Your new health insurance covers many preventive health services for your family with no out-of-pocket costs like copays or coinsurance—as long as you visit a doctor in your plan’s provider network. This is true even if you haven’t met your deductible.
These preventive services include everything from various disease screenings to vaccines. Of course, your health insurance also helps you when you’re sick by covering doctor and hospital visits, emergency care and prescription drugs.
Where you go depends on your symptoms. Although the list below doesn’t cover every possibility, it’s a good “rule of thumb” for understanding when to go where.
Your Doctor’s Office
- Usually lowest out-of-pocket cost
- Generally the best place to go for non-emergency care
- Depending on your health plan, you may need to choose a primary care physician (PCP)
- Focuses on a specific area of medicine
- Depending on your health insurance plan, you may need a referral from your regular doctor
Urgent Care Provider
- May offer care when your regular doctor is not available or you don’t need the level of care an emergency room provides
- Make sure the Urgent Care Provider you are going to visit is in your network, otherwise you may need to pay out-of-pocket costs
Emergency Room (ER)
- Treats serious illnesses and injuries: use the ER for life-threatening injuries or conditions that can’t be treated anywhere else
- ER visits have the highest out-of-pocket costs
Beyond the security that health insurance provides you and your family, there are several things you can do to make sure you’re taking full advantage of your health insurance plan.
- Be sure to read your Summary of Benefits (SOB) and Coverage documents. The new law builds many preventive services like screenings and vaccinations into your plan, with no out-of-pocket costs. For example, your health insurance probably covers an annual flu shot.
- To avoid high out-of-pocket costs, make sure to obtain referrals that are in-network.
- Be sure to use your plan’s Preferred Retail Pharmacy Network, which can help save you out-of-pocket costs.
- Take advantage of the “extras.” Your health insurance may offer discounts for health and wellness products, like gym memberships or classes on fitness and good nutrition.
If you have questions about individual or family insurance plan, please call 866-427-7497 or visit bcbstx.com.