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Starting a new health plan?

How to cope if things don't go smoothly

Published: December 31, 2013 12:15 PM

At least 6 million Americans are starting new health coverage tomorrow, including about 2 million who have purchased plans through their state’s health insurance marketplace or HealthCare.gov, and another 4 million who are enrolling in Medicaid.  In a perfect world, the transition to new coverage would be seamless. In the real world, not so much.

The Centers for Medicare and Medicaid Services (CMS), the agency that’s running health reform for the country, seems to have spent part of its holiday break churning out useful information to help people make the switch. See a complete list of fact sheets at the end of this blog.

I’ve extracted some of the most helpful pointers if you find yourself in the following situations.

I’ve paid my first premium but haven’t gotten my membership card yet.

Contact your new insurance company directly. Its website should have a customer service number. Some plans will allow you to print a temporary card from their websites. If you need health care and don’t have a card, ask your doctor or pharmacy to call to verify. “Many pharmacies have the ability to check directly to confirm coverage,” said a CMS spokesperson.

I haven’t paid my bill yet.

If you’ve gotten it, pay it immediately! Your coverage isn’t effective until you do. Contact your new insurer directly to find out the fastest way to pay if you don’t already have this information. Some insurers are giving people a grace period to pay up, but that’s up to each individual company.  Don’t press your luck.

I thought I signed up, but I haven’t gotten a bill and my insurer has no record of me.

Oops, something clearly went wrong with your application. Don’t even try to unravel this on your own. Call HealthCare.gov, if you signed up through that site, or your state marketplace if you signed up there. A customer service representative will be able to look directly at your application and hopefully figure out what the problem is. And at HealthCare.gov, “if we can’t assist customers immediately, they’ll be put into our casework system where a caseworker will be in touch with issuers directly and will be able to see whether something went wrong with their application,” said a CMS spokeswoman.

I was informed that I’m eligible to enroll in Medicaid, but I’m not sure whether I’ve actually signed up.

As we’ve said before, if you find out you’re newly eligible for Medicaid (or that your child is eligible for the Children’s Health Insurance Program), you need to apply directly to the relevant state agency. If you haven't done that, you're not signed up. HealthCare.gov has a list of all the state Medicaid agencies, which can also handle CHIP enrollment. Unlike private health insurance, Medicaid and CHIP coverage can often be applied retroactively, but don’t count on it. Apply without delay.

And don't forget, if you haven't signed up for coverage yet, you can do it until the end of open enrollment on March 31. If you enroll by Jan. 15, your coverage will start on Feb. 1.

Here are some of the consumer fact sheets CMS has prepared. They're excellent and I encourage you to download them.

Preparing for your first doctor visit with your new plan.

What to do if you signed up but don't have coverage yet.

How to deal with prescriptions if you've switched plans.

Getting emergency care.

Got a question for our health insurance expert? Ask it here; be sure to include the state you live in. And if you can't get enough health insurance news here, follow me on Twitter @NancyMetcalf.

 

 

Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper, below.

   

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