Covered or Coverage—What Does It Mean in Health Insurance?

This baby is well covered by his blanket, but maternity care may or may not have been a covered benefit for his mom. Image © shaunl/Getty Images

The world of health insurance is so full of jargon it can be difficult to understand. This is especially true when common words are used in a way you wouldn’t normally use them in your every-day speech. The words covered and coverage are fine examples of this.

So, what do covered and coverage mean when you’re talking about health insurance?

To have health insurance coverage means you’re insured. You have a health insurance policy, a contract with a health insurance company.

Your health insurance company will share the financial burden of paying for your medical care with you. In exchange, you, your employer, or the government will pay monthly premiums to the health insurance company. People who don’t have health insurance coverage are uninsured.

Usage example:
“Do you have health insurance coverage?”
“Yes, I have Blue Cross.”

To be a covered means you have health insurance. If you’re a covered health plan member, you have health insurance in the form of a health plan, for an example, an HMO. If you’re covered, you’re not uninsured.

Usage example:
When you’re covered by Medicare, you don’t need to get Obamacare because you’re already insured.

If something is a covered benefit, it is a health care service or item that the health insurance company agrees to pay for, at least in part, if you follow the health insurer’s rules about how you get that health care service or item.

For example, hospitalization services are likely a covered benefit of your health insurance. If something is not a covered benefit of your health insurance, your health insurer is not obligated to pay for it no matter how badly you need it.

Usage example:
Cosmetic surgery is not a covered benefit unless it’s needed to improve or restore the function of your body.

Your health insurance won’t pay for your facelift.

If your health plan covers something, it means your that thing is a covered benefit. Your health insurance will pay for that item or service if you need it and if you follow your insurer’s rules about how to get it.

Usage example:
“I finally have health insurance the covers maternity care, so now we’re trying to have a baby.”

To use your coverage means you’re getting some kind of health care service or item that you expect your health insurance to help you pay for.

Usage example:
If you have an HMO, make sure you understand the rules associated with using your coverage. If you stay in-network, it will pay, but if you go out-of-network, it won’t pay.

Continue Reading