Health Insurance Coverage

Health Insurance Coverage

What Does Health Insurance Cover?

Health insurance is something that just about every person should have, and the Affordable Care Act has made it so that just about everyone can get health insurance, whether it is offered at their job or not. There are many different health insurance plans that cover different things based on factors such as how much you are willing to pay for them. However, all health insurance policies do have to cover some basic services.

Doctor Visits

All health insurance policies must cover a routine doctors visit. In fact, the Affordable Care Act requires that certain doctors visits are covered 100 percent without costing you anything. This includes physicals and certain services, such as pap smears for women and vaccines for children. For other doctor visits, “coverage” does not necessarily mean your insurer will pay the costs. Most health insurance policies have deductibles and/or co-pays that require you to cover all or some of the cost of your care until you spend a certain amount in a calendar year. That means that if you go to the doctor because of an illness or injury, you could wind up paying for most or all of the costs.

Hospital Stays

Health insurance policies must cover hospital stays, at least those that are mandatory. However, the amount of coverage you get could vary greatly by policy. For example, many policies have a daily limit of how much they will pay for a hospital room, and you are responsible for any amount that exceeds that limit. There also may be limits on what type of room the policy will pay for. For example, a policy may only pay for a shared room and not a private one, which is more expensive. Hospital coverage is often one of the most complicated parts of a health insurance policy, so if you know you are going to have to be admitted to a hospital, it’s a good idea to work with your insurer to know what will and won’t be covered.


Another common thing that all health insurance policies cover is prescription drugs. However, as with hospital and doctor coverage, every policy has different rules for what it will and won’t cover when it comes to medications. For example, many insurers require you to use a generic drug if one is available and may penalize you for using a more-expensive brand name one. Some policies also require you to apply prescription costs to your deductible, meaning you pay the full cost out of pocket until you reach your deductible level. That is common with so-called high-deductible plans. Most policies also exclude coverage for certain drugs if they are considered experimental or if they are being prescribed for a condition for which they are not government approved. Most health insurance policies do not cover the cost of non-prescription drugs, even if a doctor prescribes them.

This is by no means a full list of the things most health insurance policies do and do not cover. It’s important that you read your policy and work closely with your insurer any time there are questions about whether something is covered or not.