In New Jersey, there are close to 300,000 residents who are covered under the Affordable Care Act. Many of these New Jerseyans are not taking advantage of hidden healthcare benefits that could improve the quality of their lives.
Many consumers assume that so-called elective procedures, like in vitro fertilization, weight-loss surgery, acupuncture, birth control, even chiropractic services for people suffering with back pain are not included under their insurance plan. Under the right plan, these expensive health benefits could be covered.
These hidden benefits are typically available for employees working at small businesses with less than 50 people, freelancers, part-time workers, students, seniors, the recently unemployed, or others who qualify for healthcare under the marketplace.
So how do you know which hidden benefits your plan covers?
Coverage depends on the plan you choose and where you live. In New Jersey, consumers using the marketplace have five providers to choose from — Oscar Health Insurance, United Healthcare, Horizon Blue Cross Blue Shield, Health Republic of New Jersey, and AmeriHealth.
The most popular benefits are usually hidden in the “summary of benefits” page buried inside of your healthcare booklet. If you look here, you will find a summary of procedures and services covered with your healthcare plan.
I’ve worked in the healthcare industry for 25 years, helping patients and families secure affordable coverage and understand their entitlements. As the CEO of Medicaid Advisory Group, I’ve also seen mistakes consumers make when choosing a healthcare plan. Taking a one-size-fits-all approach to healthcare is one of the biggest mistakes most consumers make when choosing their healthcare plans. They end up paying for a service they will rarely use, or they don’t get coverage for services they will need.
For example, it’s very common for young people to sign up for a healthcare plan that covers prescription drugs, even though they will likely not use them. Likewise, many seniors may not be fully covered for prescriptions. Being underinsured is equally costly. Consumers may be covered for hospital stays, while their insurance may not include physical therapy and other post-op recovery services.
Another common healthcare mistake is when consumers don’t take advantage of services they paid for. Here are some of the more popular procedures that could be covered under the Affordable Care Act and with private insurers in New Jersey.
Expensive weight-loss procedures, known as bariatric or gastric-bypass surgery, can cost upward of $20,000, but this service is covered in New Jersey under the Affordable Care Act. New Jersey even covers partial nutritional programs to help overweight people.
Many New Jerseyans may not realize alternative medicine is also covered under some health insurance plans.
Under the Affordable Care Act, the law prohibits insurers from discriminating against licensed healthcare providers, including those who practice alternative medicine, which can include visits to the chiropractor or acupuncturist.
There are 15 states that mandate some coverage for infertility treatments, but some states only cover infertility treatment on group plans, not individual policies, according to the National Infertility Association.
The Affordable Care Act requires all FDA-approved contraceptive methods prescribed by a woman’s doctor to be covered, including barrier methods (diaphragms, sponges), hormonal methods (birth-control pills, vaginal rings), implanted devices (IUDs), emergency contraception, sterilization procedures, and patient education and counseling.
I encourage all consumers to call their insurance providers and ask specific questions in regards to their treatments and coverage. Making small changes to your plan can save you money and help you avoid paying-out-of pocket.