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Myth: My Qualified Health Plan Covers Everything I Need

The second myth concerns your coverage. The enrollment period is over, and you may think that your new health insurance plan covers everything you need, making supplemental health insurance unnecessary.

Not quite! That’s only a myth! Despite having health insurance, you may still be missing vital coverage. Do you really know exactly what your policy includes and what you might have to pay for out-of-pocket?

10 Essential, but Incomplete, Benefits

In order to make sure all insurance policies provide you with basic medical services, essential health benefits  were introduced under the Affordable Care Act in 2014. Now, plans must include items and services within at least 10 categories:

  • Hospitalization

  • Emergency services

  • Preventative and wellness services and chronic disease management

  • Prescription drugs

  • Laboratory services

  • Pregnancy, maternity, and newborn care

  • Pediatric services

  • Ambulatory patient services

  • Mental health and substance use disorder services

  • Rehabilitative and habilitative services and devices

However, it does not mean that ALL items and services within these categories have to be covered. And for what’s left uncovered, there is supplemental health insurance.

What’s the Worst That Could happen?

It may surprise you to learn that a heart attack occurs every 34 seconds.1 Let’s pretend this happens to you.

You have a heart attack. Fortunately, your family is able to rush you to the hospital. Because of the condition of your arteries, you need a bypass. You don’t have a supplemental health insurance plan, but thankfully, you know that your health insurance policy covers hospitalization and surgery, so you go ahead with your procedure.

It was a success. Several days later, you are home recovering. While speaking with your health insurance claims representative, you’re shocked to find that your policy only covers a percentage of the surgery materials. If that wasn’t enough, the policy doesn’t cover 100% of the anesthesiologist or assistant doctor because they were out of network! When the bills arrive, you are faced with the coinsurance, copay, deductible, and all of the expenses left uncovered by your insurance policy.

Fill the Gaps with Supplemental Insurance

If this happens to you, fear not! Supplemental health insurance can fill in the gaps in your coverage, paying you lump-sum cash benefits to help with your out-of-pocket expenses. And don’t worry! With an agent, you don’t have to uncover the gaps in your health insurance coverage on your own.


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