What am I Covered for with Private Health Insurance?

For those who don’t qualify for public health care, private health insurance helps to cover medical expenses which can be prohibitive. Since the implementation of the Affordable Care Act it is compulsory for the majority of people to purchase health insurance if they don’t qualify for public health care. Failure to do so results in a fine.

But what is actually covered by private health insurance? With the instigation of the Affordable Care Act came the Health Insurance Marketplace which provides another way for you to buy health insurance. All policies purchased in the marketplace cover preventative services and at least 10 essential health benefits. From 2015 all policies will be required to meet this minimum standard whether they are sold in the marketplace or privately.

What essential health benefits are covered?

Currently all policies that were purchased in the 2014 open enrollment which ended on 31 March 2014 offer 10 specific essential health benefits.

• Ambulatory services
This is to cover costs for people who aren’t admitted to hospital but need hospital care on an outpatient basis.
• Emergency assistance
Cover for health care when an emergency takes place.
• Hospital care
This is to cover for inpatient care such as when surgery is required.
• Care during pregnancy and birth
For pregnant women and also covers care of the newborn.
• Provision for mental health and substance abuse issues
For individuals who experience mental health problems or difficulties with addiction to, or abuse of, substances.
• Provision of drugs
This is to cover the prescribing of drugs for medical conditions.
• Recovery services
Provides for the cost of rehabilitation to allow an individual to regain mental and physical skills.
• Laboratory work
Coverage for the cost of laboratory work required as the result of a medical issue.
• Prevention and chronic illness management
Coverage for assistance with preservation and management of health.
• Pediatrics
This is to provide cover for child healthcare.

Will all private health insurance eventually cover all of this?

Insurances provided in state marketplaces are also all required to provide 10 essential health benefits; this will also apply to every policy purchased in or outside of the marketplace from 2015. The actual benefits provided will not necessarily be the same as those listed as provided by policies purchased in the federally backed marketplace. You will need to check the benefits provided by each policy.

What are preventative services and what is covered?

Preventative services are there to try and stem the flow of ill health. The idea is to recognize the chance of illness and to prevent it from developing. As a result of the Affordable Care Act any health insurance purchased in the marketplace is required to cover the cost of preventative care. The type of care that you’ll need depends on your own circumstances, for instance colorectal cancer screening is applicable if you’re over the age of 50. There is a full list of those preventative services that are covered. From 2015 this will apply to all private health insurance, not just policies purchased in the marketplace.

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