Using Your New Health Insurance

David Sayen

If you’re one of the millions of Americans who recently obtained health coverage through the new Health Insurance Marketplace, Medicaid, or the Children’s Health Insurance (CHIP), here are some steps you can take to make the most of your new coverage.

Put your health first. Staying healthy is important for you and your family, so be sure that you maintain a healthy lifestyle at home, at work, and in the community.

Stay on top of things: Get your recommended health screenings and manage chronic conditions. Always keep all your health information in one place and let your loved ones know where that is.

Understand your health coverage. Check with your insurance plan or state Medicaid or CHIP program to see what services are covered. Make sure that you become familiar with your costs. These include premiums, copayments, deductibles and co-insurance. Be certain that you understand the difference between in-network and out-of-network services and the out-of-pocket costs to you for these services. Know the difference between primary and emergency care.

Know where to go for care: Use the emergency room only for a life-threatening situation; understand that primary care is preferred way to go when it’s not an emergency.

Find a doctor or other healthcare provider. Ask the people you trust for advice on where to find a trusted physician and do some research on the Internet. Start with your plan’s list of providers. If the plan provides you with a provider, know how to contact your plan if you want to change. If you’re enrolled in Medicaid or CHIP, know how to contact your state Medicaid or CHIP program for help.

Make an appointment. Contact your provider’s office and mention if you’re a new patient or have been there before. Give them the name of your insurance plan and ask if they accept your insurance. Tell them your provider’s name and why you want to make an appointment. Be sure to insist on days or times that work for you.

Come prepared on the day of your first visit. Don’t come alone if you think you’ll need help getting to the appointment. Have your insurance card with you and know your family health history. Bring a list of any medicines you take and include any questions and things to discuss on that list. It’s OK to take notes during this visit.

Decide if the provider is right for you. Once the first visit is over ask yourself if you felt comfortable with the provider you saw:

• Were you able to communicate with and understand your provider?

• Did you feel like you and your provider could make good decisions together?

• Remember: it’s OK to change to a different provider.

After your appointment, be sure to follow your provider’s instructions. That includes filling any prescriptions you were given. Be sure to take your new medication as your provider directed. Schedule a follow-up visit if you need one.

Medicare has a number of tools available to help answer questions you might have about your new health care coverage, and how to use it appropriately to get the care and preventive services that are right for you.

You can find these tools at the Coverage to Care website, at market place.cms.gov/c2c. They include educational brochures and videos. Many are available in both English and Spanish, and more resources will be developed over the next few months.

If you still have questions contact your insurance company directly or call Medicare at 800-318-2596 (TTY: 855-889-4325). Trained representatives are available at the Marketplace Call Center 24 hours a day, seven days a week.

David Sayen lives in Alameda. He is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii, and the Pacific Territories.