Blog
It's our experience and expertise working for you.
February 2020
January 2020
December 2019
November 2019
October 2019
September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
April 2017
Since the passage of ACA, health insurers in the US have been required to cover preexisting conditions, prenatal care, and a number of other "essential benefits". And this might give the impression to some that, basically, everything is covered and has to be by law. But that is not at all the case. Health insurance policies still include various exclusions that consumers need to be aware of when shopping for new insurance. The last thing you need is the surprise of a specific care not being included in the plan you chose. What Is Typically Excluded From Coverage? If you are thinking of switching health insurance or looking for a new policy, be sure to ask a health insurance agent to explain to you potential policy exclusions. Not all insurers have the same exclusions, but here are the most common ones:
Other Limits On Health Insurance Coverage Even when you know what is and is not covered by your policy, there are still other limitations to what it will pay. You need to be aware of these ahead of time and calculate how much you would likely pay out of pocket in a typical year (as compared to your premiums) to decipher what is the best overall deal for you and your family. All health insurance is going to have cost-sharing of some kind. You will have copayments, coinsurance, and (usually) a deductible. There may also be an annual or lifetime coverage cap or caps specific to particular kinds of care. On the flip side, there may be out of pocket limits protecting you from paying excessive amounts in a single year. Out-of-pocket limits can also be limited to particular coverage areas (such as prescription drugs); so it would be worth investing into a health insurance agent to help read the fine print. For major medical procedures, you may want to get prior authorization to make sure the insurer is going to cover it and not leave you paying in full out-of-pocket. No matter how good the coverage is when it applies, it will do you no good on those costs that are excluded. So be sure to scan each potential insurer's exclusions list to see if it contains anything you think you will need. To learn more about how health insurance exclusions work, or to discuss your options with an experienced broker, contact Summerlin Benefits Consulting today! |