How to Use Health Insurance

How to Use Health Insurance

If you have a new health insurance plan, you probably have questions about how to best use it.

There are two things you need to know right away:

  • How to find a doctor
  • Where to get your medicine.

Here’s what you need to know to get started.

Finding a Doctor, the Right Doctor

Now that you have new health insurance, it’s time to choose a doctor to help you get the most from your benefits. Choosing a care provider who’s right for you is exactly that – a choice. Here are some tips on ways you can find a doctor and other providers best suited to your unique health care needs. To get started:

  • Ask family members, friends and co-workers for recommendations. See what they like or don’t like about each doctor. You can also check websites dedicated to doctor reviews and ratings.
  • Find the names of medical professionals near you. Make sure they’re in your health plan's network so you’ll have lower out-of-pocket costs.
  • Narrow down your choices. Select a few doctors you want to try, then call their offices. Ask the staff these questions to help you decide who you want to see:

    • When is your office open? Are evening or weekend appointments offered?
    • Where is the office located?
    • Are you accepting new patients?
    • Which hospitals does the doctor use to see patients?
    • How long does it take to get an appointment?
    • Does the doctor or someone in the office speak my language?

When you like what you hear, take the next step. Schedule a visit with your top choice. During your first visit, take note of a couple of things. Is it easy to talk with the doctor? Are you comfortable asking questions? Does the doctor seem like a good fit? Remember, if you are not comfortable, it’s okay to look for another doctor.

Getting the Medications You Need

If your new health insurance plan includes a pharmacy benefit, the plan will help pay the cost for certain drugs. You’ll be able to get your medicine from several drug stores. Just like providers, certain drug stores contract with your health plan to offer reduced costs on your prescriptions. Make sure you use a drug store that’s in your health plan’s pharmacy network to lower your costs. You may also be able to have your medicine delivered directly to you via the mail. Mail order prescriptions can often help you save money.

You also can lower your drug costs when you use medicines covered by your plan. Check your plan’s formulary, or drug list, to find out what's covered.

To find out if a drug you take is covered, you’ll need to know:

  • The medicine's exact name
  • The quantity of medication your doctor often prescribes
  • The dose you are prescribed

If drug coverage is part of your BCBS health plan, you can look at your plan’s drug list by logging into Blue Access for MembersSM. Look under “Find Care.”

If a drug you take isn’t covered under your formulary, you can take these steps:

  • Talk to your doctor about options. A generic version or another covered drug could be a better choice for you.
  • Have your doctor ask your insurer to cover a drug not on its current formulary if there is a health need.
  • Appeal your health plan's decision if the request is denied. You have the right to appeal and provide information to support your need for the drug.

Spend a little bit of time learning about your health insurance plans and all the benefits it offers. When you do, you’ll be able to make full use of them to live healthier.

Originally published 8/25/2014; Revised 2023