FROM 

COVERAGE 

TO CARE

A Roadmap 

to Better 

Care and a 

Healthier

You

Step 6 – Be prepared for your visit
Start 

here 

Understand your

health coverage

• Check with your insurance plan or 

state Medicaid or CHIP program to 

see what services are covered.

• Be familiar with your costs 

(premiums, copayments, 

deductibles, co-insurance).

• Know the difference between

in-network and out-of-network.

2

Find a provider

• Ask people you trust and/or 

do research on the internet.

• Check your plan’s list of 

providers.

• If you're assigned a 

provider, contact your plan 

if you want to change.

• If you're enrolled in 

Medicaid or CHIP, contact 

your state Medicaid or CHIP 

program for help.

Know where to go for care

• Use the emergency department for a lifethreatening situation.

• Primary care is preferred when it’s not an 

emergency.

• Know the difference between primary care 

and emergency care. 

4

Put your health first

• Staying healthy is important for you and 

your family.

• Maintain a healthy lifestyle at home,

at work, and in the community.

• Get your recommended health screenings 

and manage chronic conditions.

• Keep all of your health information

in one place.

1

Your ROADMAP to health

3

2 Visit marketplace.cms.gov/c2c for more information.
Make an appointment

• Mention if you’re a new patient or have 

been there before.

• Give the name of your insurance plan 

and ask if they take your insurance.

• Tell them the name of the provider 

you want to see and why you want an 

appointment.

• Ask for days or times that work for you.

5

Decide if the provider is 

right for you

• Did you feel comfortable with the 

provider you saw?

• Were you able to communicate with 

and understand your provider?

• Did you feel like you and your 

provider could make good 

decisions together?

• Remember: it is okay to change to 

a different provider!

7

Next steps after your appointment

• Follow your provider’s instructions.

• Fill any prescriptions you were given, and take them 

as directed.

• Schedule a follow-up visit if you need one.

• Review your explanation of benefits and pay your 

medical bills.

• Contact your provider, health plan, or the state 

Medicaid or CHIP agency with any questions.

8

Be prepared for your visit

• Have your insurance card with you.

• Know your family health history and make 

a list of any medicines you take.

• Bring a list of questions and things to 

discuss, and take notes during your visit.

• Bring someone with you to help if you 

need it.

6

No

Yes

If you want to 

change your 

provider, return 

to Step 4.

3
6 Be prepared for 

your visit.

If this is your first visit to a new provider or you are using 

new health coverage, you will need to bring a few things 

with you. 

This will help your provider understand your health and 

lifestyle, and help you work together to improve your health 

and well-being during your visit and after you leave.

It is important to show up early for your appointment!

When you get to your provider’s office, check in with the front 

office staff. You may be asked to provide the following:

 • Insurance card or other documentation. 

 • Photo identification (e.g., driver’s license, government or 

school ID, passport, etc.).

 • Completed forms.

 • Your copay, if you have one. Ask for a receipt for your 

records.

The staff may ask you to fill out additional forms and to read 

over their privacy policy, which tells you how they will keep 

your information private. It is required by law.

COST TIP

If you need to change your appointment, 

contact your provider's office as soon as 

possible. Many providers charge a fee if you’re 

late, don’t show up for your appointment, or 

cancel less than 24 hours before it starts. Most 

health plans will not pay these fees.

4
When you see your provider, it is helpful to share:

 • Your family health history and medical records, if you have 

them. 

 • Medications you are taking (and the bottles so your provider 

knows what dose you take). If you need a refill, ask for one.

 • Questions or concerns you have about your health—write 

them down so you don’t forget to ask.

You may want to bring someone with you, like a friend or 

family member, to help you talk to the provider.

KNOW YOUR RIGHTS

You should be treated with respect and your information 

kept private. If you’re not happy with how you were treated, 

ask to speak with an office manager or the provider and 

tell them your concerns. If things aren’t resolved, then this 

office may not be the right place for you.

5
Don’t be shy! 

Your provider is there to help you stay healthy. They can provide 

better care if you talk with them about your health and wellbeing and share any questions or concerns you have. If your 

provider says something you don’t understand, speak up! 

You should be able to answer these questions before 

you leave your provider’s office:

 • How is my health? What can I do to stay healthy? 

 • What do I do next? Do I need blood work or another test? If 

so, what is it for? When and how will I get the results? 

 • If I have an illness or chronic condition, what are my treatment 

options? What are the benefits and concerns for 

each option? What will happen if I don’t 

take care of it? 

 • If I need to take medicine, when do I 

take it and how much do I take? Are 

there any side effects? Is a generic 

available? 

6
ASK

Ask your provider for written materials you can take home 

and read, and if there’s a phone number you can call if you 

have questions. Don’t leave until all of your questions have 

been answered and you understand what to do next.

 • Do I need to see a specialist or another provider? Did I ask 

my provider for a suggestion? Do I need a referral? If so, do I 

have it? 

 • When do I need to come back for my next visit? 

 • What do I do if I have questions when I get home?

COST TIP

If you have to take medicine 

and you’re concerned about 

how much it will cost, tell your 

provider. They may have cheaper 

options for your medicine, or 

know of programs that help 

patients pay for their medicines. 

7
Resources

8

HELPFUL LINKS

Getting Coverage

How to get coverage through the 

Health Insurance Marketplace

https://www.healthcare.gov/blog/4-

steps-to-getting-covered-in-the-healthinsurance-marketplace/ 

How much will health insurance 

cost?

http://kff.org/interactive/subsidy-calculator/

What plans are available in my 

area?

https://www.healthcare.gov/find-premiumestimates/

Contact Your Insurance 

Plan

Contacting your health plan’s 

customer service phone number

http://marketplace.cms.gov/

getofficialresources/publications-andarticles/contact-health-plan.pdf 

Value of Prevention

Understanding prevention and 

the Affordable Care Act

https://www.healthcare.gov/prevention/

Finding a Provider

Reviews and ratings of local 

providers

http://www.healthgrades.com/

Planning Your First Visit

Steps to help you plan your first 

visit

http://www.ahrq.gov/patients-consumers/

patient-involvement/ask-your-doctor/

questions-before-appointment.html

Questions to Ask Your 

Provider

Topics and questions to discuss 

with the provider during your visit

http://www.ahrq.gov/patients-consumers/

patient-involvement/ask-your-doctor/

questions-during-appointment.html

Patient-Provider 

Relationship

The importance of 

communicating with your 

provider 

http://www.ahrq.gov/patients-consumers/

patient-involvement/ask-your-doctor/

videos/index.html

Tracking Your Medicine

Patient guide and wallet card to 

keep a record of all medications

http://www.ahrq.gov/patients-consumers/

diagnosis-treatment/treatments/safemeds/

yourmeds.html
Notes

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Notes

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Notes

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marketplace.cms.gov/c2c

CMS Product No. 11843

June 2014