6 Surprising Things Health Insurance Don’t Cover

By  //  January 7, 2022

Health insurance is necessary for most people these days as healthcare costs continue to rise. In the US, for instance, health care costs have been rising faster than inflation and at a time when incomes haven’t been keeping pace.

That said, with all those increases in cost for coverage for things that aren’t included in your health insurance policy, what exactly is covered and what is not by your health insurance provider?

The following is a list of things that many people don’t know won’t be covered by their health insurance:

Cosmetic Surgery/Procedures

If you want to have double-eyelid surgery (blepharoplasty), a tummy tuck, breast implants, injectable fillers such as Botox and Restylane, or laser hair removal, know that your health insurance won’t cover these costs.

These are considered elective or cosmetic procedures that don’t necessarily fall under the realm of “necessary” surgeries.

For example, while some health insurance providers may cover breast reduction surgery because it is deemed medically necessary (as in the case of overly large breasts causing extreme back pain), they typically will not cover breast augmentation unless there is a medical condition (such as breast asymmetry) that needs to be fixed.

Critical Illnesses and Infectious Diseases

Health insurance typically does not cover genetic diseases, AIDS/HIV, and sexually transmitted infections. For example, if you have the gene for breast cancer but have never had it or any other sign of disease, your insurance will not cover any costs related to testing for that gene or annual mammograms.

If you have a traumatic episode such as an accident, most health insurance policies will not cover it. It would be best if you get separate insurance for trauma. With few exceptions, most health insurance policies will not cover accidents or injuries sustained in an accident.

For example, if you go skiing and fall and break your leg, that accident is typically not covered by your health insurance plan.

Fertility Treatments

Many women trying to get pregnant have a common question: whether their health insurance will cover fertility treatments. Unfortunately, this isn’t one of the health insurance benefits you will enjoy.

Your health insurance won’t cover costs for in-vitro fertilization, home insemination, fertility drugs, and other procedures related to infertility. Talk with a fertility specialist to learn about your options for a treatment that fits your budget.

Pre-existing Conditions

Suppose you have a pre-existing condition such as asthma or Type II diabetes. In that case, it might not be covered even if you are insuring yourself for the first time with a group plan through your employer, which may have low, affordable premiums.

If you are already enrolled in your company’s group plan, depending on the policy, you might be able to keep that coverage.

If you switch jobs or decide to go without health insurance for any reason (for example, if you’re a young adult who isn’t making a lot of money and therefore can’t afford it), know that many pre-existing conditions cannot be covered even if you later decide to obtain health insurance.

Just for Women

Some procedures and services that are considered elective or non-essential are permitted when it comes to women only. These would include peri-menopausal hormone therapy, mammograms, and routine gynecological exams. Such treatments can also be cost-prohibitive for many women.

Health Insurance for Minors/Children

Typically, some things that aren’t included in your health insurance coverage are ones that you would think would be standard (such as maternity care).

One thing most people don’t know is that pre-existing conditions will not be covered with no exceptions if you have a child with special needs or if you plan to adopt because the health insurance companies consider these conditions to be “pre-existing” and, therefore, will not provide coverage for them.

While some of the things that health insurance won’t cover are shocking, these benefits aren’t always a reason to worry. Unpredictable things your health insurance may not cover might include injuries from sports activities, illnesses from being in a car accident while uninsured, and some very rare diseases.

While having full coverage is preferred, if something goes wrong financially or medically, you should not predict the future and think that having health insurance will cover everything.