What Health Insurance Won’t Pay For

No matter your age, you need to have some kind of health insurance. This is just as true for retirees as it is for people in their twenties. As an owner of health insurance yourself, you need to have a thorough knowledge of what it does and what it does not cover. While coverage varies significantly from plan to plan, we will use Medicare as our guide to determine what health insurance policies do not typically pay for.

You need to know what health insurance does—and what it doesn't—pay for.

You need to know what health insurance does—and what it doesn’t—pay for.

Dental Care

To some, it might be surprising that health insurance doesn’t typically pay for dental care. After all, some might argue that your dental health is a significant component of your overall health. Severe tooth pain can be extraordinarily debilitating.

Generally speaking, you will need a separate dental insurance plan to cover your dental care needs. But there are some exceptions. Your health insurance plan might be able to cover the following dental work:

  • Treatment as a result of traumatic injuries
  • Necessary removal of teeth
  • Diagnostic x-rays
  • Dental treatment for medical conditions (such as infections or night guards)

Off-label Prescription Drugs

Many people assume that health insurance will pay for prescriptions. Still, you should use some extra common when it comes to off-label prescription drugs. In case you’re not sure what you’re referring to, an off-label prescription drug has not been approved by the FDA. Still, your physician may legally recommend that you use them.

Off-label drugs aren’t necessarily a bad thing. Still, you should know when you have been prescribed one and educate yourself about it, keeping in mind that your health insurance will most likely not pay for this form of prescription.

Cosmetic Procedures

In our example about dental care, we mentioned that health insurance might pay for ‘necessary’ tooth removal. To clarify, health insurance would not cover these costs if the tooth removal was done for cosmetic procedures.

Generally speaking, your benefit will not pay for any procedure performed for cosmetic or aesthetic reasons. Here is a non-exhaustive list:

  • Rhinoplasty
  • Liposuction
  • Tummy tuck
  • Hair transplant

Still, as with almost any rule, there are exceptions. There are instances in which these ‘cosmetic’ procedures could in fact be medically necessary, or an appropriate response to a certain medical condition.

Partner with Malden Solutions Today

Malden Solutions has a wealth of expertise in providing employer insurance solutions, HR solutions, and individual insurance solutions to businesses both big and small. Our team of seasoned professionals can help you navigate the rapidly-changing world of insurance with ease. We partner with businesses and individuals throughout the country to provide our dedicated services for employee benefits but also work within our surrounding communities in Maryland, Northern Virginia, and Washington, D.C. Contact us today to learn more about how we can provide effective, dynamic solutions for your business.  Stay connected with us on TwitterFacebook, and Linkedin.


This entry was posted on Friday, January 29th, 2021 at 3:18 pm. Both comments and pings are currently closed.