Do you know which healthcare plan benefits you’re entitled to?
The Affordable Care Act set basic standards regarding the general benefits that health plans must cover. But sadly, many individuals aren’t aware of the benefits included in their health insurance plans, particularly in the light of federal health care reform.
ACA requires all health plans offered in individual and small group markets to cover ten “essential benefits.” They run the gamut from hospitalization and emergency services to prescription drugs and maternity care.
Besides this, some states have even gone past these federally required benefits and require health plans within their borders to cover more services.
So, ultimately, some insurers have voluntarily been covering services that typically weren’t covered in the past. On that note, continue reading about 7 healthcare plan benefits you may not have known about.
Free or discounted health clubs
According to a healthcare software and analytics technology company, one result of the ACA is that insurance companies are vying for market share. The Affordable Care Act led to high enrollment numbers and increased competition among insurance companies.
So now, more than ever, there are many companies trying to stand out. Part of this has created a world of creativity in healthcare plan benefits. Fitness management and tracking are just two increasingly popular healthcare plan benefits, as it turns out.
And some companies offer more than deals or reimbursements for gym memberships. They might even give you money back for healthy behavior or a wearable activity tracker to keep you motivated.
For instance, Oscar, a New York-based health insurance agency, has partnered with the manufacturer Misfit to reimburse insured members back for their physical activity as registered on the tracker.
Additionally, many Blue Cross Blue Shields plan to reimburse their members for joining a weight-loss program or health club.
Smoking cessation programs
Some smoking cessation coverage is now required under the ACA. For more information, the American Lung Association website breaks down what is covered. It varies depending on what type of health insurance you have.
But as a general rule, individuals who have workplace insurance or who purchase a policy individually can expect coverage for 90 days of smoking cessation medications and four sessions of counseling.
No cost-sharing, like co-payments, co-insurance, and deductibles, is associated with this healthcare plan benefit. Smoking cessation treatment falls under the category of “mental health services and addiction treatment.”
This also covers mental health treatments and rehabilitation for other addictions.
Massage therapy or acupuncture
Some insurers are covering alternative treatments that usually branch off from traditional approaches. Some health plans embrace alternative medicine benefits, such as acupuncture, when deemed medically required.
Some plans also cover massage therapy if it’s considered medically necessary. To determine if any of these healthcare plan benefits are covered in your plan, check your summary of benefits and coverage.
It would help if you also looked at the doctors in your network to see who can provide the these type of services so you can take full advantage of everything your health plan has to offer.
Prescription medicine
Individual and small group plans are required to cover prescription medications. Their formularies must include at least one prescription in every US Pharmacopeia category and class, or more depending on the state’s benchmark plan.
Formularies are also created with feedback from pharmacy and therapeutics committees. However, they can vary significantly from one health insurer to another.
Under the preventive care policies, healthcare plan benefits must cover, at no cost to the insured, at least one version of every type of FDA-approved female contraceptive and recommended vaccine. Regarding other prescriptions, the plan’s cost-sharing rules apply.
And plans can mandate step therapy or prior authorization for pricey medications. Step therapy that, the insured is required to begin with the most affordable and least-risky medication to see if it works before trying more expensive and riskier pills.
Most health insurers position covered drugs into four or five tiers. Tier one medications have the lowest out-of-pocket costs, and Tier four or five have the highest.
Hair prosthesis
Can wigs be considered prosthetic devices and included as essential healthcare plan benefits? According to a Washington, D.C.-based attorney, the answer is a bit unclear. Apparently, wigs fall into a “gray area” when it comes to this category.
Whether they’re important healthcare benefits is determined state-by-state. There’s no clear guidance as far as the federal level goes.
Even though they’re not explicitly excluded at the federal level, they’re only included as an essential benefit if a state benchmark decides that they fall into one of the ten critical benefit categories.
One thing is straightforward, though. Health insurance companies that will cover the cost of a wig need a prescription from a physician, according to Breastcancer.org.
Chiropractic services
Chiropractic services happen to fall into another gray area where there aren’t any precise federal guidelines regarding this healthcare plan benefit. Some states might treat chiropractic issues as rehabilitative services. But each state can limit how many visits will be covered.
Experts recommend checking the Centers for Medicare and Medicaid Services website, which provides standard details for all states. For instance, the list shows that Alabama covers $600 of chiropractic costs yearly, while Pennsylvania covers 20 chiropractic visits per year.
Psychiatric therapy
Back in 2008, the Addiction Equity Act began to demand coverage of mental and behavioral health services and substance-use disorders to be equivalent to coverage of surgical and medical services, according to the American Psychological Association.
For instance, the APA has stated that an insurance company can’t charge a co-pay of $40 for a psychologist visit if it normally charges a $20 co-pay for other medical visits.
The law applies to health exchanges, employer-sponsored health programs with 50 or more employees, the Children’s Health Insurance Program, and most Medicaid programs.
A recent survey discovered that over 90% of Americans weren’t familiar with this healthcare plan benefit.
Were you aware of all these healthcare plan benefits? Please feel free to share your thoughts and experiences with us in the comments section below.
And if you found this article helpful, we highly recommend you also read: Seniors Beware: 9 Important Preventive Care Tests You MUST Get After 50
