March 29, 2024

Understanding Your New Health Plan

Posted on June 30, 2014 by in April 2010

If you’re one of the 8 million Americans who signed up for coverage during the Health Insurance Marketplace’s initial open enrollment period, how do you get the most out of your new health plan? Follow these steps to understand how your plan works. First, find out from your insurer:MedicareBoard72

— your share of the cost for a doctor or hospital visit;
— if your share is higher for using an out-of-network provider;
— what you’ll pay for prescription drugs.

When you first got coverage, your insurance company should have sent a membership package, including a proof-of-insurance card. The card will answer some of those basic questions and tell you how to contact your insurer.

Second, choose a doctor with whom you can have an ongoing relationship. Look at your insurance company’s website or handbook for providers near you who accept your health plan. Also ask friends and family for suggestions. Narrow your choices by calling the doctor offices you think might work for you and asking the staff a few questions:

— is the provider accepting new patients;
— is the office open at hours convenient for you;
— which hospitals does the provider use.

If you like what you hear, make an appointment. Be prepared to provide your name, address, date of birth, Social Security number and information about your insurance. Have your insurance card with you when you call.

You may need to wait a few weeks for a regular check-up. For your first visit, bring your insurance card, a photo ID (such as a driver’s license), any forms you were mailed and asked to complete, and a list of your prescriptions. Show up early for your appointment and check in at the front desk. The office staff will make a copy of your insurance card and ID in order to bill your insurer. If you owe a copayment, the staff will collect it when you arrive or leave. Don’t be shy.

Ask if you don’t understand something your doctor says. Before you leave, you should know the answers to these questions:

— How is your health? If you have a medical condition, what is it? What will happen if you don’t take care of it?
— What should you do to get healthier?
— If you take medicine, do you know how much to take and when to take it?
— What are you supposed to do next? (For example, do you need blood work or additional testing?) Where do you go to get it done? When do you need to see your doctor again?
— What should you do if you have questions once you get home?

If, after the first couple of visits with the doctor you’ve selected, you’re not satisfied with your choice, it’s okay to keep looking. Try someone else. You may prefer another doctor in the same office or clinic or another doctor at another office or clinic.

Once you’ve settled on a provider, see your primary care doctor regularly, even if you see a specialist for a particular illness. Your primary care physician can help answer questions about your health, change medications if they make you feel sick, and schedule your next visit should be. Don’t let excuses prevent you from make your next appointment. If you’re not sure what to do next, talk to your doctor or have someone you trust come with you to your next appointment and help you understand.

We’re all managing families, jobs and other things, but you can’t do these if you’re not in good health. It may be possible to schedule a follow-up visit after hours or on weekends. Check with your physician’s office.

Don’t put off seeing your doctor or getting a medical test because you worry about hearing bad news. Regular doctor visits and health care screenings let you detect problems early, when they’re most treatable.

Visit www.healthcare.gov or call 1-800-318-2596 if you have other questions about your new insurance coverage. Nothing is more important than getting healthy – and staying healthy.

Bob Moos is Southwest public affairs officer for the U.S. Centers for Medicare & Medicaid Services.

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