How to use your health insurance

Getting health insurance is a big step toward living a healthier and less stressful life.

Some people get health insurance, but then they don’t get all the benefits they pay for. Or some people lose their insurance because they can’t find the money to pay all the expenses. Let’s make sure that does not happen to you.

This health insurance user’s manual will help you make
decisions so you can get the most out of your new health insurance.

  Use it like a user’s manual 
  Write your information in it 
  Check off the boxes that talk about your situation

If you have questions, you can also contact:

Pranaya Rana
Consumer Education & Enrollment Specialist

Assists enrolled consumers with questions about health insurance (how to find a doctor, file a complaint, etc.)

prana@healthyfuturega.org
404 567 5016 x4

You're Covered. Now What?

No one plans to get sick or hurt, but everyone needs medical care at some point. Health insurance helps pay for these costs, and protects you from very high medical bills. It also allows you to stay healthy before you get sick. Now that you have health insurance, there are some things that you should do to get the most out of your insurance plan.

1. Pay your premium

You must pay your first premium before your coverage will be active. You can do this online when you select a plan or over the phone by calling the insurance company. You will need your insurance plan ID to pay. You need to pay your premium each month to stay covered.

2. Get Your Card

Your insurance company will send you a card in the mail with your plan’s information. You may also be able to get a printable card from your insurer’s website. The card has important information printed on it, like your plan number, group number, and contact information for the company. It is important to always take your card with you to doctor’s appointments.

3. Find a doctor

Find a doctor who you can see when you need medical care. It’s important to find one that accepts your insurance. Your insurance company can give you a list of doctors in your area that accept your plan. If you already have a doctor that you want to keep, call their office and ask if they accept your insurance. You should check with both your insurance company and your doctor to make sure the doctor is “in-network.”

4. Make an Appointment

You can get a wellness check-up every year for free. During your check-up, your doctor will ask you questions about your health, take your vital signs (like blood pressure and heart rate), and may do some routine tests to check for diseases. When you go to your appointment, make sure you bring:

  • Photo ID
  • Your health insurance card
  • Your family medical history — the doctor will ask about it
  • A list of any medications you are taking
  • Any questions you have for the doctor — it helps to write them down so you don’t forget

5.  Stay Well

After your appointment, follow any instructions that your doctor gave you. It’s very important to get any prescriptions that you were given. Take your medicine exactly as the doctor told you to. If you get sick or injured throughout the year you can make an appointment to get checked out. Unless it is a life-threatening situation, going to your doctor is much less expensive than going to the emergency room.

For more information about how to access care now that you're covered, download our full You're Covered, Now What fact sheet.

 

Finding a Primary Care Provider

A Primary Care Provider (PCP) is the doctor, physician’s assistant, or nurse practitioner who you visit when you need your yearly check-up, are sick or have a minor injury, or need other routine and preventive medical care.

You can get recommendations for a provider from several different places, including:

• Friends, neighbors, and relatives

• Your dentist, pharmacist, eye doctor, previous provider, or other health professional

• Advocacy groups — these can be an especially good resource if you need to find the best provider for a specific chronic condition or disability

 

In-Network vs. Out-of-Network

GHF_5_pcpinoutetwork

It’s important to pick a PCP that is in your insurance plan’s network of doctors (known as “in-network”). Usually, you get the best deal when you use doctors in your plan’s network because they have contracts to provide you with better rates. Your insurance plan may not pay at all for care from an out-of-network provider, which means you could pay much more.

To find the names of local doctors who are in your insurance plan’s network you can:

• Contact your insurance company by phone. The number is on the back of your insurance card

• Look on your health insurance company’s website for the “Provider Directory”

• Look in the company’s provider brochure or directory to see which providers will accept your plan. (The most up-to-date directory is on your insurance company’s website. They may also send it to you in the mail.)

• Call your doctor’s office and ask them: 1. Do you take my insurance? 2. Are you in my plan’s network?

Your health insurance company may assign you a primary care provider. However, if you don’t like the person they assigned you, you can usually change. Contact your insurance company to find out how.

 

Picking a Doctor

Call the doctor’s office and ask them questions about the things that are important to you. Some things you might want to ask:

• Are you accepting new patients?

• Does the provider speak your language? If not, is there a staff member that does?

• What are the office hours? Do they work with your schedule?

• How can you get questions answered after hours?

• Is the provider close to you? Is the office easy to get to? How would you get there?

• Does the provider have multiple office locations? If so, are you alright with possibly having to go to a different location?

• Which hospitals does the provider work with and can you get there?

• Keep in mind that it may take more than one visit to find the provider that is right for you.

 

Types of Primary Care Providers

Family Practice Doctor:  This type of doctor focuses on treating the general health needs of the whole family. Family practice doctors see all ages, from babies to the elderly.

Internal Medicine Doctor (Internist):  This type doctor focuses on treating specific diseases that occur mainly in adults, such as cardiovascular disease and diabetes. Internists only see adults, usually age 18 and older.

Pediatrician:  This type of doctor treats the health needs of children for both preventive health (for example: immunizations and wellness check-ups) and illnesses. Pediatricians see children from newborns up to age 21.

 

Need help finding a provider in your area that accepts Medicaid or PeachCare for Kids™?

Call the POWERLINE at 1-800-300-9003.

Operated by the Healthy Mothers Healthy Babies Coalition of Georgia, the POWERLINE has the most complete list of available health care resources for every Georgia county. This list includes providers who accept Medicaid/PeachCare patients. It also includes providers who offer low cost/sliding scale fees for services.

Preventive Services

Most preventive health care is FREE to you.

“Preventive care” services are health care services designed to keep you healthy and avoid illness and disease.

Most preventive care is fully covered by your health insurance plan. That means that you do not have to pay anything for it. Keep yourself healthy and ask your doctor which of these preventive services you might need.

Here are some examples of preventive care:

• Annual physical

• Well woman visits (your annual visit to the gynecologist)

• Birth control

• Flu shots & other select vaccines
         - Hepatitis A
         -
Hepatitis B
         -
Herpes
         -
Human papillomavirus (HPV)
         -
Meningitis
         - Pneumonia
         -
Tetanus, diphtheria, pertussis (TDaP)
         -
Chicken pox (Vericella)

• Blood pressure tests

• Mammograms

• Colonoscopies

• Help quitting smoking

• Nutritional counseling and help losing weight

• Breastfeeding support

• STI (Sexually Transmitted Infection) testing

• HIV Screening

You will not have to pay anything for these services as long as they are a part of your well woman exam or your annual check-up. It’s important to note, however, that if the preventive service is not the main reason you are at the doctor, you may get a bill for the visit.

 

You can find a complete list of free preventive care here

Share Your Story
WesleyStrickland
Wesley & Amy Strickland

“We would have never known that our retirement income could still qualify us for subsidies. This is great.” Retired in 2015, they found out with the help of an enrollment assister that their retirement income qualified them for financial help in the Marketplace. They enrolled in a plan that was $700 per month cheaper than their previous plan.

Accessing services if uninsured

Some medical providers, like Federally Qualified Health Centers (FQHCs) and charity care clinics, serve patients who do not have health insurance. If you need to see a doctor, these providers may be able to help you.

 

Federally Qualified Health Centers

FQHCs offer medical, pre-natal, pediatric, dental, mental health, and pharmacy services. You pay what you can afford, based on your income. Health centers are in most cities and many rural areas. To find an FQHC near you, call 404-659-2861 or go to www.gaphc.org and click “Find a Health Center.”

 

Georgia Charitable Care Network

GCCN clinics offer a variety of health care services, including medical, dental, vision, mental health, and pharmacy services. However, not all clinics offer all services and not all areas of Georgia have a charitable clinic. To find out if there is a clinic in your area and what services it may offer, call 770-738-4651 or visit www.charitablecarenetwork.com and click on the “Find a Clinic” tab.

 

Powerline

You can also call the POWERLINE at 1-800-300-9003 if you are uninsured and need help finding a provider. Operated by the Healthy Mothers Healthy Babies Coalition of Georgia, the POWERLINE has the most complete list of available health care resources for every Georgia county. This list includes providers who offer low cost/sliding scale fees for services.