If you haven’t had private health insurance before or if it’s been a while, you may want to learn about using your coverage. Once you are enrolled in a Health Plan and your coverage has begun, you can use it to help cover medical costs for services like:
- Filling prescriptions at the pharmacy
- Going to the doctor
- Getting emergency care
Prescription Medications
Health plans will help pay the cost of certain prescription medications. You may be able to buy other medications, but medications on your plan’s “formulary” (approved list) usually will be less expensive for you.
Does my insurance cover my prescription?
To find out which medications are covered through your new Marketplace plan:
- Visit your insurer’s website to review a list of prescription medications your plan covers.
- See your Summary of Benefits and Coverage, which you can get directly from your insurance company, or by using a link that appears in the detailed description of your plan in your Marketplace account.
- Call your insurer directly to find out what is covered. Have your plan information available. The number is available on your insurance card, the insurer’s website, or the detailed plan description in your Marketplace account.
- Review any coverage materials that your plan mails you.
Going to the Doctor
Most health plans give you the best deal on services when you see a doctor who has a contract with your health plan. While you may be able to see doctors who don’t contract with your plan, visiting an “in-network” provider usually means you’ll have lower out-of-pocket costs.
Finding a Doctor in Your Plan
To find out if your doctors and other health care providers are covered by your new Marketplace plan, or to find a covered provider if you don’t have one yet:
- Visit your health plan’s website and check their provider directory, which is a list of the doctors, hospitals, and other health care providers that your plan contracts with to provide care.
- See your health plan’s provider directory. You can get this by contacting your plan, visiting the plan’s website, or using a link that you’ll find on the plan description in your Marketplace account.
- Call your insurer to ask about specific providers. This number is on your insurance card and the insurer’s website.
- Call your doctor’s office. They can tell you if they accept your health plan.
- Call the Marketplace Center at 1-800-318-2596 or the broker for your health insurance, like Group Plans Inc, as we can provide that information as well.
Getting Emergency Care
In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can’t charge you more for getting emergency room services at an out-of-network hospital.
I’m having an emergency. Should I go straight to the hospital or do I need to call my insurance first?
In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside a plan’s network.
What does it mean that insurance companies can’t charge me more?
Insurance plans can’t make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.
Will I have to pay anything?
This depends on the plan you chose and the hospital you go to. This care may be subject to a deductible, for example, or a hospital may have particular rules in place.
For more information on how to use your health insurance, to learn more about enrollment, or general questions and concerns, please call us at Group Plans Inc – (623) 889-7600 and speak to one of our licensed brokers to get the full impact of understanding how to use your health plans!