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How to Prove You Have Medical Insurance

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The lowdown...
  • Your health insurance card provides essential information to you and medical personnel
  • When choosing or changing a doctor, make certain they are part of your insurance network
  • Make sure all eligible family members on your plan have their own insurance cards
  • Be aware of any changes that affect your coverage when renewing or switching policies

There will be several situations where a person will have to prove that he has health care insurance. This includes doctor visits, hospital stays, emergency room visits, and federal income tax forms.

When seeking to prove insurance in any of the above situations, be sure to include all insurance plans that are relevant. Thus if a person is on Medicare but has supplemental coverage, proof of both should be supplied.

Dependents may not always have proof but will have to depend on parent or guardian providing the necessary information.

Except in emergency cases, proof of insurance is required for the initial office visit or another medical facility.

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What kind of health insurance ID is needed?

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In most situations, the presentation of an insurance ID card is sufficient. However, as the patient, it is important to know the anticipated level of coverage. Often this information is on the ID card.

Depending on the family makeup, certain medical requirements, and the desired services, more than one ID card may be necessary.

Because of the complexity of health care, more than one insurance identification card may be needed. For example:

  • Persons covered by a Health Maintenance Organization (HMO) would have a card different that a person covered by a Point-of-Service Plan (POS) or a Preferred Provider Organization (PPO) where no prior referrals are needed.
  • Some insurance companies provided a separate Prescription Drug Coverage card that will be used at pharmacies.
  • In some cases, a different card dealing with vision or dental services may be offered, or they may be combined with the prescription drug card.
  • There are also various prescription discount cards that may cover some medications that the prescription drug plan does not cover or possibly offer a discount.

Different Cards for Different Plans

A person may have more than one insurance ID card. For example, a person with a prescription drug card and a health insurance ID card, both will contain personal information, such as name, address, co-pay amounts or other relevant data.

Health insurance ID cards may also 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.”

Since the cost of name-brand prescription drugs and generics are usually very significant. It is important to discuss with the doctor about the options that are available.

Family Coverage

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A person may have more than one insurance card if the family is covered by more than one plan. Situations where this might happen include:

  • When both the husband and wife are covered by different drug plans offered by employers, both cards have to be shown. It is not possible to collect coverage twice for the same illness or health issue. When duplicate coverage is available, the coordination of benefits clause is invoked, so that the patient will get the proper coverage but not duplicate coverage.
  • Show your health insurance ID card at the doctor’s office when you receive care. Make sure your doctor’s staff charges you the co-pay listed on your card. If you are there for a preventive visit, ask whether the co-pay will be waived. Asking this is important because check-ups and other preventive services are now free to patients under many plans.
  • Before you receive care, make sure you know your plan’s rules, and how much your care will cost. Do you need a pre-authorization or a referral for certain visits? Is your provider in your network?
  • Health Reimbursement Arrangements (HRAs): With an HRA, your employer puts money in your account. Depending on the arrangement, you may be able to carry money over from year-to-year. But, you can’t take it with you if you change employers.

Such a situation may occur if you and your spouse both have health coverage through your jobs. In that case, you may need to show both the ID cards authorizing coverage. 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 health care 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 plans. Before you receive care, make sure you know your plan’s rules, and how much your care will cost. Do you need a pre-authorization or a referral for certain visits? Is your provider in your network? These are questions that must be asked and answered.

Many Factors Impact Different Levels of Insurance

Becker’s Health Care has prepared a list of items could affect the impact of different insurance levels that may be available to the individual. Among these items are:

– Technology

According to MedPAC, technology is credited as having the most significant effect on healthcare spending growth, with studies identifying it as the reason behind anywhere from 38 percent to more than 65 percent of spending growth.

– Healthcare Product and Service Prices

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The level and growth of healthcare prices have a significant impact on healthcare cost. Studies have consistently pointed to price growth as the cause of between 10 percent and 25 percent of healthcare spending growth.

– Market Power

Provider market power also drives spending growth. Hospitals, physicians, and other providers have been consolidating at a rapid rate, and merging with others can give them greater market power over insurers and more leverage in payment rate negotiations, according to MedPAC.

Studies have found consolidation can lead to an increase of 5 percent or more in hospital prices.

– Health Insurance Coverage

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Getting health insurance coverage can potentially reduce patients’ incentives to seek the most efficient, lowest-priced care, according to MedPAC. One study of an insurance coverage experiment in Oregon found people randomly selected for Medicaid coverage used 25 percent more services than an uninsured control group.

However, the recent trend of employers and insurers placing more fiscal responsibility on patients’ shoulders in the form of higher coinsurance, deductibles, and copayments has contributed to slower growth rates recently.

– Demographics and Patient Characteristics

Changes in the age and health status of the population can make a significant difference in health care spending; the CBO has identified the aging baby boomer population as a significant driver of the increasing cost of medical.

Additionally, national income growth and expanding insurance coverage leads to investment and changes in health technologies, according to MedPAC.

Retirement Coverage

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At the age of 65 individuals are eligible for Medicare Coverage. Medicare is different than other insurance plans, in that each person has a separate policy and premium. Thus, each member of a married couple will have insurance coverage and benefits based on their particular health needs. Prescription coverage will also be offered on an individual basis.

Securing the best benefit of coverage from Medicare coverage, it is wise to have supplemental coverage. This can be accomplished by purchasing a Medicare-approved supplemental policy, which will have a monthly premium, or being part of an HMO (Heath Maintenance Organization) or Medicare Advantage plan, which rolls benefits into one package, but places geographic restrictions as to where the plan may be used.

Important Facts

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Several factors associated with health care are identified by the federal Medicare program. Therefore there are several areas to understand and consider.

  1. Determine if you can continue your employer coverage after retirement. When you have retiree coverage from an employer or union, they control this coverage. It is important to remember that employers are not required to provide retiree coverage.
  2. Make certain that you understand the premium cost and the benefits that you will receive, and if they will cover your spouse.
  3. Find out what happens to your retiree coverage when you’re eligible for Medicare. When you become eligible for Medicare, you will need to enroll in both Medicare Parts A and B to get full benefits from your retiree coverage.
  4. Explore the impacts that your existing health care coverage will have on you and your spouse. You cannot file duplicate claims and expect duplicate coverage. Therefore, existing your plan and determine how it coordinates with Medicare. You may want to talk to your State Health Insurance Assistance Program (SHIP) for advice about whether to buy a Medicare Supplement Insurance (Medigap) policy.

Since Medicare pays first after you retire, your retiree coverage is likely to be similar to coverage under Medicare Supplement Insurance (Medigap). No matter how good your employer coverage may have been, it will be secondary to Medicare once you leave the workforce.

If you work beyond 65 you can keep your existing policy. Once you do retire, your company coverage will be secondary to Medicare.

Retiree coverage isn’t the same thing as a Medigap policy but, like a Medigap policy, it usually offers benefits that fill in some of Medicare’s coverage gaps in coverage like coinsurance and deductibles. Sometimes retiree coverage includes extra benefits, like coverage for extra days in the hospital.

Conclusion

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Insurance is not always easy to navigate. The rules can be complicated, and they can change from year to year. Any persons having questions about their health care should contact their insurance agents; their employer’s company benefits office and Medicare.

If help is still needed, there are various advocacy groups in most communities that can either directly explain an issue or refer a person to the proper agency or organization for the needed assistance.

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