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)
All health plans in the marketplace must provide a summary of their benefits and coverage, which you can review on Healthcare.gov, or talk to a representative by calling (800) 318-2596. You can also call your insurance company to get details on the plan you chose. TMA has a list of marketplace plan websites and phone numbers to help. (See sidebar: “Marketplace Plan Websites and Phone Numbers.”)
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.
Marketplace plan websites and phone numbers:
Blue Cross and Blue Shield of Texas
Community Health Choice
(800) 884-4901 (HMO)
(800) 240-3270 (PPO)
IdealCare (Sendero Health Plans)
Scott & White Health Plan
Valley Baptist Health Plan (Allegian Health Plans)