Top 10 Health Services Commonly Excluded from Plans

The new Affordable Care Act law does not mean everything will change. Experts say many services that were excluded prior to the law remain unchanged. They examined over 3,000 health plans in 2014 to see which services were the most commonly excluded. Their data showed that about 80 percent of exclusions were unchanged prior to and immediately after the new law taking effect. The following were the top 10 services most commonly excluded.

1. Weight Loss Surgery Nearly 60 percent of plans exclude this type of surgery following the new health care law taking effect. Prior to that, 90 percent of plans excluded weight loss surgery. Experts said they were surprised that 40 percent of programs still excluded the surgery and similar programs as well due to the high rate of obesity in the United States. However, counseling and screening for obesity is provided as preventative care without the need to pay upfront.

2. Eye Exams For Adults Slightly more than 60 percent of plans exclude this benefit, which experts say is disappointing due to the many benefits of eye exams. They point out that optometrists can detect diabetes and other health problems early on with this simple type of exam. Not many providers offer standalone vision plans. While 50 percent of large employers offered standalone dental plans, less than 20 percent offered standalone vision plans.

3. Private Nursing Care More than 65 percent of plans now exclude this benefit. However, that number improved within the span of one year. In the past, more than 90 percent of plans excluded private nursing care.

4. Infertility Treatments Experts said more than 65 percent of plans exclude fertility treatments. This number was down from before. The amount of plans excluding these treatments before the new law took effect was nearly 95 percent. Since the average cost of each cycle is over $12,000 and most people need multiple cycles, the procedure was widely inaccessible for most people before the new law’s introduction.

5. Regular Foot Care More than 70 percent of plans now exclude routine foot care, but the number was higher before the new law started. Researchers say that the law has a large influence on the individual market for health insurance, but they said the effect on most of the excluded services was less extensive.

6. Acupuncture Nearly 85 percent of plans exclude acupuncture, but more than 90 percent of plans excluded it prior to the Affordable Care Act. Researchers said that acupuncture is a good solution for chronic pain. They think doctors should recommend it more often for arthritis or other ailments that are ongoing.

7. Weight Loss Programs Less than 90 percent of plans cover weight loss programs, but nearly 95 percent excluded them before the new law’s beginning. Experts find this disappointing due to the many serious health problems that are related to obesity.

8. Dental Services For Adults Slightly less than 90 percent of plans exclude adult dental care. This number is actually an increase from prior years. In 2013, barely more than 80 percent of plans excluded dental care for adults. However, the new law provides for pediatric dental and vision care.

9. Cosmetic Surgery More than 90 percent of plans exclude cosmetic procedures. In the past, over 95 percent excluded it, so this is a slight improvement for people who may need cosmetic surgery.

10. Long-Term Care Barely less than 100 percent of plans exclude long-term care. It was rarely included in health plans in the past, and it is still the most commonly excluded health care service. This type of coverage includes services for people who need to live in skilled nursing facilities for long periods of time due to disabilities or chronic conditions. While some younger individuals require this form of care, it is most common among the elderly.

Many people visit sites online to try to shop for insurance. The best way to find an optimal plan is to discuss needs and concerns with an agent who has access to a wider range of options. If you need advice about the right health insurance for you or for your business, call ACBI at 203-259-7580 or visit our website.


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