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11/1/2016 by 
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3 Considerations to Keep in Mind Apart from Essential Benefits  

The Affordable Care Act legally requires every single health insurance plan to cover ten key essentials. These include benefits like emergency care, ambulatory care, maternity services and prescriptions. On the surface of it, it might look like these essentials cover pretty much everything that you need. You might want to think again, however. There still are quite a few aspects that could influence your coverage. Factors like your state, plan and your provider can make a world of difference regarding coverage. So it’s important to take some special considerations outside of special benefits into account.

Prescription Drugs

As the introduction mentioned, prescription drugs are one of the benefits that the Affordable Care Act is required to cover. However, you need to remember that the price of these drugs will still vary according to the plan that you’re on. Not every drug will be covered by your plan, incidentally, so if there’s a particular drug you want to take, you need to check to see if it’s on your plan’s list. Every plan has a list of drugs that it prefers insured people to take advantage of, and other drugs might not be covered by it. Now your health care provider could make a recommendation for the drug to be requested, but it’s a complicated procedure and may not come through anyway. It’s therefore better to opt for a plan that already covers the drugs you absolutely need to have.

Additionally, if the drug you’re taking is expensive, you might be better off using a plan that requires copay instead of coinsurance.

Is your health care provider on your network?

If you switch plans, there is always the chance that your existing health care provider won’t be on the new network. Additionally, remember that not every doctor in a hospital will be on identical networks. The smaller the pool of health care providers on a network, the more insurers can reduce their own costs. You don’t really want to be on a plan that limits the number of physicians and doctors you can go to. For one thing, it’ll force you to step out of the network far more frequently and thus greatly increase your own personal expenses. Therefore, do make sure that your personally preferred health care providers belong on the new network before you switch over to a new plan.

What mental health services are covered?

Just like prescription drugs, mental health care coverage is mandatory for all insurance plans. However, specific mental health services can vary tremendously according to the state you live in. It’ll take some effort, but do read the fine print on what benefits your particular plan will offer. Plus, in keeping with the last point, figure out if your psychiatrist of choice is on the network of the plan. Unfortunately, it’s all too frequent an occurrence for therapists and mental health care providers to abstain from joining networks due to the high cost involved.

 

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