Feb. 26, 2013
Determining the benefits and costs for plans on the Affordable
Care Act’s (ACA’s) health care marketplace can be confusing. Even after
choosing a plan, many patients are still unclear about what kind of coverage
they have and how much it will cost, and the insurance company isn’t always
helpful. This week’s installment of Texas Medical Association’s (TMA’s) “Hey,
Doc” weekly education campaign offers several steps patients can take to learn
what their benefits and costs are before they visit their doctor.
week of “Hey, Doc” education programming
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
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
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.
next for TMA’s “Hey, Doc” report:
Week of March 3: What
should I do if I thought my doctor was on my insurance plan’s list, but really
isn’t? And I can’t find the specialist I need on my insurance plan’s list of
doctors. What should I do?
TMA is the largest state medical society in the nation,
representing more than 47,000 physician and medical student members. It is
located in Austin and has 112 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
Contact: Pam Udall
cell: (512) 413-6807
Contact: Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320
Click here to follow TMA on Twitter. Or visit TMA on Facebook.
Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.