Health Insurance: What’s Covered?

If you have health insurance you can have peace of mind. You won’t have to pay as much out of pocket if you have a medical emergency or need to go to the hospital. You won’t have to pay as much when you go to the doctor. You won’t have to pay as much for your medicines. But, it is important to know the benefits of your health insurance plan and what services are covered because not all insurance plans cover the same things.

In Maryland, all of the private insurance plans must pay for certain basic services; these are called essential health benefits.Within these essential benefits, there are some limitations. For example, there are a lot of prescription drugs that are very similar. An insurance company may cover one drug but not another. So, if your doctor prescribes a medicine it is important to make sure it is on the list of drugs that your insurance will pay for—this list is called a formulary.Another example is tests. Lab tests are covered by all insurance but your insurance company may only pay once a year for certain tests.      Essential Health Benefits

  • Doctor visits
  • Hospitalization
  • Emergency care
  • Maternity and newborn care
  • Pediatric care (children)
  • Dentist visits for children
  • Vision care for children
  • Prescription drugs
  • Laboratory tests
  • Mental health care
  • Substance abuse treatment
  • Preventive care/checkup (no additional cost)
  • Disease management (no additional cost)


Picture of insuranee claim formHow can you find out what treatments your insurance will pay for? To find out what treatments, tests, and medicines are covered call the member services number on your insurance card. This is an especially important step to take before having any major or expensive treatments.

How can you find out what a procedure will cost? In Maryland, the cost of all hospital procedures is set by a state agency. What a procedure will cost you depends on the co-pay and co-insurance in your insurance plan and whether you have met your deductible. Click here to watch a video on this topic visit the section on Money Talk.


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