You have selected a health plan, paid your first premium and can now start using your health coverage. One of the first things your health plan will do is send you a health insurance ID card. Your ID card is your proof of insurance when you visit the doctor, hospital or other type of provider. But it is also an easy and quick reference that lets you know how much you may have to pay out-of-pocket for care. Understanding this information can help you plan your healthcare expenses and get the care you need.
What’s On Your Health Insurance ID Card?
Your Personal Information
Not all health insurance ID cards look the same or have the same exact information. But, you can expect to see some of the same information on any card. First, your card will list your name and member ID number. If you get health coverage through your job, your employer’s name and/or the group number assigned to your employer’s plan may be listed, too. If your dependents (such as a spouse or children) are covered by your health plan, they each will get a card with their names.
Your health insurance ID card may also show that you have vision, dental and prescription drug benefits (look for the Rx symbol) if they are part of your health plan.
Primary and Specialist Care Coverage
Often, the name of your primary care provider (“PCP”) will be listed on your health insurance ID card. Many plans require you to have a PCP who coordinates your care and makes sure you stay healthy. You may choose your own PCP, or your plan might assign you one. You also can change your PCP if you choose. If you do not have a PCP, you can call your plan, or check the provider directory, to find one in your network.
Your ID card may list your co-pay for a PCP visit. This also may be listed as the “office visit” co-pay. Keep in mind that many plans now offer preventive care at no cost to you, including one PCP visit each year. You can call your insurer or check with your doctor to find out what services you can get without a co-pay.
You may also see a co-pay for specialist care. Your specialist co-pay will usually be more than your PCP co-pay. In addition to knowing the co-pay, it’s important to know your plan’s rules for getting specialist care. Do you need a referral from your PCP first? Does your plan need to authorize the service that you need? Will the plan pay for a specialist who is not in your network? Make sure you ask these questions before your visit to avoid any unexpected costs.
Where You Can Get Care
Your costs may be different depending on where you get care. On your health insurance ID card, you might see different co-pays for emergency room care, hospital care and urgent care. Often, the emergency room co-pay will be waived if you are admitted to the hospital. If you can, check what you’ll have to pay for each healthcare setting before you go.
In-Network and Out-of-Network Benefits
Your health insurance ID card can help you understand how much you will pay for care that is provided by a health provider in your plan’s network—and outside of it.
Different Cards for Different Plans
You may have more than one insurance ID card. If you have separate prescription drug coverage, for example, you might receive a separate ID card for that plan. This is the card you should show at the pharmacy. Like your health insurance ID card, your prescription drug ID card will list your personal information. It also may list several different co-pays, depending on the kinds of drugs you are prescribed—generic and brand-name drugs, or drugs that your plan has put into different “tiers.” To avoid high out-of-pocket costs, you can discuss with your doctor whether you can be prescribed generic or lower-tiered drugs. If you have dental coverage under a separate plan, you also will have a different dental insurance ID card.
You also may have more than one insurance card if your family is covered by more than one plan. This might happen if you and your spouse both have health coverage through your jobs. In that case, you may need to show both health insurance ID cards when you visit the doctor. The two insurers will coordinate your coverage between them.
If you have a flexible spending plan, you may have a separate debit card that you can use to spend on qualified healthcare services and items—this debit card is not the same as a health insurance ID card. Flexible spending plans let you or your employer put money into a special tax-free account to pay for your care. There are three main types of flexible spending plans:
You can learn more about these types of savings plans here.
Your Action Plan: Use Your Health Insurance ID Card For Quick Reference
o Compare the cost-sharing features listed on your card to your summary of benefits and make sure it reflects your understanding of your coverage.
o If you do not receive your health insurance ID card in a reasonable timeframe, contact your insurer.
o Download and refer to our Questions to Ask Your Plan Before Going Out-of-Network and
Questions to Ask Your Provider.