Ways to pay for what’s not typically covered by health insurance
Health insurance may help lower your costs for many types of care. But even the most comprehensive plans don’t include everything. From cosmetic procedures to dental services, there are some health care needs your plan may not help pay for. Knowing what is not covered and how to handle those costs can help you plan ahead.
How to check what your health plan covers
Before you go to the doctor or get a procedure, look at your plan documents. These will show you what’s included and what’s not.
Check your:
- Summary of benefits and coverage (SBC): A quick breakdown of what your plan pays for and what you’re expected to pay
- Plan details or Certificate of Coverage: A more in-depth look at benefits, limits and exclusions
- Network provider list: Costs are often lower if you use a provider in your plan’s network
If you’re a UnitedHealthcare plan member, sign in to your member account or the UnitedHealthcare app to review these documents and get benefit details. You can also call the number on your health plan ID card to ask about specific services or exclusions. Understanding what’s included now may help you avoid unexpected bills later.1
What is the exclusion list for health insurance?
Every plan has what’s called an “exclusion list.” This is a list of services or items your plan doesn’t cover. It can vary depending on your plan and insurance company. In general, exclusions fall into a few categories.2
Temporary exclusions and waiting periods
Some services may be temporarily excluded, especially when you’re new to a plan. These types of exclusions may include:2
- Pre-existing conditions
- Maternity care
- Bariatric surgery
Plans may delay coverage for these services for a set time, known as a “waiting period."2
Common exclusions in health insurance
Some services are most often not included in many plans:3
- Cosmetic procedures — Botox, chemical peels or plastic surgery that isn’t medically necessary
- Dental and vision care — Unless you have a separate plan for these services
- Certain fertility treatments — Like in vitro fertilization or egg freezing, unless listed in your plan
- Alternative therapies — Acupuncture, massage therapy or naturopathy unless recommended as part of a care plan
- Experimental or unproven treatments — If a treatment hasn’t been proven in clinical studies, it may not be covered
Even if a service isn’t excluded completely, it may need prior approval. This means your provider must get permission from your insurance plan before the service is done.1
What are ways I can pay for non-covered services?
If a service you need isn’t covered, there are options to help manage the cost:
- Flexible spending accounts (FSAs) or health savings accounts (HSAs): These accounts let you use pretax dollars for eligible medical expenses, including some that your plan does not cover¹
- Ask your provider about a payment plan: Some clinics or hospitals offer monthly payment options — sometimes with no interest
- Shop around for care: Prices can vary between providers, so it’s worth getting a cost estimate in advance
- Check for financial assistance: Some hospitals and nonprofit health centers offer help based on income
- Look into government programs: You may qualify for help paying medical bills through federal or state programs
- Ask about prior authorization or alternatives: Sometimes your provider can recommend a similar treatment that’s included in your plan, or get approval for something typically excluded⁴
How can I choose a health insurance plan that meets more of my needs?
When you choose or renew your plan, think about what you need and what it covers. Look for:
- Benefits that align with your health concerns or goals
- A network that includes your preferred doctors and hospitals
- Lower costs for services you expect to use
Plans that offer more may have higher premiums. But if they help cover services you know you’ll use, they may be worth the added monthly cost.1
Know your coverage and be prepared
Health insurance is a great tool, but it doesn’t cover everything. Understanding what’s excluded and preparing ahead of time can help you make informed choices about your care and your budget.
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