It’s no secret that most of today’s health insurance plans come with a lengthy list of healthcare services that are not included in coverage.
Earlier this year, HealthPocket, a free resource for consumer health information, published an analysis of more than 3,000 health plans in the post-ACA individual and family insurance marketplace.
Based on its report, HealthPocket’s analysis revealed the 10 most common health insurance exclusions and the percentage of plans which excluded the following services.
- Long-Term Care (99%)
- Cosmetic Surgery (92%)
- Adult Dental Services (89%)
- Weight Loss Program (88%)
- Acupuncture (84%)
- Routine Foot Care (72%)
- Infertility Treatment (67%)
- Private Nursing (67%)
- Adult Eye Exam (61%)
- Weight Loss Surgery (59%)
Although the ACA significantly expanded medical coverage for millions of Americans, provides essential health benefits that are required of all health insurance policies, and placed an annual limit on out-of-pocket health costs – it’s important to know what services are covered in your insurance plan and what you could be paying for out-of-pocket.
After all, a trip to the dentist for a $1,100 root canal, a $100 eye exam and $25 copays on prescription drug costs each month can add up fast, with or without a good health insurance plan in place.
Key Terms to Know
The reality is that no health insurance plan will cover every single medical expense, and a variety of limitations and exclusions are very common.
By definition, an “exclusion” is a medical service or item that is not covered and your health insurance will not pay for, including many of the 10 excluded services listed above.
“Out-of-pocket” health costs are the costs that are not covered by your health insurance that you pay for. Examples of these potential costs include deductibles and copays.
According to a 2014 report by the Towers Watson/National Business Group on Health, for workers with employer-sponsored health insurance, these out-of-pocket health costs have been rising an average of 40% each year since 2011.
And, as it relates to the annual limit on out-of-pocket health costs under the ACA, this key provision in healthcare reform will apply to all individual and group health insurance plans as of 2015. These annual out-of-pocket expense limits are as follows:
- $6,600 for individual health insurance plans.
- $13,200 for family health insurance plans.
It’s important to note that these limits apply to the services included in your coverage and services at in-network providers. There may be separate limits for any out-of-network care. And costs for excluded services do not apply at all to these potential out-of-pocket health costs and your annual limit.
Help Saving Money on Health Costs
Discount health programs are one solution that more than 30 million Americans are using to save money on those common “supplemental” healthcare services (and more) not included in their health coverage.
Programs and savings vary based on the services you choose, where you live and the procedure. Generally speaking, people can save anywhere from 20% to 60% off the regular fee for services like dental care, vision, alternative medicine, chiropractic and hearing. And, many discount health programs include telehealth services with 24/7 access to licensed doctors for clinical care in the convenience of your own home.
With a discount health program, which is available for a low-monthly fee, you get a membership, a list of in-network providers, and a discount on services when you visit those providers. These programs are offered on a stand-alone basis (e.g., dental or vision only) or in bundled services (e.g., dental plus vision plus telehealth).
You can find a list of companies and visit their websites to search for various discount health programs across the country here.
It’s important to note that discount health programs are not insurance and are not qualified as such under the ACA. And, you should always do your homework, read the fine print and ask questions if you’re shopping for a discount health program.
For more information about discount health programs and things to consider when choosing a program, click here.