22 Health Insurance Myths That People Still Think Are True

If you’re confused about what a health insurance policy covers, you may be at financial risk. Or, you may assume that your policy won’t cover a service only to find out that it’s covered. Making the most of the money you spend on health insurance means understanding how a policy works instead of believing myths. While each insurance plan is unique, here are the top 22 health insurance myths about health insurance that people still think are true..

Myth #1 Young, Healthy People Don’t Need Health Insurance

Do I need health insurance if I’m young and healthy?

Young people can get coverage from their parents’ health insurance policy until age 26. A healthy young person may assume that it’s a waste of money to buy their own policy after they get dropped, but they may end up regretting not doing it.

Without health insurance coverage, medical bankruptcy is a real risk because anyone can suddenly fall ill or get injured. An emergency room visit can easily cost thousands of dollars without insurance. A broken leg will cost around $7,500 and a three-day stay at a hospital costs, on average, about $30,000.⁽¹⁾ unforeseen illness or accidents happen every day no matter what age, a cancer diagnosis could mean you are looking at extensive medical bills. Otherwise young and healthy people can also get an unforeseen cancer diagnosis–it’s not unheard of. Buying health insurance may feel like betting against oneself but it’s important to always have health insurance coverage.

Myth #2: Health Insurance Is Unaffordable

What if health insurance doesn’t fit in my budget?

Don’t assume anything about insurance pricing until you compare rates. If you qualify for an ACA subsidy, rates may be as low as $40 a month, in some states. If you don’t qualify for a substantial subsidy, buying a high-deductible bronze tier plan is the next cheapest option for health insurance coverage. You’ll have to pay for doctor’s visits and other health-related services until you meet the deductible but at least there will be a cap for what you spend out of pocket. Let’s say the deductible is just under $9,000: If you have a three-day hospital stay which costs around $30,000, insurance would pay $21,000. Without insurance, you’d owe $30,000!

If you have a pre-existing condition and have frequent doctor visits, the high-deductible health insurance plan will not be the most cost-effective option, however, and buying at least a silver- or possibly gold-tier plan is advisable. See if you can cut some unnecessary costs from your budget before you shop around and compare health insurance rates.

Myth #3: I May Get Turned Down for Having a Pre-existing Condition

If I have a pre-existing condition, can I get turned down for an ACA health insurance plan?

One of the mandates of the Affordable Care Act was that ACA health plans cannot turn anyone down for a pre-existing condition. They must also cover treatment for the pre-existing condition or conditions without charging more. The only exception to this is if you have a grandfathered health plan.⁽²⁾

Myth $4: Health Insurance Covers Everything

If I buy health insurance, will it cover all my medical costs?

Health insurance may cover much of your bill, depending on the policy but it won’t cover everything. For instance, you may have a copay or coinsurance, meaning that you pay a share of the cost, depending on the policy. This is why it’s important to understand cost sharing before you shop for a health insurance plan that’s right for you.

It’s also why it’s not advised for someone with a pre-existing condition, who often sees providers, to buy a high-deductible bronze plan. A plan that costs more each month will be more cost-effective because it’ll cover more of the total cost, including copays.

Myth #5: Work-sponsored Health Insurance Is Cheaper Than an ACA Plan

Should I bother getting health insurance quotes if I am offered health insurance at work?

Depending on your salary, it may be cheaper to buy an ACA plan on the marketplace instead of the work-sponsored plan because you may qualify for subsidies that reduce premiums, sometimes significantly. Look at the specifics, like what metal tier the plan falls under and what the deductible is when comparing rates. Look at copays and coinsurance breakdowns too. This way you’ll know which health insurance plan is cheaper after you compare quotes.

Myth #6: You Are Not Covered if You Go Out of Network

Am I covered if I choose a specialist or doctor who is not in my health insurance network?

If the treatment or visit is medically necessary and you decide to go with an out-of-network provider, and you have a PPO plan, you’ll still be covered for the service, just not as much as if you go to an in-network provider. EPOs and HMOs have tighter network restrictions, however.

You’d be best off securing approval from the insurance company before going out-of-network to see if you qualify for coverage. If you’re approved, your insurer would only cover what your policy would have covered for the equivalent in-network provider.

Myth #7: Health Insurance Covers International Travel

Am I covered by my health insurance plan while traveling abroad?

Some health insurance plans may cover emergency care while traveling abroad. Most health insurance plans are only covered within a certain zone, usually in-state, but each policy varies. It’s a good idea to contact your insurer to ask about coverage because you may need to buy travel medical insurance if you need health care or medications during your trip.

Myth #8: You’re Not Covered Out of State

Am I covered by my health insurance policy in another state?

Most ACA plans are exclusive to that state because they are state subsidized. However, this is not true for all private health insurance plans. It’s best to call your insurance company and ask if you’ll be covered at your destination. Otherwise, you may only be covered for emergencies.

Myth #9: You’re Not Eligible for an ACA Plan if Offered Insurance at a Job

Can I buy an ACA plan instead of a job-sponsored health insurance plan?

You’re not legally or ethically bound to your work’s health insurance options, and there is no law against buying a marketplace plan instead. In fact, it’s a good idea to see if you qualify for a low-cost policy based on income requirements.

Myth #10: You Can Only Buy Health Insurance During Open Enrollment

If you miss the open enrollment deadline, you are still able to buy health insurance during a special enrollment, which is unique to each individual. Common life changes make you eligible for special enrollment, like losing your health insurance coverage, having a baby, changing jobs or losing a job, getting married or moving.⁽³⁾

Myth #11: Buying a More Expensive Health Insurance Plan Is a Waste of Money

Sometimes, you spend more money each month to pay less over the course of the year. A more expensive health insurance plan option may cover a larger portion of your bills. If you’re ignoring the gold and platinum health insurance policies and have an existing condition or two, you are probably spending more money on medical bills than you need to.

Look at the breakdowns for copays and coinsurance on your existing plan and a higher level plan. Next, calculate whether or not a higher premium results in greater savings over the course of an average year due to smaller copays/coinsurance.

Myth #12: Preventive Care Is Only Partially Covered With a Health Plan

Am I covered 100% for my annual checkup with health insurance?

Preventive care includes physical exams, blood tests, colonoscopies, various screenings and a list of vaccines. Both ACA and other health insurance plans are required to cover preventive care costs 100%.⁽²⁾ Most health insurance plans also cover standard vaccines, blood tests and screenings, like mammograms and prostate checks at 100%. The list goes on, and each policy varies so check your policy coverage terms or call the insurer to ask..

Myth #13: All Medications Are Covered With Health Insurance

Are all my medications covered by my insurance?

Each insurance company has a specific formulary of medications they cover, and the list should be available on their website. You can also contact the insurance company directly to find out which medications they cover. You will have to pay a copay even on covered medications.

If the medication is not covered, ask the insurer about their drug exceptions process, which may allow you to get a drug that’s not usually covered by your health plan. You’ll need a doctor to verify that the medication is necessary and alternative options aren’t effective or are harmful for you. If you qualify for the exception, your copays may be expensive but they will count towards your deductible. If you don’t get the exception, you can file an appeal.⁽⁴⁾

Myth #14: Health Insurance Covers All Car Accidents

Who pays for my injuries after a car accident?

If you’re injured in a car accident and it was the other driver’s fault, their liability coverage will pay for your medical bills. If the accident was your fault and you have medical payments (MedPay) coverage, that will pay for medical costs and health insurance will pay for any remaining costs.

If you don’t have MedPay, health insurance will cover the medical bills. In some cases, health insurance will immediately cover the costs but then ask the car insurance company for the majority if not all of the coverage afterwards. This is called subrogation, and requires no work on your part.

Myth #15: You Save the Most With the Cheapest Health Insurance Policy

Do I save the most with the health insurance plan with the cheapest monthly premiums?

You may actually be paying much more than you have to, if you buy a high-deductible bronze plan and have a condition that requires frequent visits to health care providers. The cost share on a higher tier plan, like a gold or platinum plan, may be the most cost effective option for someone who sees several specialists on a regular basis. Copays may be cheaper on a plan that costs more. So add up all copays as well as premiums when you compare health insurance quotes for different policies.

Myth #16: Health Insurance Doesn’t Cover Mental Health

Does health insurance cover a psychiatrist and therapy?

Mental health is covered by health insurance and so is therapy. Included under the umbrella of behavioral health, substance abuse treatment is also covered. In most cases, you do not need prior authorization from a primary care physician to make an appointment and get coverage for an appointment with a psychiatrist, psychologist or therapist.

However, you may need to see an in-network provider for maximum coverage. If you plan to go out-of-network, speak with your insurer to see if you qualify for partial coverage.

Myth #17: I Can’t Get Care Until I Have My Health Insurance Card

Do I have to wait to get my health insurance card before I see a doctor?

As long as you have your policy number as well as member and group identification numbers, your insurance can be billed by the provider, even if you don’t have the insurance card yet. Just make sure to copy down the correct number or else the system will not recognize you.

Myth #18: If I Use My Medical Insurance Frequently, the Cost Will Increase

Do I pay more for health insurance based on how many times I seek care?

You do not pay more for health insurance because you visit providers frequently, have a pre-existing condition or have had surgeries. The factors that insurers use to generate your premium rate is your age, location and whether or not you smoke. You will also pay more if you add a dependent to your health insurance policy.

Myth #19: Health Insurance Only Covers Hospital and Doctors

What does health insurance cover besides hospital and doctor visits?

Medical expenses that health insurance covers besides doctor visits and hospitals includes: prescription drugs, therapy, psychiatry, preventive care, screenings, laboratory tests, physical rehabilitation, substance abuse disorders, alternative medicine, imaging (MRIs and x-rays), urgent care visits and more.

Myth #20: I Will Pay More for Health Insurance Because I Have a Pre-existing Condition

Do I pay more for health insurance because I have a chronic condition?

The ACA prohibits rate hikes due to a chronic condition. You also cannot be turned down due to that condition. However, you may pay more in copays over the course of a year if you have frequent provider visits, especially if you buy a bronze or silver plan. A gold or platinum plan costs more each month but covers more of your copays.

Compare plans by adding up both premiums and copays you pay out of pocket to see which health plan is more cost effective for you.

Myth #21: Health Insurance Doesn’t Cover Pregnancy

Does health insurance cover pregnancy and pre-natal care?

Pregnancy is covered by health insurance, as required by the ACA, but some plans are more comprehensive than others. Maternity care and childbirth are both covered, unless you have a grandfathered policy. Prenatal care and vitamins prescribed by the doctor are covered, but you will likely have to pay a copay for the visit to the doctor. You’re also covered for post-natal care, Gestational diabetes screening, blood and urine testing, lactation counseling and more. Always ask the insurer what they offer before you buy a policy, if you’re planning on having a baby during the calendar year.⁽⁵⁾ How much you pay out of pocket depends on your health insurance company and your particular cost share, something that is important to consider when shopping for health insurance.

Myth #22: Health Insurance Doesn’t Cover Vision and Dental

Does health insurance cover optometrists, ophthalmologists and dental visits?

For adults health insurance doesn’t cover vision or dental visits but would cover an ophthalmologist if recommended by a general practitioner. For children, most health insurance policies cover dental and vision, as a mandate by the ACA.