5 Surprising things your health insurance might pay for

Don’t miss out on — or pay for — these services and procedures that health plans often cover.

Healthcare would be a whole lot easier if every appointment, test, and procedure came with a price tag. It would be even better if that price tag showed exactly how much your health plan will cover. Unfortunately, that level of transparency is hard to find. That means some people pay for health expenses out of pocket without knowing that their health insurance might pay for them. Others put off care that they assume won’t be covered.

“Understanding your benefits is key to saving money and working toward well-being,” Kelsey Rauenhorst says. Rauenhorst is a Medicare health plan adviser at WeCare, based in Seattle. To find out what your health plan covers, start by calling and asking about specific procedures or services. 

It’s also helpful to check your plan’s summary of benefits and coverage (SBC). An SBC details which services your plan covers and how much. It’s a standard document that’s usually on your plan’s website. (You’ll need to log in to your account to see it.) You might find things on the covered list that you’re already paying for. Common ones include breast pumps and counseling for mental health and substance use disorder. 

“The most overlooked services by those insured are preventive services,” says Vicki Dufrene. Dufrene is the director of the senior health insurance information program at the Louisiana Department of Insurance, based in Baton Rouge. Preventive services are often covered. They help find problems early, when they’re easier to correct and manage. They usually include:

  • Certain cancer screenings.
  • HIV prevention medications.
  • Blood pressure checks.

The list of things that health plans will pay for is long. But here are 5 that might surprise you. 

1. Gym Memberships

It makes sense that health plans want to help you exercise. Research shows that staying active can benefit heart health and mental health. It could even help to prevent and manage diabetes.

Check to see if your health insurance might pay for part or all of the cost of a fitness center membership. Many Medicare Advantage plans also offer the SilverSneakers fitness program at no additional cost. It gives you access to various gyms as well as online workouts. 

2. Help to Quit Smoking

Kicking the habit is hard. But it’s worth it. No matter your age or how long you’ve smoked, quitting brings a variety of health benefits. It can lower your risk of heart disease, stroke, lung disease, and cancer. And it can add as much as 10 years to your life.

If you’re ready to quit, it’s best not to go it alone. Research shows that getting help can greatly raise your chances of success. That includes:

  • Support from doctors and nurses.
  • One-on-one and group counseling.
  • Medication.

The good news is that “many tobacco-cessation treatments and medications are covered by insurance,” says Sophia Yeung. Yeung is an administrative manager of the Tobacco Cessation Program at City of Hope National Medical Center in Duarte, California. 

“Most commercial insurers will pay for tobacco cessation as long as prior authorizations are obtained,” Yeung explains. “Patients may have to cover a copay or coinsurance or put the cost toward their deductible.” Yeung points out that Medicare doesn’t cover most nicotine-replacement therapies, such as patches, gums, and lozenges. But it does cover oral medications. 

Talk to your doctor to get started on a plan to quit. Or ask your employer if you have Wellframe. This digital health management app is a benefit of many health plans. It offers a free smoking-cessation program through your plan. 

3. Virtual Visits

Early on in the COVID-19 pandemic, it was hard for people to visit their doctor’s offices. Healthcare plans and the government responded by increasing reimbursements for telehealth services. These are appointments that take place over the phone or by video chat. 

Medicare, for example, used to allow only certain providers to bill for telehealth appointments. But it expanded the use to all Medicare service providers. That includes physical therapists and nurse practitioners. After the pandemic began, nearly half of U.S. states made it easier for people to use telemedicine. And in 2021, 30 states are rethinking how they’ll cover telehealth going forward.

Now more people than ever have used telemedicine, including both patients and providers. And it’s likely to remain a part of many healthcare routines. Ask your health plan what telehealth coverage is available. You may be able to see your doctor without leaving home and have it covered. 

4. Diet and Weight-Loss Counseling

Under the Affordable Care Act, most health plans must cover diet counseling for people with obesity or chronic diseases. That can include high blood pressure, kidney disease, and type 2 diabetes, or for people at high risk for these conditions. Some health insurance might pay for or reimburse you for nutritional counseling sessions with a dietitian as a preventive service.

5. Breast Reconstruction and Wigs

Each year, more than 100,000 Americans have a mastectomy to treat or prevent breast cancer. Many may not know that insurance covers reconstruction after a mastectomy. Reconstruction is a surgical procedure to restore the shape of the breast. It usually includes breast implants or rebuilding the breast with tissue from another part of the patient’s body. Not all people decide to have reconstruction surgery. But for many, it’s an important part of getting back to the life and body they knew before their surgeries. 

Patients who lose their hair due to chemotherapy treatments for cancer can also use their insurance to help buy a wig. Plans often cover 80% to 100% of the cost. You may need your doctor to write a prescription for a “cranial prosthesis.” That’s the clinical term for a wig.

The Bottom Line: Always Check Before You Pay

Health benefits and coverage change all the time. So before you pay for anything medical-related out of pocket, make sure your health plan doesn’t cover part or all of it first. You might be pleasantly surprised — and have a little more in your wallet to show for it. 

Need additional help figuring out which health plan is right for you?

We’ve got you covered. Download the guide on How to Make Your Health Plan Work for You and learn more about different health plans and their benefits to see which fits your needs. Also, discover tips that can save you thousands of dollars on healthcare.