How Do I Know What Coverage I Have?

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? 

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 Pay 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 is 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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Marketplace plan websites and phone numbers: 

Ambetter Superior
www.superiorhealthplan.com/for-members/
(877) 687-1196

Blue Cross and Blue Shield of Texas
www.bcbstx.com/health-care-reform/health-insurance-exchange
(866) 716-5427

Aetna
www.aetna.com/about-aetna-insurance/contact-us/forms/about/contact_us.html?WT.svl=ContactUs
(800) 872-3862 

Humana
https://www.humana.com/individual-and-family-support/contact-us
(800) 833-6917

CIGNA
www.cigna.com/aboutcigna/contact-us/
(866) 438-2446
(800) 244-6224 (If you lost your ID card) 

Community First
www.cfhp.com/ContactUs/
(800) 434-2347 

Community Health Choice
https://www.chchealth.org/About%20CHC/Contact_Us.aspx
(888) 760-2600

First Care
www.firstcare.com/contact-us
(800) 884-4901 (HMO)
(800) 240-3270 (PPO)

Molina
www.molinahealthcare.com/members/tx/en-US/hp/marketplace/pages/enroll.aspx
(855) 540-1985 

Scott & White Health Plan
https://swhp.org/members
(800) 321-7947 

Sendero Health Plan
www.senderohealth.com/en/members/member-resources
(855) 526-7388



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