Transitioning Your Health Care FAQs

Are you shopping for a new health plan this Open Enrollment? Use our Health Connector Shopping Guides to help you think about your health plan options this Open Enrollment. If you choose a new health plan, take these steps to transition (move) your health care from the health insurance plan you have now to your new health plan.

What are the first steps I should take to transition (move) my health care to a new health insurance plan?

If you need to change health care providers (such as doctors and hospitals you use) under your new plan, you may want to:

What if I already scheduled surgery, tests, or doctor visits for after my new plan starts?

If you have health care services planned after the start date of your new plan, call your doctor to discuss your options. Your current referrals or authorizations for care may or may not be valid (allowed) with your new plan. You should also call your new plan to ask how any of your ongoing care needs will be handled.

What if my medication is not covered through my new plan?

If you switch plans and need a medication that is not on the list of prescription medications covered by your new plan (also called a “formulary”), you can contact your health plan’s customer service hotline to ask about their prescription drug exceptions process, which allows you to get a prescribed drug that’s not normally covered by your health plan.

Every plan must have a prescription drug exceptions process that allows you to request coverage of a prescribed drug not covered by your plan. While the process will be different for each plan, usually your doctor will send a request to your plan that the non-covered drug is clinically appropriate for your medical condition. You should contact your new health plan to learn more about its process.

What should I do when my new plan starts?

Your new plan will send you a new ID card. Show that new card to any providers you are keeping. In the meantime, if you change plans, call your doctor’s office and let them know. That way, they can help you avoid any billing issues and ensure any new referrals or approvals are in place for your care.

What if I followed these steps, but am having trouble accessing health care in my new plan?

If your health plan denies coverage, you have a right to appeal the health plan’s decision. Your denial letter from the insurance company should explain the services the health plan is denying and why. You have the right to ask your insurance company to reconsider this decision through an “internal appeal” with your health plan. If your insurance company denies your internal appeal, you have the right to an “external appeal” with an independent decision-maker.

Contact your health plan to learn more about your appeal rights. You can also learn more by reading the Evidence of Coverage booklet from your health plan.

How can I contact my new health plan with questions?

You can call your new health plan’s customer service hotline to work with them to determine how to transition your care from one health plan to another. Your new plan may also have helpful resources on its website. Here is a list of contact information for the insurers that offer plans through the Health Connector.