You Finally Have Health Insurance – Now What?

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It's green light go.Get started using your new health insurance now. Image © JP Amet/Getty Images

If you’re new to health insurance or you’ve been uninsured for more than a few months, getting health insurance coverage is a big deal. Don’t just check it off your mental “to-do list” and go on about your life. Instead, actively manage your health insurance coverage to get the most out of it.

Whether you’re paying for it yourself, you’re getting a government subsidy to help pay for it, or your employer is helping pay for it, health insurance is a big investment.

Don’t just let it sit there sucking the monthly premiums out of your checking account or paycheck. Here’s how to get started using your health insurance.

Pay Your Premiums

If you get your health insurance through your employer, this usually happens automatically. But, if you buy your health insurance privately, through COBRA, or through an Affordable Care Act health insurance exchange, you need to pay the premiums yourself. In some cases, being late can result in your health insurance being canceled and being uninsured until next year.

Setting up automatic premium payments can help. Options include having the premiums automatically deducted from an account, automatically charged to a credit card, or paid each month through your bank’s online bill payment service. If none of these options work for you, develop your own failure-proof system for paying premiums on time every month.

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Learn How Your Health Plan Works

Whether you’re new to health insurance, or you’ve been insured for years but have a new health plan, make sure you understand exactly how your health plan works before you start using your health insurance.

If you have a managed care plan, the plan won’t pay for health care you get if you don’t follow the plan’s rules.

Things like failing to get prior authorization for a health care service that requires it, failing to get a required referral, or going out-of-network when your plan doesn’t cover out-of-network care will result in you paying the bill you thought your health insurance was going to pay.

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Make a Plan for How You’ll Handle Cost-Sharing

Even if you’ve had the very same health plan for years, the deductible, out-of-pocket maximum, copays and coinsurance rates can change every year. Make sure you know how much you’ll owe when you start using your health insurance, and make a plan for how you’ll pay those cost-sharing expenses.

You can find this information in your health plan’s Summary of Benefits & Coverage or Summary Plan Description. If you don’t have that paperwork, you can call the member services number on your health insurance card and ask.

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Make a Plan for How to Get Health Care Services

Even if you’re healthy, you should choose a primary care physician and schedule an appointment so you can establish a relationship. The last thing you want to hear when you’re really sick is “I’m sorry, there’s a three-month wait for new patient appointments.” Not only will your PCP do your yearly physical exam, manage your preventive health care, and make a plan for managing any chronic medical problems you have, but he or she can be a powerful advocate on your behalf if you run into problems with a health insurance claim.

While it would be nice if your PCP could provide all of the health care you would ever need, chances are good that you’ll eventually need some type of health care your PCP can’t provide or you’ll need health care when your PCP’s office is closed. Make a plan for this so you won’t run afoul of your health plan’s rules when the situation arises. Consider:

  • Where is the closest in-network urgent care center? You’ll need to know if you need care after business hours, on a weekend, or on a holiday, but you’re not having a true emergency. Urgent care centers can take care of simple things like sprained ankles, ear aches, and small cuts that only need a stitch or two.
  • What emergency room will you go to if you need emergency care? Most health plans will cover care you get at an out-of-network emergency room as though it were in-network as long as it’s a true emergency and you went to the closest emergency room. If the closest emergency room to your home and workplace isn’t in your health plan’s provider network, make sure your health plan follows this convention.

Get Your Preventive Health Care Up to Date

As long as your health plan isn’t grandfathered, it must provide preventive care without requiring you to pay a deductible, copayment, or coinsurance. Now is the time to get your preventive care up to date.

While primary care physicians are experts in providing preventive care, some women may wish to have their yearly well-woman gynecological exam done at the OB-GYN office instead. As long as you use an in-network provider, your preventive care should be covered whether you get it at your PCP office or your OBGYN office.

If You’re Getting a Health Insurance Subsidy…

If you’re getting a premium tax credit health insurance subsidy to help pay your health insurance premiums, that subsidy is based on an estimate of your income this year. If the estimate is wrong, you could end up having to pay part of the subsidy back when you file your income taxes next April 15.

To decrease the chances of this happening, update your health insurance exchange if your income changes. Did you get a large bonus or commission? Are you getting a raise? Did you lose your job or have your hours cut back? If these financial changes are big enough to make a significant impact on your income, update your health insurance exchange.

The exchange will re-calculate your subsidy. This may change your monthly premium payment amount, so if you’ve set up an automatic payment system for your premiums, update it with the new amount.

Once a year during open enrollment, you should update your financial profile with the health insurance exchange even if your income and family size haven’t changed. If you do nothing, you’re likely to get the same subsidy amount you’re getting this year. But, your subsidy amount is based in part on the price of the second-lowest cost silver plan in your area. Since that benchmark plan’s premium will change each year, the subsidy amount you should get will change each year even if your income doesn’t. If you do nothing and take the same subsidy amount you got last year, you’ll be getting the wrong subsidy amount. You may have to pay some back.

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Re-Evaluate Your Health Insurance Each Year

Although many employers and health insurance exchanges use automatic renewal to re-enroll you in your health plan each year, don’t rely on this. Whether you use the health insurance exchange or get your health insurance through your job, each year during open enrollment, you should look at

  • How the cost-sharing expenses for your current health plan are changing.
  • Whether your current plan’s provider network still includes your PCP, hospital, lab, and any specialist physicians you use.
  • Are your prescription drugs still on your health plan’s drug formulary? Are they still on the same tier of the formulary, or have they been moved to a higher tier so you’ll have to pay more?
  • What competing health plans are available in your area, and how do they stack up against your current plan.

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