If you are one of the millions of Americans who recently obtained health coverage through the new Health Insurance Marketplace, Medicaid or the Children’s Health Insurance — also known as CHIP — here are some steps you can take to make the most of your new coverage.
1) PUT YOUR HEALTH FIRST
- Staying healthy is important to you and your family.
- Maintain a healthy lifestyle at home, at work and in the community.
- Get your recommended health screenings and manage chronic conditions.
- Keep all of your health information in one place.
2) UNDERSTAND YOUR HEALTH COVERAGE
- Check with your insurance plan or state Medicaid or CHIP program to see what services are covered.
- Be familiar with your costs (premiums, co-payments, deductibles, co-insurance).
- Know the difference between in-network and out-of-network services and your out-of-pocket costs for each service.
3) KNOW WHERE TO GO FOR CARE
- Use the emergency department for a life-threatening situation.
- Primary care is preferred when it is not an emergency.
- Know the difference between primary care and emergency care.
4) FIND A DOCTOR OR OTHER HEALTHCARE PROVIDER
- Ask people you trust and/or do research on the internet.
- Check your plan’s list of providers.
- If you are assigned a provider, contact your plan if you want to change.
- If you are enrolled in Medicaid or CHIP, contact your state Medicaid or CHIP program for help.
5) MAKE AN APPOINTMENT
- Contact your provider’s office and let them know if you are a new patient or have been there before.
- Give the name of your insurance plan and ask if they accept your insurance.
- Tell them the name of the provider you want to see and why you want an appointment
- Ask for days and/or times that work for you.
6) BE PREPARED FOR YOUR VISIT
- Have your insurance card with you.
- Know your family health history and make a list of any medicines you take.
- Bring a list of questions and things to discuss, and take notes during your visit.
- Bring someone with you to help if needed.
7) DECIDE IF THE PROVIDER IS RIGHT FOR YOU
- Did you feel 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 okay to change to a different provider! (If you want to change your provider, return to Step 4.)
8) NEXT STEPS AFTER YOUR APPOINTMENT
- Follow your provider’s instructions.
- Fill any prescriptions you were given and take them as directed.
- Schedule a follow-up visit if you need one.
- Review your explanation of benefits and pay your medical bills.
- Contact your provider, health plan, or the state Medicaid or CHIP agency with any questions.
We have a number of tools available to help answer questions you might have about your new health care coverage and to use it appropriately to get the care and preventive services that are right for you.
You can find these tools at our Coverage to Care website at marketplace.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.
Still have questions? Contact your insurance company directly or contact us at 1-800-318-2596 (TTY: 1-855-889-4325). Our trained representatives are available at the Marketplace Call Center 24 hours a day, seven days a week.
If you have questions about your Medicaid or CHIP coverage (www.healthcare.gov/what-if-i-have-new-medicaid-or-chip-coverage/), contact your state agency for more information.
David Sayen is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).