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Top 7 Services Excluded From Health Insurance Plans

Cropped SingleCare logo By | September 14, 2015

The Affordable Care Act has taken steps to expand healthcare coverage, but there are still some important services excluded from plans on the public exchange.

While purchasing health insurance is a great precaution to take, it can be difficult to find an affordable plan that doesn’t have crucial gaps in coverage. HealthPocket analyzed data from 3,094 top bronze, silver, gold, and platinum insurance plans, and found that many of them are still missing some potentially critical services.

And if you need any them, it’s important to know that before you select a plan.

With all that in mind, here are the most commonly excluded services according to HealthPocket’s analysis:

1. Long-Term Care

Long-term care agencies help individuals suffering from chronic conditions, trauma, or illness handle day-to-day activities. Although the CDC reports that over eight million people rely on long-term care organizations, 99% of all insurance plans fail to cover the services offered by nursing facilities, hospices, home healthcare agencies, and adult daytime assistants.

2. Cosmetic Surgery

We all want to look and feel our best, but cosmetic surgery isn’t just about looking younger — it’s also used to recover from debilitating injuries and physical trauma. According to the American Society of Plastic Surgeons, 15.6 million cosmetic procedures and 5.8 million reconstructive operations were performed in 2014 alone. And yet, your average plan is highly unlikely to cover the cost of these procedures.

3. Adult Dental Services

Brushing and flossing are crucial, but not all elements of dental health are in your control. Although the Affordable Care Act expanded coverage of pediatric dental care, dental work remains a coverage gap for some adults.

That’s a problem, especially when you consider that the rate of dental-related emergency room visits among adults has increased in recent years, according to the American Dental Association.

4. Weight Loss Programs

Losing weight doesn’t just take willpower — it often takes financial resources. The U.S. News & World Report estimates that average monthly gym fees add up to around $55. Meanwhile, nutrition programs like Nutrisystem can cost about $300 per month, and cheaper options like Weight Watchers cost between $20 and $50.

Even if weight loss is critical to your health, your insurance plan likely won’t help you shed those pounds.

5. Routine Foot Care

Our feet carry us everywhere — it’s only natural they’ll face some wear and tear. While it’s easy to neglect them, without proper treatment, problems like bunions, ingrown toenails, muscle inflammation, and bone injuries can grow more and more painful. Eventually, they could even become debilitating and pose a serious risk to your long-term health.

6. Infertility Treatment

The CDC reports that 12% of American women of childbearing age experience difficulty getting pregnant or carrying a baby to term. While infertility is often associated with women, around 7.5% of sexually active men under the age of 45 have also sought help with fertility.

A variety of treatments exist for both sexes, including hormonal treatment, surgical options, intrauterine insemination, and in vitro fertilization — but 67% of health plans won’t cover them.

7. Adult Eye Exam

We all know that as we get older, our eyes get worse, and the American Academy of Ophthalmology reports that, of Americans age 40 and older, more than 24.4 million have cataracts, and more than 2.7 million have glaucoma.

Millions more suffer from other ophthalmological disorders, including age-related macular degeneration, dry eye, and diabetic retinopathy. Eye exams are crucial to catching and treating eye problems as early as possible, but often fall outside of coverage.

SingleCare Stands by Your Side

Luckily, SingleCare facilitates easy and affordable healthcare without the chaos and constrictions of complicated insurance policies. Members can browse different doctors and specialists online to find the best prices, saving up to 50% on otherwise uncovered services.

And if you do have insurance, but need to see the dentist or get an eye exam? Check out SingleCare to see if we can help you fill the gaps in your insurance plan.

Regardless of your current situation, the platform provides you the option to get the care you need at prices you can afford.

(Main image credit: 401(K) 2012/flickr)