Newly Insured? 8 Things to Know About the Affordable Care Act

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Image: Woman has her pulse taken at Care Harbor LA free medical clinic in Los Angeles
A woman has her pulse taken at Care Harbor LA free medical clinic in Los Angeles, Calif. on Oct. 31, 2013.Lucy Nicholson / Reuters, file

Before the Affordable Care Act (ACA) was fully implemented in 2014, there were 30 million African Americans who lacked any kind of health insurance coverage in this country. The law hopes to bridge that gap with affordable and accessible coverage, which is now a mandate.

While the big push was to get people enrolled in health care coverage, the government is now working to help people understand the coverage they have, and what the ACA means to them and their families.

So what do you do when you get that card in the mail? Here are eight tips to make the most of your health care coverage.

1. The Coverage is Affordable, Not Free

Insurance coverage helps to pay for your medical and surgical expenses.

Many people think that getting health care coverage through the ACA is free. If you are getting coverage through the healthcare exchanges, you will probably be paying a monthly premium.

The amount is based on your income and the plan you select when you sign up. You will also have deductibles and co-pays to consider in the financial equation. Once you sign up and get your card, it is important to pay your premiums on time, or your coverage will get cancelled.

2. Do Your Homework

“While the health care can be affordable, it is also complicated to understand,” says Cara James, Ph.D. , Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services. It’s important to take time to read all the paperwork that comes with the coverage you select.

You need to understand how your insurer will pay for your care. Some require you to pay for the office visit at the time of service, and get reimbursed. Other insurers pay the provider directly. Understand what your co-pays are, for both office visits and for prescriptions at the pharmacy.

Also make sure you know what you need to bring with you to each office visit. Many providers require that you bring your insurance card and driver’s license to each visit. Others will make a copy of these records at the first visit. Be prepared.

3. Think About Insurance As Wellness Care

Many of us go to the doctor just when we are sick. If you have not had coverage, you may have gone to the emergency room when you need medical care.

According to Dr. James, “It is too soon to know if the ACA has reduced the utilization of the emergency room for non-emergency care.” She adds, “The best way to stay out of the emergency room, is to do everything you can to stay healthy.”

That includes having regular physicals and screenings, and coming up with a plan of action with your doctor. One of the major changes in the law is that insurers must provide preventative care services such as mammography, diabetes screening with no co-pays.

This is particularly important for African Americans who have higher risks for manageable and preventable diseases, such as diabetes, heart disease, stroke, and certain cancers. Knowing your numbers and risks is the first step to leading a healthy life.

4. Find a Medical Home

A medical home is a doctor’s office or provider group that will be the home base for your medical care. Think about it like a general contractor who manages your health. The medical home is also the place where you get referrals to specialists when you need one. One of the benefits of having a medical home, is that all your medical records are housed in one place.

When you first get your insurance card, you will be sent a list of providers/doctor’s offices that will serve as your medical home. You will need to pick a provider, as a part of your care. Hopefully, when you selected your insurer, you checked to see if your current provider is covered. If he or she is not, then you will have to select a new one. And remember that if you go to a doctor who is not covered by your insurer, you will probably have to pay for the visit yourself. You could rack up big, uncovered medical bills if you go to an out of coverage provider.

5. Make a First Appointment Before You Need It

The best thing you can do is make an appointment with your new provider as soon as you get your card. That way when you really need to get in for care, you can get scheduled, rather than waiting weeks or even months to be seen.

One of the biggest surprises that newly insured patients, and patients who are new to a provider face is the long wait time to get scheduled into the doctor’s office. The worst time to schedule a first time doctor’s visit is when you are actually sick. Even if you select a provider/medical home, you are not actually a patient there until you come in and are seen for the first time. During that first visit they will take down your insurance and personal information. You will also fill out health and medical history forms. You may also be asked to fill out a form giving your new medical home permission to get your past medical records from your last provider.

6. Understand the Link Between Health Literacy & the Bottom Line

We spend more time researching the cost of our shoes than we do understanding what it takes to keep us in good health. Make understanding your health and having meaningful conversations with your provider about your health a priority.

The Black Women’s Health Imperative, one of the oldest advocacy organizations for Black women’s health, is not only getting the word about on how to use health care coverage, but also how to understand it as a part of your financial literacy. Courtney Christian, Advocacy and Policy Director for the Imperative, says it is important “to know how to stay healthy and to understand how our health impacts our finances.”

“The leading cause of bankruptcy is not overspending, but overwhelming medical bills,” says Christian. The new laws mean that you cannot be dropped from care because you have a pre-existing condition or because there are dollar amount caps on how much your insurance will pay.

7. Don’t Forget About ACA When You File Your Taxes

Many people who signed up for health care insurance coverage in 2014 will get a tax break to offset the cost of paying for their premiums. You have to produce required documentation proving that you either have coverage through your employer, private coverage or the health care exchange. If you don’t have any health care, you could face a tax penalty. Make sure you bring all the necessary paperwork to the person who will be preparing your income tax forms this year.

8. It Might Not Be Too Late

Maybe you missed the deadlines for 2015, which were December 15, 2014 and up to February 2015. Most people who have not gotten insurance will now have to wait for the 2016 enrollment period. However, there are exceptions. If you have a life change event, such as loss of a job that offered you insurance, switching to a job that now doesn’t offer insurance, death of a spouse, marriage, you may be able to enroll.

And it is important to remember the ACA requires that you re-enroll every year.

Good Resources

While the Affordable Care Act can be a game changer for people who don’t have health care coverage, it is also complicated to understand. There are many community-based navigators, through churches, community health centers and other outreach organizations in your city, who can help walk you through what you need to know.

The Black Women’s Health Imperative, has developed an at-a-glance infographic with key things you need to know about getting and using health care.

The Centers for Medicare and Medicaid Service has produced this "From Coverage to Care Roadmap" and posted detailed information on the health care marketplace, as well as a place to subscribe to receive regular updates and tips to make understanding care easier.

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