What are the Essential Health Benefits of Health Insurance?
by Arina Smith Insurance 25 January 2021
If you are shopping for health insurance, you want to find a plan that has coverage relevant to you and your family. You also want coverage that is affordable and easy to manage. But how do you know which benefits you really need, and which ones are just “there?”
There are some essential health benefits that most health insurance plans offer, which should cover most of your most important healthcare needs.
The Essential Health Benefits of Health Insurance:
Prescription Drug Coverage:
The federal government has a categorized list of prescription drugs. Many common drugs are covered by health insurance plans, which can save patients a lot of money.
A trip to the emergency room or urgent care can be expensive out-of-pocket. If your health insurance has coverage for emergency services, you can save a lot of money. Your plan may also have a provision stating that if you are taken to the nearest hospital and it is out of network, you won’t be penalized.
Your health insurance likely has a certain amount of coverage for hospitalization. There may be a limit on how much is covered, however, so check your policy for details.
If your child qualifies for coverage on your health insurance (as opposed to a state plan), you have the benefit of routine well-child care, emergency visits, dental care, vision care, and even corrective lenses.
If you are healthy now and want to stay that way, preventative care services are an excellent benefit. Preventative care coverage includes diet and nutrition counseling, immunizations, and screenings for conditions like Type 2 diabetes.
Maternity and Newborn Care:
If you are planning to get pregnant or are pregnant, your health insurance may have some basic coverage for maternity and newborn care. This may include prenatal visits, lab services, labor and delivery, and hospitalization coverage.
Laboratory services include any type of testing to diagnose or screen, such as blood work or urine samples.
Mental Health Services:
Mental health is as important as physical health. Many health insurance plans offer coverage for certain mental health services, such as counseling or behavioral therapy.
If you are injured or have a disability or chronic condition, you may need ongoing rehabilitative services. Your health insurance plan may include coverage for a certain amount of rehabilitation or a certain number of visits. Many plans include coverage for a certain number of visits to a physical or occupational therapist.
These are the essential benefits offered under most health insurance plans. This list is not exhaustive, and may not represent all health insurance plans. Check your policy for more information about exactly what is covered.
Will Essential Benefits Meet My Health Insurance Needs?
Of course, there are always unforeseen events or situations that may cause you to question your coverage. For example, certain medications that are covered under your insurance may only be covered in specific doses or brands. This could be the difference between paying $10 for a 30-day supply or $300 for a 30-day supply. In such cases, your doctor may be able to switch your prescription to a dose or brand that is covered.
Essential benefits are designed to make sure you have access to basic healthcare services. If you have specific questions or medical conditions that need to be addressed, you may find it helpful to speak with an insurance agent before you purchase coverage.