Thursday, February 27, 2014

How to Find Out Your Health Insurance Marketplace Coverage and Cost

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next several years. Texas physicians and the Texas Medical Association have carefully studied the law to help you understand what the changes mean to your health care.

As the Affordable Care Act (ACA) continues to roll out, Me&My Doctor’s “Hey Doc” series will answer your frequently-asked questions, as well as some you might not have thought to ask.

Check out TMA’s past “Hey, Doc” segments.




Q. My doctor can’t get a straight answer from my insurance company. How do I know what kind of coverage I have and if I can use my insurance?

A. There are a few things you can do before you visit the doctor’s office to prepare so you know what your benefits and costs are.

First off, you want to make sure you’ve paid your premiums on time so that your insurance takes effect. Just signing up is not enough. (See Why You Should Pay Your Marketplace Insurance Premium on Time).

You can call your insurance company to get details on the plan you bought. Healthcare.gov representatives should be able to provide you a contact phone number. Talk to a representative by calling (800) 318-2596. Or you can use a list of marketplace plan websites that TMA compiled to find the phone number you need.

If you’re just now enrolling in a health plan through the marketplace, either online or by phone, make sure you write down the member ID number you receive. You’ll need that number to check on your benefits when you call your insurance company. Or if you already received a member ID card, you can use that information when you call. (See What's my marketplace insurance id card for?) Your insurance company also should send you a welcome packet after you enroll. That should explain what type of plan you bought and what your benefits and costs are. (See What are deductibles, co-insurance, and co-payments?)

Lastly, some health plans also have special websites you can use to verify your coverage with your member ID.


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