowadays, whether it’s through an employer-sponsored plan at their workplace or Medicare after retirement, but not everybody has a clear idea about what medical services their insurance covers.

It’s important to know the details of your health insurance plan so you don’t get blindsided by a large medical bill that your insurance company refuses to cover. Here are the 7 medical procedures that you probably shouldn’t expect your health insurance to pay for.

Travel vaccination

If you’re planning to travel abroad, you may need unusual vaccines against diseases such as yellow fever or typhoid which in almost every case aren’t covered by most insurance plans.

Health insurance plans do cover basic health vaccinations such as a flu or tetanus shot but when it comes to preventive vaccines that aren’t considered necessary, you may have to pay out of your own pocket. For example, if you’re applying for a visa to travel abroad, you may need unusual vaccines against diseases such as yellow fever or typhoid which aren’t covered by most insurance plans like Medicare.

Alternative Therapies

If you want to visit the chiropractor or get a massage therapy, you may want to check with your insurance company in advance to find out if they provide coverage for it. Chances are that if you’re under the age of 65, your health insurance will not cover alternative therapies such as acupuncture and message therapy. Your state may allow coverage for chiropractic care depending on how it defines the necessary benefits for healthcare packages.

If you injure yourself in an accident and the treatment requires chiropractic care, then your company will have to pay for it. Some companies do cover alternative therapies but they limit the number of annual clinical visits.

Cosmetic Procedures

As much as we all wish that medical insurance covered cosmetic surgery, you will definitely have to pay for such procedures out of your own pocket unless they are classified as a medical necessity. A face lift or liposuction isn’t considered as a medical necessity whereas reconstructive surgery after a mastectomy is.

Care for Elders in Nursing Homes

When it comes to nursing home care for elders, not all commercial health insurance companies cover the costs associated with it – but some, like Medicaid, do. Nursing homes fall under long-term care benefits which is why most insurance plans don’t provide coverage for it.

However, if an insured requires short-term nursing home care due to an injury, it is most likely to be paid for by their insurance company under their skilled nursing benefit.

Dental Care

Usually, the dental insurance packages are quite expensive, which is why most people consider them unnecessary.

One of the biggest healthcare costs not covered by commercial insurance plans is dental care. If you want your trip to the dentist’s office paid by the insurance company, you will need to buy a separate plan for it. The same principle applies to procedures related to hearing and vision.

These separate plans aren’t often regulated by the Affordable Care Act which means that there are no requirements for which benefits need to be covered or what costs need to be paid out of pocket. Even though dental procedures aren’t cheap, the insurance for them is even more expensive which is why most people consider it unnecessary.

Preventative Care

Various screenings and tests such as colonoscopies, mammograms and cholesterol tests come under the umbrella term ‘preventive care’ – but not all of them are covered by commercial insurance plans.

Depending on the recommended preventive care benefits determined by respective government agencies, your insurer may or may not cover certain preventive tests. For example, cholesterol screenings and monograms are often covered, other unnecessary screenings such as a vitamin D tests must be paid out of pocket.

Various screenings and tests, even though belong to the ‘preventive care’ category, are not covered by commercial insurance plans.

Prescribed Medication

This one might shock some readers since prescribed medicines are covered by health insurance companies as an essential health benefit. However, once you get into the detail of the conditions that apply to the coverage of this benefit, you’ll be surprised to find out that not all medication is covered by your insurance plan.

Insurance companies are required to cover at least one medicine from each USP class which means that they have the power to choose which drugs they may or may not include in their plan. While most generic drugs are covered, some expensive ones are not.