Insurance

How do I know which services are covered?

 | 
October 5, 2020

If you already have an insurance plan and want to keep it, review your benefits to see which services are covered. Your plan may not cover the same services that another plan covers. You should also compare your plan with those offered through the Health Insurance Marketplace. The Health Insurance Marketplace is a service that helps you shop for and compare health insurance plans. It is operated by the federal government..

Essential Health Benefits?

Most insurance plans will cover a set of preventive services. This does not mean they are free. You may still need to pay deductibles, copayments, or other out-of-pocket costs.

These preventive services include shots and certain health screenings. If you buy a plan through the Health Insurance Marketplace, your insurance will cover the preventive services. It will also cover at least 10 essential health benefits required by the Affordable Care Act (ACA). All private health insurance plans offered in federally facilitated marketplaces will offer the 10 essential health benefits (EHBs):

State-run marketplaces are also required to offer 10 EHBs, but the list of benefits may differ from those offered by federally facilitated marketplaces. Plans may offer additional coverage.

Preventive Services

Preventive services can detect disease or help prevent illness or other health problems. The types of preventive services you need depend on your gender, age, medical history, and family history. All plans from the Health Insurance Marketplace must cover the following without charging a copayment:.

  1. For Adults.
  2. Pregnant women or women who may become pregnant:

Preventive health services for children (and when they should be provided) depend heavily on age. To learn more about what services may be covered for your child, see a complete list appropriate for his or her age on healthcare.gov.

What is a medical necessity? Is that different from a covered service?

Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.

Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug, or service you need isn’t covered by your policy.


What should I do?

Your doctor will try to be familiar with your insurance coverage so he or she can provide you with covered care. However, there are so many different insurance plans that it’s not possible for your doctor to know the specific details of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.

  • Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested, or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them.
  • If you still have questions about your coverage, call your insurance company and ask a representative to explain it.
  • Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.

How do you start a claim on Care health insurance

Your insurance company may ask you to pay for some of the care you receive. This is often called cost sharing because you share or pay some of the costs, and your insurance company pays the rest. There are different types of costs that you could pay.

Get in touch with a Access Medical  sales rep to get more information

No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income.

Your premium can be lower, based on your income

When you fill out a Marketplace insurance application, you’ll find out if you qualify for these savings. Learn how you can save on your monthly insurance bill with a premium tax credit.

Latest articles.