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!

If you’re paying for health insurance 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 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.

Does Medicaid pay for gym membership?

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 ran experiments with behavior incentives funded by federal grants in the 2010’s.

It’s not just your state’s Medicaid laws that come into play. Some Medicaid plans extend this benefit even if the state does not require it. Many of these programs are run in partnership with the YWCA/YMCA and other like community organizations.

Call your Medicaid provider. They’ll be able to tell you if it’s a covered benefit or available as part of an auxiliary rewards program.

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. 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 durable medical equipment (DME). Durable 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 the hot tub, 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.  

Buying a hot tub sans insurance company? 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.

Does Medicaid cover hot tubs?

In most states, yes. That’s assuming that the hot tub is prescribed as a necessary piece of durable medical equipment by your doctor. And it doesn’t mean your insurer will make the process easy.

Some states have restrictions on qualifying DME, though restrictive policies can — in some cases — be litigated.

Does Medicare cover hot tubs?

Yes, if you have Medicare Part B coverage. There are several caveats to get coverage, though.

First, your doctor must deem a hot tub medically necessary and write you a prescription. Your doctor must participate in Medicare, though we’re assuming that’s already the case.

Then, you have to find a manufacturer who also works with Medicare.

You may still have to pay for 20% of the cost, and plan deductibles apply.

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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34 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
    2. Liz

      What is the insurance provider? Does anyone know which insurance provider will cover the cost of a hot tub. I live in Arizona?

      Reply
      1. femmefrugality Post author

        I do not know, as even with the same insurance provider different plans may offer different coverage options. I’d recommend tearing through your own policy or calling around and explicitly asking potential insurers. I’d also recommend having this convo with your doc, who is likely to be more familiar with insurers in your area.

        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
  10. Michele Prevatt

    I wonder if I could get them to pay for an ipool, instead of a hot tub. I’ve had a two level lumbar fusion, and three cervical surgeries. First one, three levels, all went well for about 2 weeks. Then I slipped on the ice getting out of the car and pulled all of the screws out. Fixing that required a revision of the first surgery (the orginal hardware to be removed and replaced), then flipped over and have even more plates, screws and rods out in to stabilize my cervical spine. I have never really recovered from this surgery. What was originally a three level fusion (bad enough, right) to a five level fusion. I look like a cross between a Jack the ripper survived and Frankenstein. Scarring almost all the way across the front of my neck and another scar running from the base of my head to just below my shoulders in the back. I am in constant pain and do not wish to go back on all the pain pills. I have learned that whenever I am in water deep enough to float in, I am almost pain free.
    If this is at all possible, how would I go about making it happen? I really do not need a hot tub , but an above ground pool or an I pool to float and exercise in, just might give me the want/will to live again. Plus would be way less expensive then a hot tub.

    Reply
    1. femmefrugality Post author

      I say go for it! Insurance companies are a pain, so you might run into some speed bumps, but if you meet these three conditions it’s worth giving it a shot:

      1. Your plan does not explicitly exclude iPools .
      2. Your plan does cover medical equipment.
      3. Your doctor feels it would be helpful, too, and is willing to write an Rx.

      Reply
  11. Candie

    Do you know if they would cover any outside pool for aqua therapy. Because I cannot get to a gym that often.

    Reply
    1. femmefrugality Post author

      Hmmm I honestly have no idea. First step would be to see if your plan covers medical equipment. Then I’d talk to your doctor. They’ll have a better idea than I do, and they’re the ones that will have to write you a prescription, anyways. Sorry I couldn’t be of more help!

      Reply
  12. Amy Winters

    Thanks for pointing out that massages may be covered by health insurance if you see a physical therapist regularly. My aunt has been working with a physical therapist to regain dexterity after a bad accident. She still suffers from pain, and I think regular massages would really benefit her. I’ll definitely tell here to see if her health insurance will cover massages!

    Reply
  13. Paul Anderson

    I was web searching, trying to find out if any US states offer gym memberships for us on Medicaid, like Medicare does with Silver Sneakers. That search led me to here, based upon this statement I assume:
    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.
    It is that handful of States I’m trying to find out about; anyone know?

    Reply
    1. femmefrugality Post author

      This is a great question. There have been some shifts since I originally wrote this piece; let me dive into the research again and I’ll let you know for sure.

      Reply
    1. femmefrugality Post author

      It will depend on your plan! Talk to your doctor and call the insurer. It would fall under medical equipment if I understand correctly. I have filed such a claim before myself–just not for a hot tub and not with BCBS.

      Reply
  14. Debra Franzen

    Love the information. I have a reinburstment for gym membership on my plan. I like to find out about the massage also.

    Reply
  15. Gail

    Has anyone figured out what states offer gym memberships yet? I just was putting on an old pair of pj pants the other night and I was so ashamed. They would not go over my hips. Im only 32 years old and Im the mother of an 11 and 3 year old. The way I see it, Im digging myself an early grave knowing my family history and all. I cant stand the thought of my children not having me in their younger years because mommy died from being over weight. I am also a single mother on a state funded housing program. My babies need me. So if anyone could specifically tell me of colorado may be one of these states??? Tia…

    Reply
    1. femmefrugality Post author

      If we’re talking about Health First Colorado–the state’s Medicaid plan–a very brief cursory overview would make it appear that gym memberships are not explicitly covered, but not explicitly not covered either. Do you have a PCP? If so, I would relay my health concerns to them and ask them about the membership. If others have pursued it and if anyone has ever been approved. Could they write a prescription for me? Because even if it was denied, I could potentially make an argument to appeal.

      Your doctor is going to know the answers to these questions based on your local market far better than I could answer, but in the meantime I’d delve into the long-form policy handbook and research any legal arguments others have successfully implemented in the past to get the same benefit.

      It would be way cooler and easier if it were explicitly covered! But again, my research was very cursory–I’d encourage you to talk with your local medical professionals!

      Reply

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