What does health insurance generally cover?

Health insurance generally covers the cost of doctors or emergency room visits, medicines, routine vaccinations and tests, surgeries, and psychological care. Depending on the type of insurance coverage you have, you may need to pay a portion of the expenses in addition to the premium you pay for general coverage. Some policies have more extensive coverage, which includes dental and vision care. A group policy will offer different benefits than an individual plan might, and whether you have a managed care plan, an indemnity plan, or a consumer directed plan, your coverage will vary. Each policy type and each policy will differ so be certain that you understand your policy before seeking treatment.

Dr. Michael Roizen, MD
Internal Medicine
Depending on the type of plan you have, health insurance may cover the following:
  • annual physical examinations
  • cancer screenings such as pap smears, mammography, colonoscopy, and PSA tests
  • routine blood work such as complete blood count (CBC) to check for anemia and other problems
  • blood glucose tests to check for prediabetes or diabetes
  • blood pressure and blood cholesterol monitoring
  • electrocardiogram (ECG, EKG) and X-rays, if needed
  • recommended immunizations
Along with the preventive care and screenings, health insurance also helps (helps is a key word here -- most policies which used to cover everything now only cover a part of everything) to cover the costs of doctors’ visits, prescriptions, and other treatments you or your family need. We want to emphasize the phrase “help to cover the costs” because if you ask anyone anywhere in the nation, chances are they’ll be about as unhappy about health insurance costs as the city of Cleveland was when Lebron James left. Don’t let that deter you, though. Uninsured people are 50% more likely to be hospitalized for an avoidable problem than those who have health insurance, and are more likely to become ill. Ben Franklin really was right when he said, “An ounce of prevention is worth a pound of cure.”

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.