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What the Majority of Health Insurance Plans Cover

Updated on November 19, 2014

Health Insurance is a Necessity

Having health insurance is extremely important in today's society, because you never know what tomorrow will bring. One day you're sitting at home, the next you're in the hospital with something serious. Whether you're there because of an injury, sickness, or disease, health insurance is critically important to have. And beyond that, having a plan that covers a wide range of potential health circumstances is a necessity.

Many health insurance plans cover the following:

  • Annual physical examinations.
  • Pap smears, colonoscopies, PSA tests, mammograms, and other screenings that look for cancer.
  • Tests for anemia and other blood-related problems, such as complete blood count (CBC).
  • Blood glucose tests that check for diabetes or pre-diabetes.
  • Blood cholesterol and blood pressure monitoring.
  • If necessary, x-rays and electrocardiograms (ECG or EKG).
  • Recommended immunizations.

While these procedures are just a sampling of those most commonly covered by the majority of health insurance providers these days, each health insurance policy is unique and coverage of specific treatments, prescriptions, and doctor's visits may vary from one policy to the next.

Essential Health Benefits

If you purchase a health care plan through a health insurance marketplace, the insurance will have coverage over preventive services as well as approximately 10 of the essential health benefits required by the Affordable Care Act (ACA). The majority of private health insurance plans offered through federally-facilitated marketplaces offer essential health benefits, such as:

  • Ambulatory patient services, which is the outpatient care you receive without admittance to any hospital.
  • Emergency services.
  • Hospitalization for services such as a minor or major surgery.
  • Newborn care and maternity services both before and after the baby is born.
  • Substance use and mental health disorder services, such as behavioral health treatment, which includes psychotherapy and counseling.
  • Prescription drugs and medications.
  • Habilitative and rehabilitative services, as well as devices and services that help those who have injuries, chronic conditions, or disabilities recover or gain physical and mental skills.
  • Laboratory and pediatric services.
  • Wellness and preventive services, as well as chronic disease management.

For example, surgeries are usually paid for by health insurance policies; however, if you need a surgery performed, you’ll usually be required to obtain pre-authorization from your health insurance company. Doing so ensures that there will be no surprises when the bill comes. This request for pre-authorization is usually sent by your doctor once he or she sees that the surgery in question is necessary. The process to receive an answer normally takes between 24 hours and up to as many as 30 days. If the answer from your health insurance provider is “yes”, you’ll be able to see the breakdown of the anticipated costs.

What Health Insurance Covers

Remove Risk

Health insurance takes a lot of the risk out of emergencies, but you can still take a gamble with your policy, which is why it's extremely important to know what you're coverage entails before you run to the hospital to get checked out, especially if it's only something that could be considered minor or manageable at home.


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