Health Highlights

You finally have health insurance…what do you do now?

Published on: 07/06/2015

Health insurance is a contract between you and an insurance company to pay for part of your medical costs when you get sick or hurt. It also includes free preventive care such as vaccines and check-ups, which are part of your “health maintenance.” Health maintenance includes visits with your primary health care provider to discuss health habits, family history, as well as any questions or concerns you may have. It includes screening tests such as pap smears, mammograms, cholesterol testing, colon cancer screening, which can help with early detection.

During your office visits remember to write down instructions from your provider, healthy living tips and schedule any follow-up visits required. Fill your prescriptions when they are due so you don’t run out.

Choosing your health care provider is important when planning your health care needs. It is a good idea to ask questions and research a provider to find one that best suits you and your requirements. Make sure you feel comfortable working with them over time. Think of things that will be important to make you feel comfortable when you are choosing a provider. Remember that it is okay for you to find another provider if the one you have chosen does not seem to be a good fit for you. Your insurance will have a provider directory that will list all providers accepting your plan.

Understanding your health coverage and benefits is important. Terms such as co-payments, co-insurance, deductible amounts and out of pocket expenses can be confusing. Someone at your health plan will be able to explain these terms and how they apply to your policy. The information on your card includes a phone number so you can call to ask questions when you are in need of assistance. You should know how much it is going to cost you to visit your doctor if you get sick or hurt, as well as how much it will cost you if you have to go to an Emergency Room. Always have your insurance card available. Remember to keep your card in a secure and safe place.

It is important to know when you should visit your primary care physician and when you should visit the Urgent Care or Emergency Room. You should make appointments with your primary care provider when you are sick or hurt and only visit an Urgent Care or Emergency Room when you are very sick or have a life-threatening situation. It could cost you more money out of pocket to visit an Emergency Room than it would to go to your normal provider. You may end up waiting for a longer time in an Emergency Room and the provider you see may not know you. Your primary care provider has access to your full medical record and will be able to help you long-term.

For most people, the last day to enroll in a 2015 Marketplace plan was February 15, 2015. But in some cases you may still be able to get coverage this year. If you have certain life changes – like having a baby, getting married or losing health coverage, you may qualify for a Special Enrollment Period. If you do, you can enroll in a Marketplace plan outside the annual Open Enrollment period. Also, members of a federally recognized Indian tribe and Alaska native shareholders can sign up or change plans once per month throughout the year.

You may be able to enroll in coverage through Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide free or low-cost health coverage. You can apply any time during the year, and if you qualify you can enroll immediately.

There has been an additional Special Enrollment Period for individuals and families who did not have health coverage in 2014 and are subject to paying a fee or “shared responsibility payment” when they file their 2014 taxes. This special enrollment period will allow those individuals and families who were unaware or didn’t understand that there would be a fee if they didn’t have insurance for 2014. These individuals or families will be able to purchase health insurance coverage from March 15 through April 30. If they do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes next year. In order to qualify for this Special Enrollment Period, they must attest that when they filed their 2014 tax return they paid the fee for not having health coverage, and that they first became aware of the fee after February 15, 2015, in connection with preparing and filing their 2014 taxes.

If you are newly insured and need help figuring out where to start; or you need to explore your Marketplace insurance options including Special Enrollment Period, we are here to help! Please contact Mid-State Health Center’s Enrollment Coordinator at 603-536-4000 Ext: 1450, or e-mail us: marketplace@midstatehealth.org.

Take advantage of being insured to get healthy, remain healthy and live a happy, long life!

Karla Wagner
Marketplace Outreach & Enrollment Coordinator, Mid-State Health Center