What’s not covered by health insurance can also vary depending on the plan. Your Summary of Benefits Coverage (SBC) document that comes with your health plan will itemize the care and services covered, as well as what’s not covered. When you know how your health plan works, you are better able to avoid paying unnecessary out-of-pocket costs. Here are some types of services that are not typically covered:

• Alternative medicine—such as massage, acupuncture, herbal healing, and more.
• Cosmetic surgery—things like plastic surgery, laser skin removal, liposuction, rhinoplasty (nose job), etc.
• Weight loss surgery—things like gastric bypass and bariatric surgery may not be covered. This depends on the plan you get, though. Some procedures may be covered, if medically necessary, so check your plan documents carefully.
• Vein surgery—laser surgery to correct spider veins is often considered cosmetic and may not be covered unless a doctor can show it’s medically necessary.
• Elective surgeries—especially surgeries that a doctor cannot prove a medical need for.
• Unapproved medical care—if you fail to get a required precertification for care or a service, your health plan may deny you coverage. Precertification is pre-approval from your health insurer. Many health plans require this type of pre-approval for certain types of procedures or treatments.
• Experimental treatments or procedures—for example, surgeries that use new technology or methods that may not have proven outcomes.

The benefits of health insurance include:

• Lower out-of-pocket costs for care since it’s shared with your health plan.
• $0 preventive care—annual check-ups, routine health screenings (mammogram, colonoscopy, cholesterol screening), and certain vaccinations are fully paid for by your health plan. This means getting routine care costs you nothing. If you had to pay for this on your own, you’d pay hundreds of dollars out of your own savings each year, or you’d make decisions not to go to the doctor, with possible impacts to your own and your family’s health.
• Coverage for unexpected costly medical care, such as hospitalization and care for a serious illness like cancer, or in the event of an accident or serious injury. That’s not to say there is no cost to you, but once you meet your deductible, your plan helps pay a large share of the cost. If you hit your annual out-of-pocket maximum (the most you need to pay in a year) then your plan starts paying for all of your care.
• Peace of mind—having a health plan may give you some comfort in knowing that there is a limit to how much you need to pay out-of-pocket for costly medical care. In addition, since your health plan pays for most preventive care, you can also have the peace of mind that you and your family can get all your routine care, with little to no additional cost. (Some plans may require a small copay at the time of a visit

Health insurance only works when you have it. Consider your lifestyle. Do you live risk-free or do you like to live life on the edge? Adventurous? Or a homebody? Do you have a chronic health condition that requires treatment? Do you have a family to care for? These are things to keep in mind when considering whether you should get health insurance:

• If you are offered a health plan through your employer, you should get it. Your employer helps foot the bill for your medical care. Preventive care is usually no cost to you—a big savings for you and your family.
• If you have a family to care for, consider the potential costs of not having health coverage for them. Would you be able to pay for even routine check-ups and screenings? With a health plan, you can have peace of mind that in most cases, the plan pays 100% for most preventive care.
• If you would not be able to pay the costs for unexpected illness, or injury you should get health insurance. If you’re wealthy and can manage to write a check for hundreds or even thousands of dollars, maybe you’re able to live without health insurance. But if you’re like most people, a major illness or accident is not an expense you can easily pay on your own.
• If you just need coverage in the event of a serious accident. If you don’t want to pay for a comprehensive health plan and feel you’re healthy and at low risk for illness or injury, you might consider catastrophic health insurance. These plans offer you a basic level of coverage in the event of a serious accident.
• If you’re between jobs, consider short-term health insurance to ensure you and your family are covered during any gap in normal medical coverage.