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3: Analyze Your Circumstances

Understand What Your Health Care Plan Covers

What Your Health Care Plan Covers


Whether you have a health plan through an employer, a health exchange, Medicare/Medicaid or if you pay as you go, knowing what is covered and what your costs will be is important to your financial situation.

Consider this scenario: During a Saturday morning soccer game, your daughter is elbowed in the eye and quickly experiences pain. You have health insurance through your employer, and it covers emergency room visits for a $100 copay. So, you take your daughter to the nearest ER. Fortunately there’s no serious damage, but she does have a corneal abrasion that is treated with a topical anti-inflammatory drug and antibiotic. You leave the ER with instructions to follow up with an ophthalmologist in the next few days. Whew — glad that’s over, right?

Well, maybe not. Depending on your coverage, an ER visit can quickly exceed your copay — sometimes costing more than your mortgage payment. Charges for using out-of-network facilities, ambulance fees and even physician costs (many ER doctors are “contractors” who may not be within an insurance network) can add up to huge bills. And, the costs are even higher if you don’t have insurance.

Knowing what your health policy covers can guide you in containing costs.

Scavenger Hunt: Your Health Care Coverages

When you sign up for insurance coverage, you should get a summary of the benefits under the plan. The National Association of Insurance Commissioners provides a sample Summary of Coverage to guide you. Use these definitions to complete the My Health Care Coverages worksheet regarding your own policy. Print this worksheet to identify your health care coverages. At the end, list any other questions that come to mind as you review your policy. Note: You can complete this for any type of coverage you have (e.g., medical, dental, vision, etc.).

Health Care Coverage

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