If you’re paying for healthinsurance anyways, make sure you’re getting the most for your money. Here are five surprising things your health insurance may cover. Plans and coverages vary, but it’s worth investigating to find out.
Does Medicaid cover diapers?
Having a child over age three who is not potty trained can be taxing, both emotionally and fiscally. If your child has a disability or learning delay, you could get your diapers for free.
Depending on your state, Medicaid will cover diapers in this situation. If your child falls into one of those categories, odds are you already have some version of Medicaid–if you live in a state that chooses to support its disabled children through Medicaid.
When I say disability I of course mean things along the lines of children with Autism or Down’s Syndrome, but “learning delays” is a much broader term. Perhaps your child has delays with fine or gross motor skills, or they aren’t talking or communicating at a level that is “normal” yet. Both of these things can lead to serious problems with getting your kiddo on the potty every time.
Talk to your doctor at your child’s three year check up, and ask them to write a prescription. Even if you don’t have Medicaid, some private insurers will still offer this benefit.
Does my insurer cover a gym membership?
Your health insurer wants you to be healthy. Healthy people don’t file as many claims. And the less claims insurers have to pay out, the more money they can keep in their pockets.
As a result, many insurers cover gym memberships in one way or another. Some work with specific gyms to give you a discount or even a free membership, while others will offer your a set amount in reimbursem*nt.
If your insurer doesn’t cover gym memberships, that doesn’t mean you can’t get fit. Trying working out at home or going to reasonably priced gyms like 24 Hour Fitness. If you want to try them out, you can get a free pass here.
If you have Medicaid, gym membership may be covered depending on which state you live in. Most states do not offer it as a benefit, but a handful ran experiments with behavior incentives funded by federal grants in the 2010’s.
It’s not just your state’s Medicaid laws that come into play. Some Medicaid plans extend this benefit even if the state does not require it. Many of these programs are run in partnership with the YWCA/YMCA and other like community organizations.
Call your Medicaid provider. They’ll be able to tell you if it’s a covered benefit or available as part of an auxiliary rewards program.
Are massages covered by health insurance?
Are you in desperate need of a massage?
Well, you may be able to get that covered, too. Especially if you have chronic back pain, were in an accident, or see a chiropractor/physical therapist regularly. If you have pain, talk to your physician about it. If you can get a prescription from any of these medical specialists for massages, insurers will often cover the therapy.
Here’s the thing: To get a hot tub covered by insurance, you have to have an actual medical need for it. Like injury. Spine problems. Etc. If you do, asking your doctor if s/he thinks hot tub therapy would help certainly doesn’t hurt.
If they do think it would be beneficial to your situation, make sure they write a script. From there, call your insurance company. If you’ve got the Rx, and your policy doesn’t specifically state that a hot tub isn’t covered, it should count as a qualifying piece of durable medical equipment (DME). Durable medical equipment is covered on many plans.
If it’s not, and you still really want and can afford that hot tub, take the prescription with you when you buy it. That will eliminate the sales tax.
Be very careful here, though. If you’re throwing hot tub parties or your family is using it, you could run into some serious trouble if you get audited.
In most states, yes. That’s assuming that the hot tub is prescribed as a necessary piece of durable medical equipment by your doctor. And it doesn’t mean your insurer will make the process easy.
Some states have restrictions on qualifying DME, though restrictive policies can — in some cases — be litigated.
Does Medicare cover hot tubs?
Yes, if you have Medicare Part B coverage. There are several caveats to get coverage, though.
First, your doctor must deem a hot tub medically necessary and write you a prescription. Your doctor must participate in Medicare, though we’re assuming that’s already the case.
Then, you have to find a manufacturer who also works with Medicare.
You may still have to pay for 20% of the cost, and plan deductibles apply.
Are there any instances of insurance covering formula?
Yes. If your child needs a prescription formula, such as Alimentium or Nurtamigen, it may be covered.
Usually these coverages are in the form of reimbursem*nt, and usually your health insurance company will give you the run around–even if prescription formula is clearly covered in your policy.
Stay strong. This stuff is expensive. It’s worth saving your receipts not giving up. You pay for that benefit, and you deserve to have them fulfill their end of the bargain.
If you live in one of the following states, there is legislation dictating that your insurance cover these prescription formulas, regardless of if they want to or not:
New York
New Jersey
Illinois
Oregon
Texas
Minnesota
Arizona
South Dakota
Kentucky
Maine
Maryland
New Hampshire
Massachusetts
Pennsylvania
Connecticut
Rhode Island
Get more details about each state’s specific legislation here. Knowing your rights within the law can be a powerful tool to speeding up the process.
Another option for families in states which do not mandate this coverage is to look into your local Women, Infants, and Children program.
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