How to Find Out Your Health Insurance Marketplace Coverage and Cost

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.

TMA’s 20th week of “Hey, Doc” education programming

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.

What’s 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.

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