What Does My Health Plan Cover?


| 3 min read

Once you have health insurance, it's easy to just tuck the card in the back of your wallet without giving it much thought. After all, you're covered. You have nothing to worry about it until you get sick or injured. Right? If you're guilty of taking this laissez-faire approach, you might be missing out on more than you know. For starters, waiting until an emergency to figure out how to use your coverage can cost time, money, and a heck of a lot of stress. Michigan resident Paul Bellau told AHealthierMichigan.org how his choice to go to the emergency room instead of urgent care cost him $600, and several hours of his time. “I had a doctor at the time, but he was about 40 minutes away and the ER was only five,” Paul said. “I thought I was saving time by not driving all the way out there and back. Turns out, it would have been easier and cheaper to have seen him.” There are also many benefits- outside of emergencies- that you're missing out on by not understanding and taking advantage of your health insurance.

So what does your health plan cover?

Under the Affordable Care Act, individual and small group insurance plans include 10 essential health benefit categories. Millions of people may now have access to more comprehensive coverage that includes items and services within at least the following 10 categories:
  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavior health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive, wellness and chronic disease management services
  10. Pediatric services, including oral and vision care
Keep in mind that each member may have different types of items and services that are covered, depending on what type of health insurance he or she purchased. If you're a Blue Cross Blue Shield of Michigan or Blue Care Network member, here's how to find out what's covered under your specific plan:
  1. Log into your account at bcbsm.com
  2. Hover over "My Coverage" in the blue bar at the top of the page
  3. Select "Medical" from the drop down

How do you know where to go for care?

For tips on how to save money by using the right care in the right setting, listing to Dr. Kipa talk about smart ER practices on the Healthier Michigan Radio Show: https://soundcloud.com/bcbsm/healthier-michigan-radio-show-dr-kipa-and-smarter-practices#t=0:00 Like this blog? Here are some related posts you might enjoy:
For more health insurance tips visit bcbsm.com/101 or follow the hashtag #Covered101 on our social channels. If you have a specific question, please submit your query online through our Customer Action Center. Photo Credit: Brian Talbot
MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association