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Knowing Your Options – What Does a Medical Insurance Cover?

Posted on November 21, 2018

(HealthNewsDigest.com) – If you don’t have medical insurance yet, you must be wondering what it feels like to have one. Will the policy cover every medical situation you find yourself in? If there’s an emergency and an ambulance is called to take you to hospital, will the provider cover the costs? What if you’re diagnosed with a serious disease that could cost a lot of money to treat?  Would you still be able to count on your insurance provider?

What You Need To Know

Let’s begin by saying that it’s very important that you get medical insurance. In a world where disease and accidents are waiting all over, that policy could save your life.

Onto the exact points covered by a medical insurance policy, it depends on the policy you’re buying. The good news is that most insurance companies will happily tell you what’s covered (known as covered services) and what isn’t covered.

However, even if you’re not told what’s covered, just remember that all medical insurance policies cover two broad categories of services; essential health benefits and supplementary services.

Essential Health Benefits (EHBs)

An EHB is a service that every medical policy must cover under the Affordable Care Act (ACA). Currently, there are 10 EHBs;

  • Ambulatory patient services – this refers to outpatient care that you receive without being admitted to a hospital.

  • Emergency services: Also known as paramedic services, emergency medical services are services that require urgent medical response, providing out-of-hospital treatment, and transport to hospital.

  • Hospitalization: Hospitalization is where the patient has to stay in hospital for an extended period, such as during intensive care or surgery.

  • Laboratory services: Laboratory services cover all tests that are performed in a clinical laboratory to aid in the diagnosis and treatment of the patient.

  • Maternity and newborn care: All medical insurance policies cover medical costs before and after a child is born.

  • Mental health and substance use disorder: If a policy holder has a mental or drug problem and goes through counseling and physiotherapy, the policy will cover the costs.

  • Pediatric services: This refers to medical services offered to children of the policy holder, including oral and visual care.

  • Prescription drugs: In most cases, after a session with the doctor, you’ll be told to buy certain drugs. A medical insurance policy covers the costs of prescribed drugs.

  • Preventive and wellness services: These are services such as blood pressure screening and HIV testing that can help detect or prevent illness or other health problems.

  • Rehabilitative and habilitative services and devices: These include services and devices provided for people with injuries, disabilities, and chronic conditions to help them gain or recover mental and physical skills.

Supplementary Services

Supplementary health insurance refers to any services above and beyond the 10 EHBs listed above. For instance, if you feel that the basic package doesn’t cover all your dental health needs, you can purchase “supplementary” dental services. Visit GoMedigap.com/medicare-supplement-plans/ , for example, to learn more about supplementary medical covers.

Now, Go Ahead and Buy a Medical Cover

You need it and your family needs it too. If you still have trouble picking the right policy, don’t hesitate to seek professional assistance.

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