medical expenses in health insurance

Medical Expenses Not Covered By Health Insurance And How To Handle Them

Selecting the right health insurance plan is crucial to ensure you get coverage for medical expenses when you need it most. However, even comprehensive plans have exclusions and may not pay for certain treatments, procedures, or healthcare services. Being aware of these exclusions can help prevent unexpected healthcare costs. Here are some common things health insurance may not cover and tips on how to handle them.

 1. Cosmetic Surgeries 

Cosmetic surgery performed to improve appearance, such as breast augmentation, liposuction, or nose reshaping, is typically not covered by health insurance. Cosmetic procedures are generally classified as elective surgeries, not medically necessary treatments.

Some exceptions exist. Procedures to correct deformities from birth defects, injuries or illness may be covered if deemed medically necessary. For example, breast reduction for back pain relief or reconstructive surgery after mastectomy for breast cancer. Check with your insurer first to confirm coverage.


  • Compare prices between cosmetic surgeons and negotiate fees or payment plans.
  • Look into financing options like loans or credit cards with promotional periods. 
  • Time procedures when you have extra funds like tax refund season.
  • Get non-surgical cosmetic treatments not usually covered, like Botox or laser skin resurfacing, as holiday gifts.

 2. Pre-existing Conditions

Pre-existing medical conditions present before obtaining health insurance, like diabetes, cancer, hypertension, etc., may be excluded for a period of time with some plans. This means costs associated with that condition may not be covered initially. 

The length of the pre-existing condition exclusion period depends on state regulations and the plan. Some states and plans do not allow the denial of coverage for pre-existing conditions. With others, exclusions may apply for up to a year.


  • Understand any pre-existing condition clauses before signing up for insurance.
  • Maintain continuous health coverage to avoid gaps that may trigger pre-existing condition denials.
  • Appeal denials if a condition was not properly disclosed or diagnosed during underwriting.
  • Look into resources like high-risk pools or public programs that may cover pre-existing conditions.

 3. Infertility Treatment

Treatment for infertility, including in-vitro fertilization (IVF), is often limited or excluded from coverage. Some states require infertility treatment coverage but benefits may be restricted to certain procedures, medications, or dollar amounts.


  • Get employer, union, or other group plans that may offer better infertility benefits compared to individual plans.
  • Look for clinics running discounts or financial assistance programs based on income. 
  • Ask your doctor for sample medications or less expensive protocols.
  • Use health savings accounts (HSAs), flexible spending accounts (FSAs), or pay cash for simpler procedures like ultrasounds or bloodwork that are more affordable without insurance.

 4. Alternative Therapies

Alternative treatments like acupuncture, naturopathy, and homeopathy are usually not covered unless state-mandated. Even then, coverage may be limited to certain conditions or therapies. Chiropractic care may be covered for injury rehabilitation but excluded for general wellness.


  • Check licensing requirements for practitioners offering cash discounts without insurance.
  • Ask providers about package deals or sliding scale fees. 
  • See if acupuncture or other services can be billed as more traditional medical treatments like pain management or physical therapy which are covered. 

 5. Over-the-counter drugs and Supplements

Non-prescription medications (over-the-counter) and health supplements like vitamins, nutraceuticals, and herbal products are generally not reimbursable through insurance. 

Some account-based plans like HSAs, FSAs, or HRAs may allow reimbursement if prescribed by a doctor. Plans with pharmacy benefits may cover prescribed OTCs like antacids, allergy, or cough medicines requiring a prescription. But supplements are rarely covered.


  • Use coupons, loyalty programs, or apps to get discounts on OTC purchases. 
  • Buy in bulk or ask for price matching to get deals on supplements.
  • Consider footing the bill for lower-cost items to save insurance for more expensive prescription medications and treatments.

 6. Alcoholism Treatment 

Although insurance may cover the costs of detox and rehabilitation for alcoholism, coverage often excludes treatment for physical diseases that result from long-term excessive drinking. This includes liver disease, heart damage, bleeding issues, nerve damage, and more.


  • Check into government programs or nonprofits offering help paying for substance abuse programs or treatments.
  • If diseases are recognized as distinct diagnoses, appeal coverage denials citing the medical necessity of treatment.
  • Enroll in group support programs like Alcoholics Anonymous for free aid in managing alcoholism.

Understanding exclusions in your health plan helps avoid unexpected costs so you can plan your finances accordingly. When possible uninsured costs arise, research payment assistance options and negotiate costs for optimal savings.

Read More- What Challenge Do Indians Face When It Comes To Buying Health Insurance?

How To Handle Non-Covered Expenses?

If you incur major medical expenses that are excluded from your policy, here are some ways to handle them without affecting your finances much:

Have adequate emergency corpus – Maintain separate emergency funds to pay for uninsured medical costs so that these don’t derail other financial goals.

Enhance policy with add-ons – Buy add-ons like OPD coverage, maternity rider, and critical illness cover based on your specific needs and life stage.

Buy a comprehensive plan – Some policies offer more comprehensive coverage than basic plans. Evaluate them for your needs.

Upgrade to family floater plan – Floater plans allow using the total sum insured for anyone in the family so unpaid expenses of one can be covered by others. 

Increase deductible amount – Choosing plans with higher deductibles and co-pay allows you to reduce premiums while bearing minor costs yourself.

Pay uncovered costs through savings – If uninsured costs are within affordable limits, pay through current income and savings rather than buying add-ons.

Consider fixed benefit plans – They pay a fixed amount on the occurrence of an event. Can supplement indemnity plan costs. 

Claim tax benefit – Uncovered healthcare costs can be claimed for tax deductions up to ₹50,000 in a year.

Prefer network hospitals – Use insurer’s network hospitals as far as possible to minimize non-covered expenses and get a cashless facility.