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 Using Your Health Insurance Coverage New York State requires that most children and adults receive health coverage through a managed care plan. A managed care plan receives a monthly payment to provide all the medical care needed by its insured members. Those plans that participate in the Medicaid Managed Care Program receive payment from New York State. Some Medicaid eligible individuals may be exempt or excluded from managed care enrollment due to a serious medical condition. These individuals will be allowed to receive health care services on a fee for service basis. |
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Choosing a Health Plan and Primary Care Provider In order to choose the right health plan for you, ask your current doctor or primary care provider which health plans she accepts. If you do not have a primary care provider, you can ask a friend or co-worker for a reference. A primary care provider will coordinate your health care, including referring you to specialists when needed. Some questions to think about before choosing a primary care provider:
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Trial and "Lock-in" Periods If you are enrolled in Medicaid (coverage for children or adults) or Family Health Plus you have 90 days to decide if the health plan in which you are enrolled is right for you. You can change to another health plan at any time during the 90-day trial period. After the 90- days, you must remain enrolled in your plan for the next 9 months know as the "lock-in" period, unless you have a special reason to transfer. For Child Health Plus, there is no 9- months "lock- in" period. Transfers to other plans can take place at anytime during the 12 month enrollment period. After the 12 month enrollment period in Child Health Plus, Medicaid and Family Health Plus, you must renew your health care coverage. You will receive a mail-in renewal package 90 days prior to your health coverage expiration date. A face-to-face interview is not required for renewal of coverage. You only have to complete and return the renewal forms, which contain a pre-printed form with the insured's household information. |
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Accessing Health Services When you join a managed care plan, you can generally only use doctors, hospitals, and other medical providers who participate with that health plan. These doctors and other providers make up your plan's network of providers. Unless otherwise specified by your health plan, you may have to pay all or part of the bill for care that is received from doctors who are not in the network. In order to effectively use your coverage, find out about the health benefits offered by your plan. These are called "covered health services", and should be in your health plan's Member Handbook. Along with receiving a plan identification card from the health plan, you will also receive a Common Benefit Identification Card to access those services covered by Medicaid, but not covered by the plan. For example, members must continue to use their Common Benefit Identification Card to purchase prescription and non-prescription drugs. If your health plan does not provide dental services, you can use your card and go to any dentist accepting Medicaid coverage for services. However, if the health plan does provide dental services, you must use the in-network dentists. |
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Other Helpful Resources HRA Medicaid Helpline New York Medicaid Choice Community Health Advocates Medicaid Managed Care Consumer Guides |
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EMAIL A FRIEND |
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PRINTER FRIENDLY FORMAT |
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