Congratulations! You’ve taken a critical first step by purchasing an insurance plan. Perhaps you’ve just purchased an Obamacare plan or maybe this is your first time with individual coverage (i.e., health insurance not obtained through an employer).
The next important step is actually understanding and using your coverage to, hopefully, help improve your health and protect your finances.
Here are some tips to help you get started using your health insurance.
1. Get to know your health insurance plan.
Review your membership materials when they arrive. Familiarize yourself with basics such as copayment amounts, coinsurance and the deductible, as well as differences in benefits for in-network and out-of-network care and whether or not you need to contact your health insurance carrier to have certain medical care preauthorized. (Tip: Check out the Essential Health Insurance Terms to know for help deciphering the terminology.)
Make sure you received a health insurance card (some companies provide a PDF version for you to print). Familiarize yourself with the information on the card—copayment amounts, customer service numbers and so on.
Most health insurance companies give you the ability to conveniently manage medical appointments, communicate with them securely, view health records and pay your monthly premium online. Information about creating or logging in to your account is usually included with your welcome packet. Familiarize yourself with your account and what materials the insurance company makes available online.
2. If you have a preferred provider, confirm that they are in-network.
Not all healthcare providers take all health insurance plans. Contact your insurance carrier to verify that the doctor you will see is covered by your health insurance plan and is considered in-network.
You can use your health insurance plan’s online provider directory to locate in-network doctors and clinics; however, when scheduling your appointment, it is wise to ask if the provider still accepts your health insurance. Online directories can sometimes be out of date.
3. Have a plan for what to do in the event of a minor injury or illness.
Don’t wait until you step on a rusty nail while painting your garage trim to find out where to go to get a tetanus shot. Locate your nearest in-network urgent care or in-store clinic and their hours of operation now.
In addition to their locations, verify the copay for these visits and find out if your insurance covers virtual clinic visits. These can be less expensive and a lot more convenient for treating minor problems like skin rashes, pink eye, and sinus infections.
Remember, in a true emergency, call 911 and obtain emergency services. Insurers cannot require that you get prior approval before obtaining emergency room services and cannot make you pay more in copayments or coinsurance for getting emergency care from an out-of-network hospital.
4. Be proactive about prescription drugs.
You don’t want to run out of a prescription and find that it’s not covered by your new plan. If you’re currently taking a prescription drug, confirm if your current pharmacy is in network. If it’s not, locate a new in-network pharmacy. Secondly, verify that the drug you’re taking is part of the drug formulary covered by the insurance company either by checking online or calling them directly.
5. Be prepared for office visit payments.
The doctor’s office tends to leave people feeling a little unsettled. Avoid additional discomfort in the form of billing surprises by confirming your benefits and copayments in advance. Office-visit copay amounts are often listed on your insurance card. If you are uncertain, call the customer service number listed on the back of your health insurance card or in your membership materials.
6. When you go to the doctor, bring your health insurance card.
When you check in at the clinic or hospital where you receive medical care, they will want proof of insurance. They need this information to bill your insurance company and also to determine if they need to collect a copay up front. If you do not provide this information, you may be billed directly and have to file a claim with your health insurance company on your own.
7. Remember – You have to pay out of pocket until you reach your deductible. Once your deductible is reached, you will likely owe coinsurance for medical care.
Health insurance benefits other than covered preventive services do not typically kick in until your deductible has been met. That means you will pay out of pocket until you reach that amount. Once you fulfill the deductible, you will be responsible for a percentage of covered medical care.
For example, if you buy a health insurance plan with a $3,000 deductible. You will pay for covered medical expenses out of pocket until you reach $3,000. After that, if you have a $1,000 bill for services covered by your health insurance benefits and your health insurance plan pays 80 percent coinsurance for those services, you will owe $200.
Learn more about how health insurance deductibles work.
8. Get preventive care—and get it from network providers
Under the Affordable Care Act, health insurance plans that fulfill the individual responsibility requirement must cover certain preventive care services at no additional cost to the insured. These services vary by age and gender; they may include vaccinations, well-woman visits, blood pressure screenings and colorectal cancer screenings, to name a few.
Utilizing these services is one of the best ways to maximize the value of your health insurance.You cannot be charged a copay or coinsurance for these included services when you utilize in-network providers, even if you have not yet fulfilled your deductible.
So whether it’s getting screened for depression or getting adult immunizations, be proactive about your preventative care in the coming year.
9. Pay medical bills on time and don’t be afraid to ask questions.
After you receive medical care, you will get an explanation of benefits in the mail. This document is not a bill. It simply explains what services you received, how you were charged and how much your health insurance benefits covered.
You will receive a bill separately. Before you pay, call your health insurance carrier if you need clarification about the billing process or do not feel you were properly charged.
For more information, read 7 Tips for Understanding and Negotiating Your Medical Bills.
10. Finally, fill in the gaps.
Now that you’re an expert on your health insurance policy, did you identify any gaps in your coverage? Maybe you wish to obtain dental coverage or are concerned that your deductible is out of reach should you need to use your policy. (Known as high deductible health plans, they are becoming more and more common.)
The other great thing about these plans is they’re not subject to open enrollment. You can enroll at any time! Get started with a quote today, or contact an insurance advisor* directly to discuss your needs.
What to do next…
Want to make your high deductible policy more affordable? Learn more about Hospital Plans.
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