Navigating the System

Empower yourself as a patient, and learn how to get the most out of your benefits. Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.  This section will help you navigate the health care system when you need care.

Topic Area: Getting care, what's covered

What do I need to know now that I have insurance?

Health insurance is not always easy to understand. Take some time to find out what your insurance will pay for and learn how to use your coverage.

Be on time with your premium payments

  • If you bought health insurance yourself, you should get the first bill from your insurance company within 10 days of signing up. You could lose your coverage if you don’t pay your premium on time every month. If you don’t receive a bill, call customer service and ask about it.
  • If you have health insurance through your employer, they are responsible for paying the premium. Most likely, your portion will be deducted from your paycheck.
  • If you have coverage through COBRA, you are responsible for paying the premium by the deadline each month.

Keep your health insurance ID card handy

  • After you’re enrolled, you will either receive ID cards in the mail, or get instructions to download and print cards from the plan’s website. Your insurance ID card is proof of your coverage. Review your ID card and contact the insurance company if you notice any errors.
  • You will need your ID card when you visit your doctor and if you call your insurance company to ask questions.
  • If you need care before you get your card, call customer service to ask what information you need to give the doctor’s office.

Learn what’s covered and what’s not

Avoid unexpected costs and make sure that you get the care you need. Before you receive care, understand:

Check out the Managing Your Cost section of this guide for more information and tips.

Know where to go for care

  • Find out if your doctors are in your plan’s network. Knowing which doctors and hospitals are in-network and out-of-network can make a big difference in how much you pay. In many cases, there is no health insurance coverage when you go out of network.  This means that you will need to pay the entire provider charge.  Learn more.  Check your plan’s website or call customer service to search for your doctor or find a new one.
  • Choose your health team. If you don’t have a regular doctor or facility that you use, or if the provider that you use isn’t in-network, you will want to choose a new primary care provider. Do your research by using your plan’s online doctor search and reading provider bios, or asking friends, family, and co-workers. You may also wish to find a primary care provider who has a relationship with any specialists that you rely on for care. Websites like NHHealthCost, which show cost  and quality information, may help you decide where to receive care.
  • Find a nearby urgent care center before you need it. If it’s not an emergency but you need care right away, an urgent care center is a good option. Learn more  Find out where the closest in-network urgent care center is and make a note of it so you’re prepared for when you need it.
  • Make sure you know whether or not you need a referral or preauthorization. Some plans require you to get a referral from your primary care provider if you need to see certain kinds of specialists. Or, you may need preauthorization before you get certain kinds of care. Learn more.

Find out how your coverage can help you stay healthy

  • Preventive care is often covered at no cost to you as long as you use an in-network provider and it’s on the list of covered services. Learn more.
  • Health and wellness in formation. Most insurance company websites offer all kinds of education and helpful tips to help you stay healthy.

Discounts. Many insurance companies offer health-related discounts to members. Check your plan’s website or call customer service to find out what’s available.


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