Health insurance terminology can be confusing. What exactly does it mean when a healthcare service is covered?

Generally, it means that your health plan provides support to help you pay for healthcare and protects you from paying big medical bills.

<h4>Common misconception
</h4>
Many believe that having something &ldquo;covered&rdquo; by health insurance means it&rsquo;s completely free &ndash; but that is not the case. It does not always mean that the service will be paid for 100%.

<h4>What does covered healthcare REALLY mean?
</h4>
Covered healthcare services mean that insurance will pay for some of it (you&rsquo;ll pay a reduced price) &ndash; or all of it. There could be some cost-sharing involved or, in other words, out-of-pocket expenses like your deductible. But keep in mind that you pay less for covered, in-network healthcare even before you meet your deductible because insurance companies negotiate lower rates with in-network providers.

Generally, negotiated rates are below full price for medical fees and reduce what you have to pay out-of-pocket when you are treated by in-network doctors and hospitals. Think of health insurance&nbsp;companies as your advocates, ensuring you get care for a lower cost and that unnecessary price increases are kept in check.
Coverage examples:

Scenarios will vary based on your plan type.

<ul>
 <li>Scenario 1: Urgent care is covered under your health plan, but a copay still applies. A copay is an out-of-pocket expense. If the copay is $75, you have to pay this amount &ndash; usually at the time of service.</li>
 <li>Scenario 2: Your foot x-ray is covered under your health plan, but you haven&rsquo;t met your deductible yet &ndash; or paid anything toward it this year. A deductible is an out-of-pocket expense. If your annual deductible in this case is $1,000, and the cost of this covered X-ray is $200, you will need to pay $200. What makes this service covered is that you are paying the lower rate negotiated by your insurance company ($200), and the cost counts toward the annual deductible. Now $800 would remain to be paid by you for future services before insurance starts to pay its share.</li>
 <li>Scenario 3: Hospital stays are covered under your health plan. You were unexpectedly in the hospital for three days after a car accident. The <a rel="noopener noreferrer" href="https://www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs/" target="_blank">average cost</a> of a three-day hospital stay is around $30,000 dollars. If your plan has a $3,000 dollar out-of-pocket maximum, then once you pay $3,000 toward your care including deductibles, coinsurance, and copays &ndash; your health insurance pays for the rest of your hospital stay. This protects you from about $27,000 dollars in medical bills.</li>
</ul>
Preventive care: It&rsquo;s important to note that most health plans are required to cover preventive care without any cost-sharing. This means even if you haven&rsquo;t met your annual deductible, you can still receive preventive care services at no cost to you. Preventive care includes things like vaccines, screenings, and some check-ups.

<h4>How to figure out what your health insurance plan covers
</h4>
<ul>
 <li>Your Summary of Benefits and Coverage (SBC): If you don&rsquo;t already have one, ask your insurance company for a copy of your plan&rsquo;s Summary of Benefits and Coverage which all plans are required to have. It will also be available on your online member portal. It&rsquo;s a helpful tool that breaks down what your plan covers and cost-sharing amounts.</li>
 <li>Call your insurance provider: If you have questions about what your plan covers, you can contact your insurance company&rsquo;s customer or member services department &ndash; that&rsquo;s what they are there for! Blue Cross Blue Shield of Arizona members can call the number on the back of their insurance card.
 </li>
</ul>
We understand that health insurance can be complicated. To learn more cost-sharing terminology, visit: <a href="https://www.azblue.com/inspire-health/blog/breaking-down-how-health-insurance-works" target="_self">Breaking Down How Health Insurance Works (azblue.com)</a>.

What is a Covered Health Service?

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