What to Expect Now That You’re Covered

Now that you have insurance, you should know what to expect next. Here’s some key information that’ll help you learn how your coverage works and how to get the most out of your benefits. Once you enroll in your insurance plan, you’ll receive:

  • Your health plan identification card(s)
  • A benefit booklet and other useful details
  • A notice of when your policy takes effect and when you can start using your benefits
  • Regular communication from your health plan about benefits, claims filed by providers on your behalf (called an Explanation of Benefits), and other important details to keep you informed

Your Health Plan Identification Card:

  • Your health plan identification card is a reference card that lists your member and group identification numbers, copays and important phone numbers.
  • You’ll present your health plan identification card any time you visit a doctor or hospital, or have a prescription filled.
  • You will also need to present your card for certain tests, such as getting blood tests done at a laboratory, or an X-ray or CAT-scan at an imaging center.
  • Your doctor, hospital, and pharmacy use the information on your card to verify your coverage.
  • If you misplace your card or need more copies, you can request them from your health care company. Some health care companies also offer online access to your account, where you can print a temporary copy of your card and request new cards.
     

 

Before You Go to the Doctor:

  • Get familiar with the basics of how your insurance works. Your health care company’s website will likely have a lot of information and online resources.
  • Check if your provider or hospital is in your plan’s network. Visits to a provider who isn’t in your plan’s network will cost you more. This information will help you to better plan for out-of-pocket expenses.
  • Before you go to your visit, make a list of questions or concerns you’d like to discuss with your provider.
  • Be sure to note all of your medications if you’re seeing a new provider or if you’ve changed medications since your last visit.

After You Go to the Doctor:

  • As a member, you’re responsible for paying copays at the time of service. Once your deductible is met, your health care company will pay the balance of your costs for medical services directly to your doctor.
  • If you pay your doctor for services that are covered, you can also submit a claim to receive reimbursement.
  • You’ll be billed directly by your provider for services provided outside of your plan coverage.
  • You’ll receive an Explanation of Benefits each time you see a provider. This is a summary of the services you received, the amount paid by the plan, and your expected out-of-pocket costs such as deductible, copay and coinsurance.
  • On your Explanation of Benefits, you may see charges from different providers for the same procedure on the same date of service. For a surgery, there may be charges from the surgeon and the anesthesiologist in addition to the operating room and supplies. For a visit to the emergency room (ER), you may have a separate charge from the ER and hospital.

Paying Your Premium:

  • If you purchased your own coverage, you’ll have to pay your first premium before you can start using your benefits. You can continue to use your insurance as long as you keep your payments up to date.
  • Depending on your payment structure, you’ll receive a bill for your premium:
    • monthly
    • every other month
    • quarterly
  • Your health care company will likely offer a variety of payment options, including credit card payments or drafting directly from your checking account. Check with your insurance company for more information about methods they accept for payment.
  • If you are eligible for Medicaid coverage, generally there are no or low monthly payments, co-pays or deductibles. They have a variety of payment options.
  • Medicare has an “Easy Pay”  option that is free if you set up an electronic payment that is automatically deducted from a savings or checking account each month. Learn more  about the four ways you can pay for your Medicare plan.

Keep Your Costs Down:

  • Only go to the emergency room for a real emergency.
  • Visits to urgent care centers, unlike emergency rooms, can save you money when you can’t wait to see your doctor for a condition that isn’t a serious emergency. Urgent care centers are able to treat illnesses such as colds and the flu, do x-rays and treat for minor emergencies such as minor burns, sprains and lacerations.
  • If you have an HMO plan, be sure to use your primary care provider (PCP) as your first stop for care. Your provider will refer you to a medical specialist if one is needed.
  • Ask for generic drugs when you receive a prescription from your doctor. Generic drugs are as safe and effective as brand name drugs, but they cost less.
  • Stay in network when you make an appointment to see a provider.
  • Check your Explanation of Benefits to make sure you weren’t charged for services you didn’t receive.
  • Health insurance may cover all costs for your annual preventive care exams with your Primary Care Provider. Annual wellness visits may be included in your benefits. If so, they will not cost you anything out of pocket. Check with your insurance company to find out. These preventive health care services include:
    • Annual flu vaccines and standard immunizations
    • Screenings for blood pressure, cancer, high cholesterol, depression, obesity, and Type 2 diabetes
    • Pediatric screenings for hearing, vision, autism and developmental disorders, depression, and obesity
    • Mammograms

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