5 Surprising Things Health Insurance Covers

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Okay, I'm definitely checking my policy to see if my health insurance covers formula or a hot tub. The third one on this list is pretty amazing, too!

With the exception of residents of a few states, you now have to have health insurance.  If you’re paying for it anyways, make sure you’re getting the most for your money.  Here are five surprising things your health insurance may cover.  Plans and coverages vary, but it’s worth investigating to find out.

Some state's Medicaid programs cover diapers for kids with disabilities.Does Medicaid cover diapers?

Having a child over age three who is not potty trained can be taxing, both emotionally and fiscally.  If your child has a disability or learning delay, you could get your diapers for free.

Depending on your state, Medicaid will cover diapers in this situation. If your child falls into one of those categories, odds are you already have some version of Medicaid–if you live in a state that chooses to support its disabled children through Medicaid.

When I say disability I of course mean things along the lines of children with Autism or Down’s Syndrome, but “learning delays” is a much broader term.  Perhaps your child has delays with fine or gross motor skills, or they aren’t talking or communicating at a level that is “normal” yet. Both of these things can lead to serious problems with getting your kiddo on the potty every time.

Talk to your doctor at your child’s three year check up, and ask them to write a prescription. Even if you don’t have Medicaid, some private insurers will still offer this benefit.

Does your health insurance or Medicaid cover gym membership?

Does my insurer cover a gym membership?

Your health insurer wants you to be healthy.  Healthy people don’t file as many claims. And the less claims insurers have to pay out, the more money they can keep in their pockets.

As a result, many insurers cover gym memberships in one way or another. Some work with specific gyms to give you a discount or even a free membership, while others will offer your a set amount in reimbursement.

If you have Medicaid, gym membership may be covered depending on which state you live in. Most states do not offer it as a benefit, but a handful have experimented with behavior incentives.

Call your insurer to see what their policy is.  It just might be worth switching gyms!

If your insurer doesn’t cover gym memberships, that doesn’t mean you can’t get fit. Trying working out at home or going to reasonably priced gyms like 24 Hour Fitness. If you want to try them out, you can get a free pass here.

Is massage therapy covered by health insurance?

Are massages covered by health insurance?

Are you in desperate need of a massage?

Well, you may be able to get that covered, too. Especially if you have chronic back pain, were in an accident, or see a chiropractor/physical therapist regularly. If you have pain, talk to your physician about it.  If you can get a prescription from any of these medical specialists for massages, insurers will often cover the therapy.

Don’t know where to find a masseuse in your area? Use Spafinder Wellness 365’s search tool.

Insurance will sometimes pay for a hot tub if you have a medical need for it.

Wait–hot tubs are covered by insurance?!

WHAAAAAAAT?!?!  

I know.  It’s crazy good news.

Here’s the thing:  to get a hot tub covered by insurance, you have to have an actual medical need for it. Like injury. Spine problems. Etc. But if you do, asking your doctor if s/he thinks hot tub therapy would help certainly doesn’t hurt.

If they do think it would be beneficial to your situation, make sure they write a script.  From there, call your insurance company.  If you’ve got the Rx, and your policy doesn’t specifically state that a hot tub isn’t covered, it should count as a qualifying piece of medical equipment. Medical equipment is covered on many plans.

If it’s not, and you still really want and can afford that hot tub, take the prescription with you when you buy it.  That will eliminate the sales tax.

Plus, if insurance doesn’t cover hot tubs–even as a piece of medical equipment–it could be tax deductible as a medical expense.  So is the electric you’ll use to run it.

Be very careful here, though. If you’re throwing hot tub parties or your family is using it, you could run into some serious trouble if you get audited.  If you want more details, here’s a great article and an interesting forum on the topic.

Buying a hot tub yourself? Just because it’s tax deductible doesn’t mean you shouldn’t score a great deal. Make sure to check out sites like Groupon before making your purchase.

Check out the states that require insurance to provide prescription formulas.

Are there any instances of insurance covering formula?

Yes. If your child needs a prescription formula, such as Alimentium or Nurtamigen, it may be covered.

Usually these coverages are in the form of reimbursement, and usually your health insurance company will give you the run around–even if prescription formula is clearly covered in your policy.

Stay strong. This stuff is expensive. It’s worth saving your receipts not giving up. You pay for that benefit, and you deserve to have them fulfill their end of the bargain.

If you live in one of the following states, there is legislation dictating that your insurance cover these prescription formulas, regardless of if they want to or not:

  • New York
  • New Jersey
  • Illinois
  • Oregon
  • Texas
  • Minnesota
  • Arizona
  • South Dakota
  • Kentucky
  • Maine
  • Maryland
  • New Hampshire
  • Massachusetts
  • Pennsylvania
  • Connecticut
  • Rhode Island

Get more details about each state’s specific legislation here.  Knowing your rights within the law can be a powerful tool to speeding up the process.

Another option for families in states which do not mandate this coverage is to look into your local Women, Infants, and Children program.

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20 thoughts on “5 Surprising Things Health Insurance Covers

    1. femmefrugality Post author

      It’s really worth getting to know your insurance plan… boring initially, but worth it long term!

      Reply
  1. taylorqlee

    God, I’d love to get a massage under my health plan. Not sure if it’d be a medical need though. And would it go toward my deductible anyway? (I should look this up.)

    Reply
    1. femmefrugality Post author

      You totally should… You might get a pleasant surprise! If it’s not covered, for some professions they are tax deductible.

      Reply
  2. evenstevenmoney

    My friend has great health insurance and they allowed a certain gym/activity expense so he was able to participate in the Ironman and insurance paid for it all, kind of crazy but makes sense wish more companies did it that way. Don’t try to fix a problem that’s already their, let’s prevent the problem from ever occurring.

    Reply
    1. femmefrugality Post author

      I could not agree more! Health care costs would go down dramatically if we truly focused on the preventative. That’s part of what healthcare reform was supposed to do… We’ll see how that all pans out, though. Major props to your friend! Ironmans are intense.

      Reply
    1. femmefrugality Post author

      It can be a nightmare to wade through for sure. My rule of thumb is if it’s related to health, call up and ask!

      Reply
  3. Toni

    Okay. No I didn’t know any of those items. Those are good to know. I’m beginning the PT stage and this is daunting. I wasn’t ready so we had to take a break. LOL!

    Reply
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  6. middle_class

    I stumbled across the 3+ diaper benefit a year ago and it’s been sooo helpful. My insurance does not cover it but my state’s medicaid program provides coverage. I had to talk to my pediatrician, submit a request to insurance, get a denial, and then provide the denial letter along with doctor’s prescription to an incontinence supply company (that had a lot of experience with medicaid cases).

    Reply
  7. Gary @ Super Saving Tips

    My wife’s insurance just started covering gym memberships up to $200/yr and that will be a big help to us. Many insurers have wellness plans and it’s worth seeing what they offer. My insurer has started offering incentives (gift cards) for various small things like routine bloodwork and a home wellness visit with a nurse.

    Reply
  8. Savvy

    Good to know. I do get about a $5 discount off my Jazzercise membership each month. Makes the monthly expense a little more doable. It started at $35 now I pay around $40 which is still cheaper than my Y membership of $62.

    Reply
  9. Tyler

    I have a friend who is a massage therapist and I have just given her all the money left on my FSA card at the end of the year for the last several years. I haven’t had to pay for a massage in a long time.

    Reply

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