How to Use Health Insurance

January 25, 2018

So now you’re covered by a health plan. Congratulations! But, maybe you’ve never used health insurance, or you’ve hardly ever used it. Here’s a guide to help you.

Using your card. Your new health insurance card is very important. You need it for ID if you require any medical services. You should get one from your employer, if you get your health insurance from your job, or from your health plan, if you have insurance you pay for yourself. Keep it in your wallet at all times. Maybe take a picture of it with your phone in case you ever misplace it.

Finding a primary care physician (PCP). Your PCP is your main doctor, who looks after your general health. Your PCP may recommend a specialist if you have a specific health problem. A specialist is a doctor who’s an expert on a certain kind of illness or part of the body.

How do you find a PCP for yourself? You may want to pick a PCP who’s in your health plan network. A doctor who’s “in network” belongs to a group of providers (healthcare professionals and facilities) that have a contract with your health plan, so you pay a lot less. If you pick a doctor who’s “out of network,” it could cost you a lot more. So you may want to stay “in network” if you can.

To find the best PCP for yourself, you can do one of three things:

  • Ask your friends and family if they like their PCP and see if that doctor is in your network and accepting new patients. You can find out by calling the doctor or asking your health plan.
  • Call your insurance company and ask for help in finding a PCP in your area who’s accepting new patients.
  • Go on your health plan’s website. There will likely be a tool that will help you find a doctor in your area. Make sure the doctor is accepting new patients and speaks your language (if English isn’t your first language). Does the doctor have weekend and/or evening hours? Be certain you find a doctor whose office is in the area of your home or work, so you can easily see your PCP.

Scheduling your first checkup with your new PCP. It’s better to manage your health before problems arise or before a health problem gets too serious. When you get your health insurance card, call your PCP to schedule your first visit. See if you can get a physical checkup at the same time, to find out if any possible health problems can be spotted right away.

Visiting the doctor. When you see your doctor, here’s a checklist of what you should bring:

  • Your insurance card and a photo ID.
  • Enough money for your copay (see below), which is what you owe for your appointment.
  • A list of questions or concerns to discuss with the doctor.
  • A paper and pen so you can take notes of what your doctor says.
  • Another person, if you’d like to have someone also listen to the doctor or if you need help with English.

After your first visit with your new doctor, how did you feel about your visit? Did you like your doctor? If, for some reason, you don’t feel comfortable with your doctor, find another in your network. It’s your health!

What am I supposed to pay? When you have health insurance, you have to pay for certain things. Here are the most common ones:

  • Premium: This is the amount your insurance company charges you every month for coverage. If you get your healthcare coverage at work, your employer may pay all or part of your premium.
  • Deductible: That’s how much you have to pay for healthcare before your health plan starts to pay. Suppose your deductible is $2,000. Before your plan kicks in and starts paying for covered healthcare services, you would have to pay $2,000. Your deductible may not apply to all services. (To learn more about how to save money on a deductible, read How to Save Money on a Deductible in this issue.)
  • Copay: This is a fixed amount you pay when receiving care from a doctor or other provider (for example, $30 for a visit to a PCP).
  • Coinsurance: This is what you owe for a covered healthcare service, calculated as a percentage. If your coinsurance is 20 percent, it would cost you $20 for a $100 office visit.
  • Out-of-pocket maximum: This is the highest amount you have to pay for covered health services in a year. For more on this, see Reaching Your Out-of-Pocket Maximum in this issue.