Here are 10 common health insurance benefits offered by many plans, though specific coverage varies depending on the insurer and policy:
- Preventive Services: Most health insurance plans include coverage for preventive services. This encompasses routine checkups, health screenings, vaccinations, and wellness visits aimed at preventing illness or catching health issues early. Often, these services are offered without any out-of-pocket costs, meaning no copayment or deductible is required for the patient.
- Hospitalization: Health insurance typically covers the cost of being admitted to the hospital for a wide range of treatments, surgeries, and recovery. This includes both planned hospital stays, such as for surgeries, and emergency admissions. Coverage generally includes room and board, medications, surgeries, and any necessary inpatient care.
- Prescription Drugs: Insurance plans offer varying levels of coverage for medications prescribed by healthcare providers. The amount covered often depends on the type of drug (e.g., generic, brand-name, specialty) and whether it is included in the plan’s formulary. Many plans use a tier system where generic drugs are often the least expensive for the patient, while specialty or brand-name drugs may require higher copayments or coinsurance.
- Emergency Services: Coverage for emergency room visits and urgent care is a standard feature of most health plans. This includes ambulance services, whether ground or air transport, and care needed to stabilize an acute medical condition, such as severe injuries, heart attacks, or strokes. Typically, emergency services are covered regardless of whether the provider is in-network or out-of-network, although the level of coverage might vary.
- Maternity and Newborn Care: Most plans provide coverage for pregnancy-related services, from prenatal checkups to labor and delivery, as well as postnatal care for the mother and baby. This may include regular visits to an OB-GYN during pregnancy, screenings, childbirth, and the hospital stay. Additionally, newborn care immediately after birth is covered, which could include tests, vaccinations, and any necessary treatments.
- Mental Health and Substance Use Disorder Services: Many health plans now include mental health care as a core benefit. This can encompass outpatient therapy sessions, counseling, inpatient treatment for mental health conditions, and coverage for treatments related to substance abuse. This benefit is critical in supporting individuals with depression, anxiety, addiction, and other mental health challenges.
- Pediatric Services: Plans often include healthcare specifically tailored for children, such as pediatrician visits, vaccinations, and regular checkups. Many plans also offer dental and vision care for children as part of the package, which can include routine eye exams, glasses, dental cleanings, and preventive dental care like sealants and fluoride treatments.
- Rehabilitation Services: For those recovering from an injury, surgery, or illness, health insurance may cover rehabilitation services such as physical therapy, occupational therapy, and speech therapy. These services help patients regain their physical and cognitive functions and support recovery from conditions like strokes, major surgeries, or accidents.
- Lab Tests: Coverage for laboratory services, including diagnostic tests like blood work, urine tests, and imaging (such as X-rays, MRIs, and CT scans), is a standard part of many insurance policies. These tests help diagnose, monitor, and manage a variety of health conditions and play a key role in preventive care.
- Chronic Disease Management: For those with long-term health conditions like diabetes, asthma, or heart disease, insurance plans often offer programs to help manage these conditions. This may include regular checkups, medications, health coaching, devices like insulin pumps or glucose monitors, and educational resources to support better disease management and improved quality of life.
These benefits are generally part of most comprehensive health insurance plans, particularly those that comply with the Affordable Care Act (ACA) in the U.S. Each plan may vary in how much it covers for specific services, but the general categories remain consistent across many insurers.