Will My Uninsured Medical Expenses Count Toward My Deductible?
Unfortunately, uninsured medical expenses (that is: medical costs that aren’t covered by your insurance plan) will NOT help you reach your deductible. Your deductible is the amount of money that you spend on covered medical expenses before your health plan shares the cost of your care.
Uncovered medical costs also won’t be counted toward your plan’s out-of-pocket maximum.
This is why it’s important to seek care that’s covered by your insurance whenever possible.
Medical devices that aren’t covered by your plan are treated the same way. Even if your treatment was necessary and appropriate, only covered costs will count towards your deductible.
You can ask a doctor to give you a prescription or referral that your insurance will cover. Some plans won’t cover specific drugs because they prefer to cover a very similar drug instead. For example, some insurers will balk at paying for a name-brand drug but will pay for a generic version of that same drug.
In limited circumstances, such as the need to see a specific doctor for a rare disease, your health insurer can pre-approve out-of-network care. Your plan may share the costs or pay for it as if it was in-network care.
Some health insurance plans offer limited recognition of out-of-network claims or have a separate out-of-network deductible. If you visit a doctor and pay out-of-pocket, then it may be worth submitting a bill to your insurance company. Although your plan won’t be required to count the bill against your deductible, they may do so if they have adopted a more generous policy.
Health Savings Accounts and Flexible Spending Accounts have more lenient rules about medical costs. If you have an HSA or FSA, you can still use them to pay for qualified medical expenses whether or not they’re covered by your insurance policy.
Taking the Next Steps
If you find that your healthcare coverage is too limiting for your needs, then consider finding another health insurance policy. Note that the Affordable Care Act dictates that you can purchase plans only during Open Enrollment unless you are eligible for a Special Enrollment Period.