Read the fine print when choosing health insurance to ensure it covers 4 'very common' costs: Doctor

"A lot of health is unpredictable ... but there are certain things you can plan for, like pregnancy."


The average cost of an employee-sponsored health insurance plan for a family of four was more than $22,000 in 2021, according to an annual survey of employers conducted by the nonprofit Kaiser Family Foundation.

Employees paid nearly $6,000 of that total, with employers covering the remaining cost. Since 2011, average family premiums have increased 47%, more than wages (31%) or inflation (19%), the survey found. 

With health insurance premium costs rising, you want to make sure the plan you pick during open enrollment covers your medical needs. You may be surprised to learn many common health-care costs aren't covered by some plans. "You have to look at the fine print," says Dr. Davis Liu, chief clinical officer at Lemonaid Health and the author of "The Thrifty Patient."

Here are four "very common" medical needs some insurance plans don't cover, according to Liu.

1. Maternity care

"A lot of health is unpredictable, especially for younger people, but there are certain things you can plan for, like pregnancy," says Liu. If you're planning on having a baby in 2022, there are specific benefits you'll want to look out for. 

The average out-of-pocket spending for insured families for the delivery and newborn hospitalizations was $3,068 from 2016 to 2019, according to a study by the University of Michigan. Emergency C-section births can increase a hospital bill by thousands of dollars. 

"You want to make sure you have maternity coverage when you have a crash C-section that costs $20,000," he says. Make sure to find out what your insurance company will cover before signing up. You can find out by calling the insurance carrier or by asking your employer's benefits department.

If you're planning on having your baby delivered by a certain OB-GYN at a specific hospital, make sure both the doctor and the hospital are in-network with your new plan, Liu says.

2. Prescription drugs

While the majority of Americans have health insurance that includes prescription drug coverage, more than one-third of adults say that in 2020, they or a household member were told their health insurance plan would not cover a drug prescribed by their doctor, according to a survey of nearly 1,900 adults conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health.

"If you're on medication for diabetes, that may be one you want to make sure, like, 'Hey, does my plan cover prescription drugs?' Shockingly, some don't," Liu says. 

Many insurance companies don't cover what are known as "lifestyle" medications, such as acne medications, sexual health medications, or weight loss drugs. Asking your potential health insurance provider if they cover medications you're already on is a smart move, says Liu, especially if you have a preexisting condition. 

3. Contact lenses  

Many health insurance companies don't cover vision. Separate vision insurance may be offered through an employer or a private insurance company. 

If you wear contact lenses, Liu suggests making sure your new insurance carrier covers contacts, as many do not. 

You want to make sure you have maternity coverage when you have a crash C-section that costs $20,000.
Dr. Davis Liu
Chief clinical officer, Lemonaid Health

4. Telehealth 

"Covid has really changed whether or not people want telemedicine access," says Liu. Especially because "televisits allow you to not take time off of work, but it can save you time and money." 

If you value telehealth services, find out whether or not your potential insurance plan covers the benefit before signing up, he says.

While you're comparing potential health-care plans, there's a free resource you can use to make sure the plan you're getting is well rated. To get a report card on potential health-care plans, Liu recommends the National Committee for Quality Assurance website NCQA.org. The site is updated monthly and, according to the organization's website, offers a "detailed assessment of insurers' structure, process, performance and consumer satisfaction."

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