If, like many Americans, you have been uninsured for several years and just recently obtained coverage under the Affordable Care Act (ACA), you may need a little course in how to navigate the healthcare system. Your health insurance card isn’t something you should tuck away into your wallet to use only when you’ve had an accident or become ill. A main goal of Obamacare is to switch the nation’s healthcare system from one that focuses on treating illness to one that works to prevent illness and promote health and longevity.
Finding a doctor
Before you selected your health plan, you should have checked your plan’s provider list to find out which doctors and facilities accept your plan. You will find this information at the insurance company’s website or, if you selected your plan at Healthcare.gov, follow the “details” link to your plan and select “Provider Directory.”
From the providers list, select a Primary Care Physician (PCP). This doctor will coordinate your care. Your PCP will get to know you, your health history and your unique needs. A PCP will monitor your health and recommend regular screenings.
Schedule an appointment with your doctor of choice to establish yourself as a patient. If you have reached middle age without regular check-ups, your doctor may schedule you for cholesterol, diabetes and colorectal cancer screenings. Women may also be referred for breast and cervical cancer screening. These preventative tests will not cost you any money; the ACA requires insurance policies cover these tests with no co-payments or deductibles.
If your doctor prescribes medication, check with your plan to see which pharmacies are “in-network,” meaning they have contracted with your insurance company to fill prescriptions at an agreed-upon rate. In-network pharmacies will take your insurance card as payment, although most plans require a co-payment. Some plans have a deductable amount that you must pay before prescription benefits kick in.
If you have an emergency that requires immediate care, head for the nearest hospital. Even if the nearest hospital is not in your provider network, you will not be charged more than if you went to an in-network hospital. In addition, insurance companies cannot require you to get pre-approval before receiving emergency room services.
Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.