The Top 10 Medical Services Plans That Don’t Cover

TopTenA report by HealthPocket finds significant consistency in the health care services that individual and family health insurance carriers don’t cover. The following are the top 10:
1. 98% don’t cover long-term care.
2. 98% don’t cover cosmetic surgery.
3. 94% don’t cover infertility treatment.
4. 93% don’t cover weight loss programs.
5. 92% don’t cover private nursing.
6. 92% don’t cover acupuncture.
7. 92% don’t cover children’s dental check-ups.
8. 90% don’t cover weight loss surgery.
9. 87% don’t cover children’s eyeglasses.
10. 81% don’t cover adult dental services.

The Essential Health Benefits under the Affordable Care Act (ACA or Obamacare) will improve access to children’s dental check-up and children’s eyeglasses.

Weight management programs and weight loss surgery are routinely not covered in the health insurance market even though one third of U.S. adults are obese. ACA requirements will ensure coverage of weight loss diagnosis and counseling, but insurers may continue to refuse payment for surgical interventions and enrollment in third party programs, such as Weight Watchers.The exclusion of insurance coverage for infertility treatments can make the procedures inaccessible for many Americans. The average cost of a treatment cycle is $12,400, and multiple cycles are often needed for success.

Since most of the medical service exclusions within the Top 10 list can continue after the implementation of health reform, it is vital that consumers  examine their benefit coverage options closely when they shop for health insurance this October, says Kev Coleman, head of Research and Data at HealthPocket. In addition, coverage for hospital deliveries (67%) as well as prenatal and postnatal care (64%) are frequently excluded services. These medical procedures, which are included in the Essential Health Benefits, will get greater coverage because of the ACA.

Last Updated 12/01/2021

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