Learn How to Access Government Health Care Coverage

When you apply for health coverage on the Health Insurance Marketplace  (or BeWellNM.com in New Mexico), you may find that you qualify for a low-cost or government program, such as Medicaid (low-income or disabled individuals), Medicare  (for those over 65 years, or younger people with a disability, or those with End-Stage Renal Disease), the Children’s Health Insurance Program (CHIP), Military Health Insurance for Veterans, or programs for American Indians and Alaska Natives.

Use the following information to help you understand Government health care options and to ensure you can access your benefits.

Understanding Medicare

Medicare is the federal government health insurance coverage if you are 65 or older (or turning 65 in the next three months and not getting benefits from Social Security), or a younger person with a disability, or if you have End-Stage Renal Disease. You won’t get Medicare automatically when you turn 65 years old.

  • The annual Medicare Open Enrollment  or 2020 health care coverage began on October 15, 2019 and continues until December 7, 2019. Supplemental Medicare Insurance, also known as Medigap, has different enrollment guidelines.
  • Use an enrollment checklist on the official Medicare government website to ensure you understand the enrollment process, required documentation and timeline.

Step 1 – Check Your Health Plan Identification Card
After you have enrolled, you will receive your health plan identification card with your confirmation letter in the mail. Upon receiving it, you will want to review the following:

  • Effective date
    Your confirmation letter and health plan identification card will show your effective date—the date your coverage begins. However, you can still use your benefits even if your card has not arrived in the mail.
  • Personal information
    Make sure the information on the health plan identification card is accurate. If you have any questions or concerns, please call the customer service number, located on the back of your card.
  • Primary Care Provider selection
    Please check that the Primary Care Provider (PCP) listed on your health plan identification card is the one you selected at the time of your enrollment.

Step 2 – Understand Your Plan’s Network (for Medicare HMO Plans)
If you ever feel the need to see a medical specialist, the best way to make sure your services will be covered is by coordinating your care through your Primary Care Provider (PCP). It can also save you money. Your PCP will be able to give you a referral to see a specialist that is within your provider network, so you don’t get stuck paying any unnecessary out-of-pocket expenses for seeing a specialist who’s not in your provider network.

Step 3 – Review Your Evidence of Coverage
Review your Evidence of Coverage (EOC) document which lists all of your plan benefits, costs and more. It’s an important legal document, so keep it in a safe place.

Step 4 – Notify Your Primary Care Provider and Pharmacy
Show your Primary Care Provider (PCP) and pharmacy your new health plan identification card so they have the most up-to-date information to prevent your claim from being denied due to incorrect information.

Be sure to take advantage of the mail-order program for eligible maintenance medications. You’ll enjoy the ease of having your prescriptions delivered to your mailbox.

Step 5 – Schedule Your Annual Wellness Visit
Your annual wellness visit is a great way to take charge of your health, ask questions and get advice from your doctor. There’s no copay or cost to you.

Understanding Medicaid and Children’s Health Insurance Program (CHIP)

Medicaid and CHIP are types of low or no-cost health insurance through the federal government if you and your family meet low-income requirements, you are pregnant or have a disability. Each state’s program is a little different depending on the needs and goals of that state. Your eligibility is based on your household size and income and determined by the government. You can apply any time of year on one of these websites, and if you qualify, your coverage can start right away:

Your state will determine if you qualify for Medicaid. Contact your state for renewal or application information.

Understanding Military Health Coverage Options for Veterans

If you don’t have veterans or other health coverage, you can use the Health Insurance Marketplace  (or BeWellNM.com in New Mexico) to enroll in a plan. If you’re already enrolled in any of veterans health care programs, such as VA Civilian Health and Medical Program (CHAMPVA), Spina Bifida Health Care Benefits Program (SBHCBP) or TRICARE, then you don’t need to get additional coverage.

For more important information on veterans health care plans, visit the Department of Veterans Affairs website.

Understanding Health Care Coverage for American Indians and Alaska Natives

If you do not have health care coverage and are a member of a federally recognized tribe, you can find out what health care benefits are available to you through the Health Care Marketplace (or BeWellNM.com  in New Mexico). Members of federally recognized tribes are allowed to purchase and enroll in Marketplace or Exchange health care coverage monthly.

If you aren’t a member of a federally-recognized tribe and don’t qualify for any other special enrollment period, you must enroll during the yearly open enrollment period from November 1, 2019 to December 15, 2019.

For more information about coverage options for American Indians or Alaska Natives, visit the Indian Health Service website.