THE NEXT STEP – MAKING THE MOST OF YOUR COVERAGE

May 26, 2016 • By Dr. Cara James, Ph.D., Director, Office of Minority Health at the Centers for Medicare and Medicaid Services
Cross-posted from The CMS Blog

Dr. Cara James

Millions of Americans are gaining health coverage every year. Between 2013 and 2014, African Americans and Latinos saw the largest declines in uninsured rates[1]. During the 2016 open enrollment period, over 2.2 million individuals of color selected plans through the Marketplace[2]. Getting coverage is a big accomplishment, but it is just the first step. Regardless of your race or ethnicity, taking advantage of your coverage so you and your family stay healthy is an equally important step.

You may be getting coverage for the first time, or you may have coverage but do not use it very often. Regardless of how long you have had health coverage or where your coverage comes from (e.g., your employer, the Marketplace, or other sources of coverage), you may have a lot of questions on how you and your family can best use it to get the care you need. In 2014, the Centers for Medicare & Medicaid Services (CMS) launched, From Coverage to Care (C2C) to help individuals do just that – move from getting coverage to receiving the care they need. C2C is an ongoing initiative designed to help individuals achieve better health and navigate their way through the health care system.

C2C includes a number of resources such as the Roadmap to Better Care and a Healthier You and the newly released 5 Ways to Make the Most of Your Health Coverage, is designed to help you figure out what you can do to put your health first for a long and healthy life. One of the first ways is to confirm your coverage. Make sure your enrollment is complete and that you have paid your premium if you have one. This way you can use your health coverage when you need it.

The next step is to know is where to go for answers if you have questions about your enrollment and coverage. If you have questions about your enrollment status or premium, contact your health plan. Your health plan will also be able to tell you what services are covered and what your costs are likely to be. The Roadmap can help explain key health insurance terms, like “coinsurance”,” and “deductible”. The Roadmap also provides information on establishing and maintaining a healthy lifestyle, finding a provider, and helping patients engage in their health care. The Roadmap is available for download in eight languages, a tribal version, and in video format on the C2C website.

It’s important to remember that health insurance isn’t just for when you are sick. You can use your coverage to get recommended health screenings and preventive services which can help you stay healthy. You can find out which screenings may be right for you by visiting, MyHealthfinder.gov. Seeing your healthcare provider also provides an opportunity to ask questions about what you can do to stay healthy. When choosing a provider and making an appointment, it is important to pick someone who is in your network, if your plan has one. If the provider you select is out-of-network, the visit may end up costing more. If illness does take you to the doctor’s office, be sure to fill any prescriptions that the doctor may prescribe. Some drugs cost more than others, so if you are concerned about potential costs, ask in advance how much the prescription is and if there are more affordable options.

Insurance can be confusing, but there is help. Check out all of the From Coverage to Care resources and find out what you need to do to make the most of your coverage so you can live a long and healthy life.

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[1] Office of the Assistant Secretary for Planning and Evaluation (2015). ASPE Data Point: Health Insurance Coverage and the Affordable Care Act. Retrieved from:https://aspe.hhs.gov/pdf-report/health-insurance-coverage-and-affordable-care-act-september-2015

[2] Office of the Assistant Secretary for Planning and Evaluation (2016). ASPE Issue Brief: Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report. Retrieved from: https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf[PDF 1.71 MB]