7 Things Many Obamacare Insurance Plans Won’t Cover
Obamacare has been under a microscope for quite some time. As people actually sign up for Obamacare plans, the public continues to watch and wait to see how it turns out for these individuals. Are they benefiting from the new policy? Or does it costs them more money out-of-pocket?
As with any new policy, there are pros and cons to the Affordable Care Act (ACA). Those in lower and moderate income brackets — at 400% of the poverty level or below — may benefit from tax credits or even medicaid (if they earn 133% of poverty or less), but those in higher income brackets may have to pay really large out-of-pocket costs. The increased age limit for children on their parent’s plans to 26, coupled with policies prohibiting insurance companies from denying coverage or over-charging for pre-existing medical conditions, helps a group of individuals who faced challenges with medical insurance coverage in years past. On the other hand, we will now have to pay a small tax penalty if we don’t have insurance coverage, and because some private insurances don’t cover Obamacare’s 10 essential benefits, there has been some complications centering around plans that don’t provide all 10 of these essentials:
- Ambulatory patient services (outpatient care you receive without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Pregnancy, maternity, and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
These essentials may be a requirement, but this does not mean your insurance is going to cover everything. Using a Bankrate publication and other reports from policyholders, we found additional information on coverage requirements. Here are a few things a plan from your state’s Obamacare marketplace may not cover:
Although prescription drug coverage is an essential benefit that marketplace plans must cover, this does not mean that your insurance provider will cover every single prescription medication. For instance, although contraceptives are generally covered by insurance, “health plans sponsored by certain exempt ‘religious employers,’ like churches and other houses of worship, don’t have to cover contraceptive methods and counseling. If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket,” according to Healthcare.gov.
You also may find that your insurance will cover certain (generic) brands, or cheaper medication treatment options, as opposed to a more expensive alternative.
Long-term care options — like assisted living facilities and home health aides — can be incredibly expensive for some patients. Most insurance policies — including Obamacare policies — do not cover these costs. You may have to purchase separate long-term care insurance to pay for these costs. The costs of these plans vary by provider, but based on data from the American Association for Long-Term Care Insurance, plans can range between $1,300 per year and upwards of $5,000 annually.
Acupuncture is an alternative medical procedure that some patients undergo for pain relief or to relieve other symptoms. According to the University of Maryland Medical Center, researchers do not know exactly how the ancient Chinese procedure works, but one theory says the procedure stimulates nerve fibers that send signals to the brain and spinal cord. The brain then produces hormones and chemicals to improve symptoms and relieve pain. “Acupuncture may also increase blood circulation and body temperature, affect white blood cell activity (responsible for our immune function), reduce cholesterol and triglyceride levels, and regulate blood sugar levels,” reports the Medical Center.
In spite of the potential benefits of acupuncture, there’s a good chance your insurance policy won’t cover the procedure. If you decide to get these treatments, you may have to pay $75 to $125 per visit. Other alternative medicines like herbal supplements, homeopathic treatments, and even chiropractic care may not be covered either.
Most insurances don’t cover elective cosmetic surgeries like breast implants and face lifts. Obamacare plans most likely won’t cover these costs either. The only way these procedures have any chance of being covered by your policy is if you have a serious, medical necessity that requires such a procedure.
Americans paid a combined total of around $11 billion in physician and surgery fees for plastic surgery procedures in 2012. Around $3.2 billion of that money was for breast implant surgeries, rhinoplasty surgeries, and botox procedures, according to the American Society of Plastic Surgeons.
The national average cost for a breast lift (mastopexy) is $4,332. Want a buttock lift? It’ll cost you $4,633 of your hard earned cash.
Weight loss surgery
This is perhaps the most surprising inclusion on this list. As one of the more deadly diseases, the obesity epidemic has been gaining more and more attention in recent years. Last year, NBC News published data from the American Journal of Public Health. “Obesity kills far more Americans than we think it does, according to a controversial new study that suggests obesity accounts of about 18% of all deaths in the United States — three times previous estimates,” said the news report.
Each year, thousands of people turn to weight-loss surgery. This cost may have to come out of their pockets, though, as many Obamacare plans don’t cover the procedure. According to Kaiser Health News, “Medicare and some two-thirds of large employers in the U.S. cover bariatric surgery. But the procedure is pricey — an average of $42,000 — and many small employers, including those in Mississippi, don’t cover it.”
According to the CDC, around 7 million women between the ages of 15 and 44 have an impaired ability to get pregnant or carry a baby to term and around 1.5 million women are classified as infertile. Millions of couples seek infertility services in hopes of becoming pregnant and having a baby. Unfortunately, these services may have to be paid out of pocket as many insurance plans don’t cover these costs.
“On average, nationally, a ‘fresh’ IVF cycle costs $12,000, before medications, which typically run another $3,000 to $5,000,” according to a Forbes publication.
Dental and vision coverage
You may be able to find a plan that combines medical, dental, and vision coverage into one plan. But, in many cases, you’ll have to purchase dental and vision coverage separately and pay a separate premiums for each service. Children, however, may have their vision and dental covered under your plan.
“All Qualified Health Plans (QHPs) sold on the Marketplaces include pediatric vision coverage…If your Qualified Health Plan doesn’t include adult vision coverage, you can buy a “stand-alone” vision plan. Stand-alone vision plans aren’t offered through the Marketplace, and tax credits can’t be applied to them,” reports Healthcare.gov. “Dental coverage for children is an essential health benefit. This means if you’re getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. While it must be available to you, you don’t have to buy it.”
Taking the good with the bad
If you visit the Facebook page “Thanks Obamacare,” you’ll find stories of people who were helped by the ACA and statements of support. “…The ACA is beginning to achieve its aims of reducing the number of uninsured Americans and restraining healthcare costs. It’s packing its biggest punch among those who’ve been kept out of the individual market because of its cost,” reads one comment on the Facebook page. The page also has over 2,600 likes, as of late.
The nation is divided on its opinion of the ACA, with slightly more than half of Americans saying they are against it. A July 2014 poll by the Henry J. Kaiser Family Foundation found that 53% of respondents say they have an unfavorable view of the law, and 37% view the law in a more positive light. The remainder of respondents gave no opinion.
Even though some people have an unfavorable view of the law, most people would rather improve it than get rid of it all together. “Despite the increase in the share with an unfavorable view of the ACA, a strong majority of the public continues to prefer that their representative in Congress work on improving the law (60%) rather than working to repeal and replace it with something else (35%), shares that have been consistent over the last several months,” says the Kaiser report. Such findings show the hope people have that Obamacare will improve our health care system.