Millions of Americans obtained health coverage through the new Health Insurance Marketplace or through Medicaid. For many of these newly insured individuals and families, this insurance is their first health coverage in a long time or ever. Now what? How can you get the most from this coverage? What do all these terms such as in-network, deductible, co-insurance (and many, many more) mean? How do you find and choose a doctor (“provider”), make an appointment, prepare for a visit and more? The Centers for Medicare & Medicaid Services (“CMS”) has launched an education initiative entitled From Coverage to Care with educational materials and videos available in both English and Spanish to help people make the most of their coverage.
From Coverage to Care roadmaps (48 page information and resource guides):
From Coverage to Care videos (11 short videos available in English and Spanish):
- Chapter 1: My New Health Plan Capítulo 1: Su primer seguro medico
- Chapter 2: Understand the Plan Capítulo 2: Entienda su plan
- Chapter 3: Words to Know Capítulo 3: Las palabras que debe conocer
- Chapter 4: Where to go for Care Capítulo 4: Adónde Ir
- Chapter 5: Finding a Provider Capítulo 5: Localice un proveedor
- Chapter 6: Making an Appointment Capítulo 6: Haga una cita
- Chapter 7: Almost Ready Capítulo 7: Ya está casi listo
- Chapter 8: My First Visit Capítulo 8: Mi primera visita médica
- Chapter 9: Like or Dislike Capítulo 9: Me gusta o no
- Chapter 10: The Day After Capítulo 10 : Después de la cita
- Chapter 11: The Final Word Capítulo 11: La palabra final
HealthCare.gov also answers many common coverage questions. Some of the topics covered include:
- Understanding your health care coverage: Make sure you start by knowing how your health plan or coverage works. Become familiar with the services that are covered and how much you’ll have to pay. You can also learn what any new terms mean and how they apply to your coverage.
- Using prevention to stay healthy: Your coverage is designed to serve you beyond just getting sick. At regular check-ups, you can ask questions on the steps you can take to become healthier. After all, prevention is a critical part to staying healthy – and under the Affordable Care Act, many preventive services are covered with no copays or additional costs.
- Understanding Primary Care vs. Emergency Care: You’ll visit your primary care provider for both routine check-ups and when you feel ill. When you are feeling extremely sick or are in a life-threating situation, you’ll visit the emergency department. You may pay a higher copay or coinsurance for emergency care visits.
- Following up after appointments: Remember that good care doesn’t stop when you leave your provider. Make sure you follow your health care provider’s instructions, schedule your follow-up appointments, if needed, and fill any needed prescriptions.
If you have questions about your new health care coverage, contact your insurance company directly or healthcare.gov at 1-800-318-2596 (TTY: 1-855-889-4325). Trained representatives are available at the Marketplace Call Center 24 hours a day 7 days a week if you need help. If you have questions about your Medicaid coverage, you can contact your state agency directly for more information.
For American Indians and Alaska Natives (AI/ANs), health coverage under the new Health Insurance Marketplace works a bit differently. Members of federally recognized tribes and Alaska Native shareholders can enroll in Marketplace coverage any time of year. Out-of-pocket costs like deductibles, copayments and coinsurance may not apply based on income levels. AI/ANs can get (or keep getting) services from the Indian Health Service, tribal health programs, or urban Indian health programs as well as using their new coverage to get services from providers on the Marketplace plan or via Medicaid, as applicable. Utilizing your new health coverage when accessing services at Indian Health Services, brings more funding into the IHS and allows IHS to provide more health care to all AI/ANs. More information is available at HealthCare.gov and tribalhealthcare.org.
You have this great new health coverage, learn how to get the most out of it!
Patrick Aitcheson is the Interim National Coordinator of the Diverse Elders Coalition. The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.