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Medical Insurance: Inclusions and Exclusions

Do you know what your medical insurance

You know that you need a medical insurance policy, but do you know what your policy covers? Do you know what events and illnesses aren’t covered by your Boston health insurance?

While all policies have slightly different coverage based on the premium amount, the insurance provider, and other factors, the basics of a health insurance policy are typically the same.

What does a typical health insurance policy include?

As you would probably expect, health insurance covers most of your doctor’s visits. The most important of these is your annual physical with your general physician. In addition, your insurance should cover additional visits to other specialty doctors, including a dermatologist, podiatrist, optometrist, and more. The obvious exclusion to this list is your annual (or bi-annual) visit to the dentist, which would be covered by a separate dental insurance policy or dental insurance rider.

A health insurance policy will also typically include coverage for vaccinations. This includes those that you get at the doctor’s office and those given at a drugstore, like the flu shot. Your medications and prescription drugs will also typically be at least partially covered through your insurance policy.

The final coverage included in most Massachusetts health insurance policies is for emergencies. Trips to the emergency room are at least partially covered under nearly all health insurance policies, so rest assured: if you have a medical emergency, you don’t have to worry about your money in addition to your health.

What won’t my medical insurance cover?

Unfortunately, having a health insurance policy doesn’t guarantee you coverage for all health-related expenses. Here are a few examples of things that most policies don’t cover:

Deluxe Hospital Services: Your insurance will probably cover at least some of your surgery, but don’t expect it to cover hospital dry cleaning, or on demand tv while in your recovery room.

Court Ordered Tests: If you are ordered by a court to have a test done (for example, a genetic test) the fee for this test will come out of your own pocket.

Elective Cosmetic Surgery: If you want to get some Botox, a facelift, or a rhinoplasty, your insurance isn’t going to pay for it out of the goodness of their hearts.

Experimental Tests or Procedures: If you want to take part in an experimental treatment for a condition, you’re going to have to do it at your own risk, and on your own dollar.

Artificial Conception: If you’re having trouble conceiving, it’s not really a health risk. Your insurance company won’t pay for any fertility treatments, or artificial conception.

If you would like to know exactly what your Boston medical insurance policy does (or doesn’t) cover, all you have to do is call Vargas and Vargas Insurance Agency at 617-298-0655. An agency representative would be happy to review your policy and tell you what your policy will pay for, and what you should expect to have to pay for out of your own pocket. If you are unhappy with your current coverage, we can also get you a free quote on a better, more comprehensive health insurance policy.

Photo credit: Dr.Farouk / Foter / CC BY

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