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- A rider is any type of amendment to a health insurance policy
- They can add coverage or exclude coverage depending on a situation
- Since 2014, health insurance plans have not been able to include exclusionary riders in their policies
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There are a variety of health insurance plans available. Within each plan, there is also the possibility for further variance. Riders, which are essentially amendments to a coverage plan, can be added on a case-by-case basis.
These health care riders can expand coverage for an additional cost and make the overall plan more suited for a particular individual or family. When shopping around for health insurance plans, it can be a good idea to also consider potential riders that you can add.
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What’s currently included in your health insurance plan?
The Affordable Care Act mandated that insurance companies in the Marketplace provide coverage for 10 essential benefits. They include:
- Emergency care
- Ambulatory services
- Hospitalization
- Pregnancy, maternity, and newborn health care services
- Services that fall under mental health and substance use disorder care
- Prescription drugs
- Rehabilitative services
- Lab services
- Wellness care
- Pediatric care
While each plan has to provide coverage related to each of the areas listed above, the specific policy may differ. Some plans may have higher deductibles and copayments, for example. Others may provide more comprehensive coverage, especially in the area of maternity and pediatric care, while having higher monthly premiums. For this reason, you should review the finer points detailed in a contract before choosing a particular plan.
What if you don’t have a Marketplace plan?
Many Americans have insurance provided through their employers or from another source that is not the Marketplace. In this case, insurance companies are not required to provide coverage for those 10 essential benefits. However, there are many plans that do have a similar level of coverage compared to the Marketplace plans.
How does a rider come into play?
If you feel that a standard plan isn’t ideal for you, you can speak directly with an insurance company about adding a rider. In the past, riders included both inclusionary and exclusionary provisions. Those exclusionary provisions often prevented patients from receiving coverage related to pre-existing conditions. This could have been quite expensive in some cases. In an effort to protect Americans, the law no longer allows exclusionary riders. Many people saw this as a key element of the Affordable Care Act.
Riders can be added to your specific plan according to your preferences. In exchange for having that additional coverage, you will likely be charged a higher monthly premium.
It may take careful consideration and a lot of comparison shopping before you’re ready to make a final decision on a health care plan and any potential riders that you’d like to add.
What do riders cover?
Riders can vary in terms of what they may apply to. They can include:
- Waiver of premiums
- Personal accident riders
- Critical illness coverage
- Riders related to hospital stays
With a waiver of premiums in place, you may not have to pay premiums if you’re hospitalized for a long time. This may make sense for older or more medically fragile individuals who may expect to have loss of wages while they’re admitted to a hospital.
Personal accident riders may be something to consider if you have a relatively dangerous job or participate in hobbies that carry some risk. With this rider, you may be able to receive compensation after an accident occurs.
Since major accidents often result in extensive, and expensive, treatment, this type of rider can put you in a more financially favorable position after an accident. Your family may also receive benefits in the case of a fatal accident.
If you have a critical illness like cancer, a heart condition, or multiple sclerosis, you can expect to undergo extensive treatment for months or years. Many insurance plans will provide you with coverage to help offset related health care costs, but if you feel that you may need additional compensation, you can add a critical illness rider. With this rider, you might be able to receive additional benefits like cash payments once you’ve been diagnosed.
Other riders can expand the benefits you’ll receive. Some may give you more money to cover expenses related to your rehabilitative treatments, and others can give you the option of upgrading your hospital room to a semi-private or private one.
What You Should Think About
The additional flexibility of riders makes them attractive to many people. When trying to figure out which plan may work best for you, remember to find out more about potential riders that you can add.
The extra cost may be worth it to you since your rider could result in greater benefits being paid out to you or your family in case something significant happens.
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[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]
- https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
- https://www.healthcare.gov/glossary/rider-exclusionary-rider/
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