One of the most frequent questions the expert CareCoverage team receive from members is, “Is this covered?” Whether they’re seeing a new doctor, changing medications, or exploring a new treatment, it’s a good question to ask beforehand to avoid surprises.
What Does Health Insurance Cover?
When a service is covered by your health plan, it means that the plan will pay for some or all of the cost. Covered services typically include regular doctor visits, tests, urgent and emergency care, hospital stays, prescription drugs, medical equipment, and more. Usually, your doctor also needs to be within your insurance network, which is the list of doctors that accept your insurance.
How much your plan pays depends on the type of care and where you get it. For instance:
Some services, like preventive visits, are completely free to you, as your plan covers the entire cost.
For other services, such as a visit for a sinus infection or filling a prescription, you’ll pay a fee. The amount varies based on your plan and whether you’ve met your deductible.
To maximize your benefits, use services covered by your plan and see providers within your network.
How to Check If Your Health Insurance Covers Something
Every plan, even those from the same insurance company, covers different doctors, clinics, prescriptions, and services. It’s important to check that the care you need is covered before making an appointment. Here’s how you can find out:
Summary of Benefits and Coverage (SBC): This document lists the services your plan covers and the costs. You can request a copy from your insurance company or, if you’re a HealthPartners member, sign in to review your coverage online.
Cost Estimation Tools: Some plans offer tools to help estimate out-of-pocket costs for specific services at certain locations. These tools can provide insights into both coverage and potential expenses. HealthPartners members can access cost estimate tools online.
Doctor Search Tool: Use your plan’s network search tool to check if a doctor or clinic is covered. This is especially useful to ensure that the healthcare provider you wish to see is within your network. HealthPartners members can sign in to search their network for covered providers and locations.
Formulary (Drug List): If your plan includes prescription drug coverage, it will have a list of covered medications. Review this list to ensure your prescriptions are included and to check if any special approvals are needed. Some plans also offer tools to compare prescription costs. HealthPartners members can compare prescription costs online.
Member Services Team: Don’t hesitate to contact your insurance company if you have questions about coverage. Member Services representatives can provide detailed information on whether a doctor, prescription, or service is covered and what your insurance will pay. HealthPartners members can find contact options online or call the number on their member ID card.
Understanding your health insurance coverage can save you time, money, and stress. Always check what’s covered before receiving services, and utilize the resources provided by your insurance company to get the most out of your plan!
We’re happy you found this article informative! Go back to our blog page to find more tips, tricks and guidance on getting the right health insurance for you!
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