What Does My Health Insurance Cover?

Olivia Durkee

| 2 min read

Olivia Durkee is a Corporate Communications Intern at Blue Cross Blue Shield of Michigan. She is a rising senior at the University of Michigan in Ann Arbor studying Communications and Media. She enjoys hiking, reading, crocheting and camping in her free time.

Understanding health insurance, what it provides, how it works and how to obtain it can be a complicated experience for individuals who are starting to look for their own plan. Read more to find out what types of health insurance are available to you, and what they cover.

Types of health insurance plans

There are different types of health insurance plans that you can register for. Deciding what plan fits your lifestyle and needs best is the first step in the process of getting your own health insurance.
One type of health insurance is Health Maintenance Organization or HMO. HMO plans tend to have lower premiums and require you to choose a primary care provider to coordinate your healthcare. You will need referrals from your primary care provider to see specialists, but preventative care services are often covered without additional costs.
Another type is Preferred Provider Organization or PPO. PPO plans offer more flexibility as you can visit any doctor or specialist without a referral. While these plans have higher premiums than HMOs, you will have partial coverage even if you visit a provider who is not in the network.

Essential medical services

All health insurance plans are required to cover 10 services listed under the Affordable Care Act (ACA) and typically cover essential medical services. However, the extent or depth of coverage and associated costs may vary depending on the plan type. In health care terms, coverage refers to the extent of medical services and expenses that your insurance policy pays for. The level of coverage you receive from your provider significantly impacts the out-of-pocket expenses that you take on yourself.
The ACA requires these 10 services to be universally covered by all insurers:
  • Ambulatory care
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services

Deciding what plan is right for you

Based on the type of insurance you have, the type of coverage you receive will be different. If a service is covered, this means that your healthcare plan will pay for some of or all of the cost of the service. Always review plan details, including premiums, deductibles, copayments and the network of providers in order to find the best fit for your needs and budget.
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