If you need medical services and have insurance, now is the time to pay attention to what’s happening with your health insurance policy. 

To help you start the year off feeling confident and informed about your health insurance, we talked with the Family Health Clinic’s Health Insurance Navigators, Barb Hickner and Antoinette Valle.

Whether you have a new insurance policy or the same insurance policy, below you will find helpful information for what to expect for your health insurance policy this year. 

Insurance is important because when you get medical services through in-network providers, you’ll receive these services for an agreed-upon price that’s secured through your insurance. Insurance providers might also cover preventative services like immunizations and physical exams for free. 

Barb Hickner and Antoinette Valle, Health Insurance Navigators at the Family Health Clinic

If you have a new insurance policy, what should you be aware of? 

On January 1st, all of your deductibles and out-of-pocket minimums are set at zero. That means you might have to pay all of the costs of your services before your plan starts paying. 

If you have a new insurance policy, it’s important to make sure that your current providers are in-network with your new policy. To find out if your provider is in-network, call your provider and ask if they take your specific plan. Be as specific as possible. 

If you have a new insurance policy and your current provider is now out-of-network, contact your insurance provider to see if they still might pay some of the cost, or you might consider finding a new provider that is in-network. Your insurance provider may not pay for the services if you receive medical services that are out-of-network.

Some insurance policies now cover 100% of the cost of preventative services like a physical or a flu shot regardless of your deductible or copay. Find out what preventative services your insurance network might cover by reviewing your plan.   

If you have the same insurance policy, what should you expect? 

On January 1st, all of your deductibles and out-of-pocket minimums reset to zero. That means you might have to pay all of the costs of your services before your plan starts paying. 

Even if you have the same insurance policy, it is smart to review your plan because you might have access to free services that you have not taken advantage of previously. Some insurance policies now cover 100% of the cost of preventative services regardless of your deductible or copay.  

Every year, your insurance provider will send out new insurance cards. You can discard or shred your old card for security purposes and make sure you present your new card at pharmacies or provider offices because numbers can change. It’s important to present your newest card. 

Did you know? Many insurance policies cover immunizations like Hepatitis A, Hepatitis B, the flu shot, measles, mumps, tetanus and more. Every plan is different; review your plan or contact your insurance provider to find out what they cover. 

Barb Hickner and Antoinette Valle, Health Insurance Navigators at the Family Health Clinic

If you decide you don’t like your insurance policy, what can you do?

If you want to switch your insurance plan, you have to wait for the insurance open enrollment period unless you qualify for a Special Enrollment Period. Open enrollment happens only once a year (see the next section for more information on open enrollment and special enrollment.)

If you know you want to switch, review your options for the next year before the open enrollment period so that when the open enrollment time comes, you have already selected a plan that you know will be best. 

Depending on your employer or how you get your insurance, you might have a tool to help you review how much of your plan you used in the previous year. 

When can you change or apply for an insurance policy?

• You can change it during open enrollment. Your open enrollment period might change depending on your employer/HR department or where you get your insurance. Generally, it’s towards the end of the year, but make sure you know when your specific time is. 
• You can change it if you qualify for a Special Enrollment period. A Special Enrollment is based on a life changing event like moving, losing a job, or having a baby. 
• You can apply for Medicaid at any time. 

Do you need help with your insurance?

At the Family Health Clinic, we have Insurance Navigators who are dedicated to helping you navigate your insurance plans. We can help you with multiple types of insurance plans, including Medicare.

If you know someone who does not have insurance, the Family Health Clinic can work with them to price their medical services through a sliding-fee scale. 

 If you would like to speak with one of our navigators or learn more about the sliding-fee scale, call (800) 321-5043.