About eight million Americans have signed up for new health insurance under the Affordable Care Act, but that doesn’t mean these newly insured folks know how to use their new coverage. Many of the lower-income people who have taken advantage of the health care law’s subsidies in order to buy insurance have been uninsured for years. Some have never been insured before.
National advocacy groups are working to help the newly insured understand how to use their coverage. Proper use of health insurance will help keep costs down without compromising quality of care. If you’re one of the many Americans with questions about how to use your new health insurance, read on to learn about filling prescriptions, seeing a doctor and getting emergency care under your insurance plan.
Health Insurance Confuses Many
While it’s true that health insurance enrollment is up since the Affordable Care Act rollout earlier this year, many of the newly insured lack the basic health insurance literacy they need to understand their rights and obligations under their new plans. Especially for people who have never been insured before, premiums, co-pays, deductibles, provider networks and other features of health insurance can be complicated.
A Kaiser Family Foundation survey found that, of the 4,400 Assister Programs set up to help Americans navigate the health insurance marketplaces, almost three-quarters reported that a majority of consumers struggled with terms such as “network service” and “deductible.” The New York Times reports that the Centers for Medicare and Medicaid Services, as well as individual insurance providers, are spearheading educational initiatives aimed at helping providers and community service groups to teach the basics of health insurance literacy to those who are just becoming insured after a long lapse in coverage.
How to Fill Prescriptions with Your Health Insurance
For many Americans, access to health care means access to prescription drugs. Your new health plan may cover some or all of the cost of your prescription medications. You can find out which prescription drugs are covered under your health insurance plan by:
Checking your Summary of Benefits. Your insurance company should send you a detailed document that outlines your benefits and coverage. It should include your insurer’s formulary, or list of covered drugs.
Going to your insurer’s website. You should be able to find a copy of the formulary here, too.
Calling your insurance company. They should be able to tell you if your medications are covered.
Your insurance provider may not cover all of your needed medications or may place a limit on the number of doses it will pay for under your plan. Insurers have been canceling coverage of many drugs to cut costs. If your prescription drugs aren’t covered, you can fit them into your health care budget by ordering them from our online pharmacy.
How to Find a Primary Care Provider
Many uninsured and under-insured Americans have gotten into the habit of relying on the hospital emergency room for care, because they couldn’t afford to see a primary care doctor. A primary care doctor can help you when you’re sick in a non-emergency situation, at a lower cost than the emergency room. He or she can also keep you healthy with preventative care.
If you don’t have a primary care doctor yet, call your health insurance provider to find out which doctors are in your plan’s network. Network service providers are those who have contracted to work with your insurance company and will accept your plan. If you already have a primary care provider, you may ask your insurance company, or your provider, if your plan will cover the cost of his or her care.
Plans sold under the Affordable Care Act will cover preventative care, which includes an annual check-up, screening for depression and diabetes, gynecological care for women, blood pressure tests and certain other screenings and procedures. You should schedule a checkup, or wellness visit, as soon as possible, even if you’re not sick. This will make it easier to get an appointment with your provider if you do get sick.
Getting Emergency Care with Insurance
If you’re sick and it’s not really an emergency, you should go to your primary care provider. If you can’t see your provider, because his or her office is closed or because he or she doesn’t have any openings that day, ask him or her to refer you to an urgent care center. Urgent care centers handle non-emergency medical care throughout the day and night, so you don’t have to wait for your provider to be able to see you.
When you get sick, you may have to pay a co-pay, which is a fee that you pay when you see a doctor or pick up a prescription. You may also have to pay a deductible, which is the amount you’ll have to pay out of pocket before your insurance benefits kick in. Make sure you understand these terms.
If you have a true medical emergency, go to the emergency room of the closest hospital to you. You may still have to pay out of pocket costs, but your insurance provider can’t require prior approval or make you pay more for emergency care at an out-of-network hospital.
If you’re like many Americans who are newly insured under the Affordable Care Act, you may find health insurance confusing. While there’s definitely a learning curve, you should soon find that your new plan gives you access to more and better care.