What Health Insurance Does Cover, and Doesn’t

[ProSense]

What Health Insurance Does Cover, and Doesn’t

By CATHERINE RAMPELL

As required by last year’s health reform legislation, the Labor Department has put together a report on employer-sponsored health insurance coverage that shows what benefits are typically covered by these plans. The results, in one chart:



A service is counted as “covered” whether or not 100 percent of the service is paid for by the insurance plan. The report listed a service as “covered” if the health plan documents specifically mentioned coverage of it (as opposed to not mentioning it, or specifically saying that the service was excluded).

As you can see, having private insurance doesn’t guarantee that the life-saving service you need — like kidney dialysis, or an organ transplant — will be covered at all by your plan. And even some services that would be considered relatively basic by many patients, like regular gynecological exams, are excluded.

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Using employer coverage as a base is good, but it's almost certain that lifetime limits had a to do with preventing access to care in some instances.

[Ian David]

1. This is why we need health CARE, not health INSURANCE. n/t

[canoeist52]

2. You are forced to buy whatever insurance your company offers.

Even if it won't really cover your medical needs. That's my beef with the MA health legislation- you can't choose the state plan if it's a better deal.

[Bluenorthwest]

3. Too bad we don't have universal health care and instead keep

straining to put profit over people. Sad stuff. Candidate Obama was in favor of a public option, and strongly opposed to individual mandates, and what he delivered was the opposite of that. I'll never forget his insisting that Insurance Co's 'deserve' their profits. They don't have to earn them, they are just deserving of profit on the back of your sick kids. They deserve it.

[AndyTiedye]

5. We Never Had the Votes for a Public Option, Let alone Single Payer

[Armstead]

6. There were close to enough votes, and they should have let the opponents filabuster

A LOT of Democrats in Congress did support a public option. Instead of placating the GOP and the ConservaDem outliers by klilling it without a fight, the Democrats could have separated it out as a separate vote, fought form it hard in the court of public opinion, and let the GOP and the outliers try to filabuster it.

At least it woiuld have had a shot, and woul;d also have set the stage for subsequent passage by legitimizing it in terms of the debate.

[Recursion]

9. The opponents did filibuster it

There were cloture votes on amendments which failed. That's a filibuster.

[Armstead]

10. I was talking about a unified front by Obama and all of the Dems who supported it

..not necessarily amendments by individuals or small groups

[Recursion]

11. I'm not aware of a parliamentary procedure called a "unified front"

What motions does it allow?

[Armstead]

12. It is called political organization, will and coordination

You know, the grease in the wheels of democracy for about 200 years

[Recursion]

8. How much of those does Medicare cover? (nt)

[jwirr]

4. One thing that is glaringly lacking in that list is coverage for medications. nt

[Recursion]

7. Medicare covers dialysis in almost all cases

I'm surprised any private insurance companies cover it.