Top 10 Medical Services Not Covered

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HealthPocket today released its analysis of the "Top 10 Medical Services Excluded by Health Insurance," with long-term care (98 percent); cosmetic surgery (98 percent) and infertility treatments (94%) leading the list of the most common services not covered by insurance. The Essential Health Benefits that will be required for all plans under the Affordable Care Act (ACA or Obamacare) starting in 2014 will improve access to two services on the list: children's dental check-up and children's eyeglasses.

Coverage of medical services in the individual and family health insurance market is not standardized, yet an examination of 11,365 health plans revealed significant consistency in what insurers are not willing to pay for. Weight management programs and weight loss surgery are routinely not covered in the current health insurance market despite the fact that one third of US adults are obese. ACA requirements will ensure coverage of weight loss diagnosis and counseling, but insurers may continue to refuse payment for enrollment in third party programs such as Weight Watchers as well as surgical interventions. 

As is the case with weight loss, the exclusion of insurance coverage for infertility treatments affects millions across the US. With the average cost of a treatment cycle at $12,400, and  multiple cycles often needed for success, lack of coverage for in vitro fertilization can make the procedure inaccessible for many Americans.

Top 10 Medical Services Excluded by Health Insurance

Rank

Medical Service

Percentage of Plans Excluding Benefits

#1

Long-Term Care

98%

#2

Cosmetic Surgery

98%

#3

Infertility Treatment

94%

#4

Weight Loss Program

93%

#5

Private Nursing

92%

#6

Acupuncture

92%

#7

Children's Dental Check-Up

92%

#8

Weight Loss Surgery

90%

#9

Children's Eye Glasses 

87%

#10

Adult Dental Services

81%

The HealthPocket research also examined the five medical services that just missed inclusion within the Top 10 List. Coverage for women for hospital deliveries (67 percent) and for prenatal and postnatal care (64 percent) are frequently excluded services affecting a significant portion of the population. These medical procedures are included in the Essential Health Benefits and will therefore receive greater coverage because of the ACA.

"A lack of insurance coverage for widespread conditions like obesity and infertility affects millions of people across the United States," said Kev Coleman, Head of Research and Data at HealthPocket. "Given that most of the medical service exclusions within the Top 10 list can continue after the implementation of health reform, it is vital that consumers closely examine their benefit coverage options when they shop for health insurance this October."  

The full analysis of services excluded from health insurance coverage can be found in HealthPocket's Infostat. This report is part of a series using health plan data to produce unbiased market analysis and guidance for consumers navigating America's changing health insurance environment. Results were based on an analysis of plan information collected from US Department of Health & Human Services records on July 25, 2013. Consumers can find a list of excluded benefits within the Plan Details section of HealthPocket.com for any displayed Individual and Family Plan.