Making the Most of Your New Health Coverage

Make the most of your health coverage

Once you have health insurance, it is important to understand how to use your benefits. This includes knowing where to go for care, and how to make the most of your doctor's visits.

Know where to go for care. Your health insurance plan allows you to see different types of doctors depending on the type of care you need:

● Primary Care Provider: for when you feel well and need a regular checkup, or when you feel sick. Your primary care provider may also be your HIV provider, helping you manage your HIV and get your lab tests and medication refills.
● Specialty Care Provider/Specialist: for when you have symptoms or conditions that a primary care provider doesn't treat. If your HIV provider is not your primary care provider, they may be considered a specialist by your health plan. Call your insurance company to see if pre-approval is required before you make an appointment with any specialist.
● Urgent Care Clinic: If you are sick or injured and your doctor's office is closed, call your insurance company to find out if there's an urgent care clinic nearby that accepts your insurance. Most people save time and money by going to urgent care instead of an Emergency Room.
● Emergency Room: If you are very sick, seriously injured, in a life-threatening situation or having any other medical emergency, you should go to the Emergency Room. The Emergency Room is the most expensive type of care and you may have to wait to be treated.

Make the most of a medical visit. Before your first visit with a new doctor, ask your last doctor to send your medical records to your new provider. This will help your new doctor understand your medical history and current health care needs.

● Before every visit, prepare to bring:
● Your insurance card
● A photo ID
● A list of your medications
● Information about other health care appointments you have had since your last visit
● Information about ongoing health conditions or symptoms
● A list of questions to ask your doctor

● During each visit: Make sure your doctor knows your concerns and answers your questions. Ask your doctor to explain what you need to do to stay healthy. You can bring a family member or friend to your appointment to help you.

● After each visit, be sure to:
● Follow your doctor's instructions, including to refill a prescription, make an appointment, see a specialist, or get a test done.
● Call your doctor if you do not understand their instructions, need to know when to schedule your next appointment, or have questions.
● Open the mail. You may receive an Explanation of Benefits letter from your insurance company telling you what services you got during your visit and the cost. This is not a bill. Ask your case manager for help if the letter is not clear to you.
● If you need to pay any money, you will receive a separate bill from your doctor's office.

For more information: The ACE TA Center has developed the Making the Most of your Coverage guide to provide tips for people living with HIV on how to start using their new health insurance benefits.

The ACE TA Center works with the Ryan White HIV/AIDS Program to help diverse clients get enrolled in health coverage. targethiv.org/ace