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It’s almost always best to get routine care and recommended preventive services from a primary care provider. There are big differences between visits to your primary care provider and emergency care.

When to see your primary care provider

• You’ll see your primary care provider both when you’re sick and when you’re well for regular care. They’ll get to know you and help track your health over time.
• You can get primary care providers in doctors’ offices, clinics, and health centers nationwide.
• Before you schedule your first appointment, contact your health plan to see how much you’ll have to pay for a primary care visit. The copayment for your visit may cost you between $0 and $50.

When to seek emergency care

• You should go to the emergency room only when you’re injured or very sick. You may wait several hours before you’re seen, and you’ll likely pay a larger copayment, co-insurance and have to meet your deductible before your health plan helps pay your costs.
• Providers in the emergency room probably won’t have access to your health records.
• Always in a life-threatening or emergency situation, call 9-1-1.

See other differences between regular and emergency care.

All Marketplace plans cover prescription drugs. Fill any prescriptions you got from your doctor and take them as directed. Here are 3 things to know about filling prescriptions:

• You may have a prescription copayment. A copayment is the amount you owe for each prescription you fill. Copayments are usually between $0 and $50, depending on your insurance plan.
• Check with your insurance company to see if you need preauthorization (also called “prior approval”). Your health plan may require preauthorization for certain drugs, unless it’s an emergency.
• Different health plans allow you to get your medications from different pharmacies (called “in-network pharmacies”). Call your insurer, or visit their website to find out which pharmacies are in their network.

Get more information on prescriptions and what to do when your drug isn’t covered.

If you applied for 2020 Marketplace coverage through a Special Enrollment Period, you may be asked to provide documents to confirm the life events that make you eligible. You must send them before you can start using your coverage.

You’ll learn if you have to provide documents after you submit your application. It’s best to pick a plan first and submit your documents afterwards. After you pick a plan, you usually have 30 days to send the documents.

Documents & deadlines for your life event

• The documents you can submit vary based on your life event.
• Select your life event for the documents you can submit and key dates.

How to submit documents

• Provide the required documents as soon as possible after you pick a plan.
• Doing so will prevent a delay in your coverage starting.
• You can submit them online or copies by mail. Follow these steps.
• After you submit them, you’ll get a letter or notice in your HealthCare.gov account within a couple of weeks saying if your Special Enrollment Period has been confirmed.

Learn more about when the Marketplace needs documents to confirm a Special Enrollment Period.

Now that you have Marketplace health coverage, learn what you can do to stay healthy and get the care you need:

Tips for staying healthy

• Make time for physical activity, healthy eating, relaxation, and sleep.
• Get the preventive services that are right for you.
• Don’t forget to schedule follow-up visits. Ask your provider to notify you in advance when recommended health screenings should occur.
• If you have questions or concerns between visits, just call your provider. It’s their job to help answer questions you have about your health.

Tips for getting proper care

• You can get health care many different places, including the emergency department. But it’s best to get routine care and recommended preventive services from a primary care provider. They’ll work with you to ensure you get the right services, manage chronic conditions, and improve your general health and well-being.
• Generally, you can find primary care providers in offices, clinics, and health centers.
• Not all types of providers and facilities take all insurance plans or types of coverage. Before you make an appointment, call the office to make sure they accept your coverage.

Read the From Coverage to Care: Roadmap to Better Care and a Healthier You (PDF, 698 KB) for tips and information on putting your health first, knowing where to go for care, and preparing for appointments.

If anyone in your household had Marketplace health insurance in 2019, you should have already received Form 1095-A, Health Insurance Marketplace Statement, in the mail. Here are 5 important things to know about this form.

Helpful tips about tax Form 1095-A:

• You should already have Form 1095-A. It comes from the Marketplace, not the IRS. If your form didn’t come by mail or you can’t find it, check your online Marketplace account before contacting the Marketplace Call Center.
• Store it in a safe space with other important tax information, like W-2 forms. This way, you can easily find it when you sit down to file.
• Before doing anything with the form, make sure it’s accurate. Check basic coverage and household member information, and confirm the premium for your second lowest cost Silver plan (SLCSP). Contact the Marketplace Call Center to report any errors.
• If you request a new, updated form, it’s important that you don’t file until we send you the correct version. If you already filed, you may need to file an amended return using the information from your new 1095-A.
• You’ll use the information from your 1095-A to “reconcile” your premium tax credit. To do this, you’ll compare the amount of premium tax credit you used in advance during the year against the premium tax credit you actually qualify for based on your final income for the year. Any difference will affect your refund or tax owed. See a step-by-step guide to “reconciling” your premium tax credit.

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You may be hearing about the coronavirus (officially called 2019-novel coronavirus or COVID-19) in the news. Currently, the rules in your Marketplace health plan for treatment for COVID-19, remain the same as for the treatment of any other viral infection. Check with your health insurance company for their specific benefits and coverage policy. Here are some other things to know about how your Marketplace health plan works when it comes to coronavirus:

Understanding your coverage

• Lab and other services: Individual and small group market issuers are generally required to include laboratory services as a category of Essential Health Benefits. Coverage for a specific diagnostic or laboratory service can vary by plan, so check with your health insurance company about their coverage for lab tests and related services for diagnosis and treatment of COVID-19. This is also true for your health plan’s coverage for physician and hospital services related to the diagnosis and treatment of COVID-19.
• Telehealth: Telehealth services or home health visits may already be covered by many health insurance companies. You should check with your health insurance company to determine whether these services are covered and what you’ll pay.
• Enrolling in coverage: If you aren’t currently enrolled in coverage, you can see if you qualify for a Special Enrollment Period. As a reminder, federal law and regulations provide protections against pre-existing condition exclusions in health insurance coverage. If you are eligible, health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Marketplace plans can’t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19.

For more information about the Coronavirus, please visit: coronavirus.gov

You have until April 15, 2020 to file your 2019 federal income tax return. If you had a Marketplace plan in 2019 and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you’ll have to "reconcile" your tax return.

Through “reconciling,” you’ll find out if there's any difference between the premium tax credit you used and the amount you qualify for. Any difference between the two figures will affect your refund or tax owed.

How to "reconcile" your premium tax credit on 2019 taxes:

1. Find your Form 1095-A, and verify its accuracy. If you didn’t get one, check your online Marketplace account. If it’s not there, try the Call Center. See how to be sure the information is correct.
2. Print Form 8962 (PDF, 112 KB) and instructions (PDF, 356 KB).
3. Use the information from your 1095-A form to complete Part II of Form 8962. Refer to this table as a guide.

Get more information on 2019 health coverage and your federal taxes.

Now that Open Enrollment is over, you can enroll in or change Marketplace coverage only if you have a life event, like getting married, having a baby, or losing health coverage, that qualifies you for a Special Enrollment Period.

Does my life event make me eligible for a Special Enrollment Period?

There are 4 basic types of qualifying life events:

• Loss of health coverage: Losing job-based coverage (whether through yourself or a family member) or eligibility for Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP)
• Household changes: Marriage, child birth or adoption, divorce, or death
• Residence changes: Certain household moves, like moving to a new ZIP code or county
• Other qualifying events (like income changes): Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP), leaving incarceration, etc.

See the full list of life events.

How do I apply for 2020 coverage through a Special Enrollment Period?

• If you qualify for a Special Enrollment Period, create an account or log into an existing one to enroll in a plan for 2020.
• You may be asked to submit documents to confirm the life event that makes you eligible.

Not sure your life event counts as a Special Enrollment Period? Just answer a few quick questions to find out.

Health coverage pays for provider services, prescriptions, hospital care, and special equipment when you're sick. It's also important when you're not sick. Now that you're enrolled in a health plan for 2020, here's how you can use your new coverage throughout the year no matter your situation.

Understanding & using your new coverage

• Preventive health: Most coverage includes immunizations for children and adults, annual visits for women and seniors, obesity screening and counseling for people of all ages, and more for free.
• Prescriptions: Health plans will help pay the cost of certain prescriptions. You may be able to buy other medications, but those on your plan's "formulary" (approved list) usually will be less expensive. To find out which prescriptions are covered through your new Marketplace plan, visit your insurer's website, call them directly, or check your Summary of Benefits and Coverage.
• Regular & emergency care: Most health plans give you the best deal on services when you see a doctor who has a contract with your health plan. While you may be able to see doctors who don’t contract with your plan, visiting an "in-network" provider usually means you'll have lower out-of-pocket costs. But in an emergency, get care from the closest hospital that can help you.

Learn more about using your insurance coverage.

Attention: 2019 tax filing season has started. Here’s what you can do now to get ready.

3 steps to get ready for 2019 tax filing:

1. Look for Form 1095-A.

   • If you or anyone in your household had a 2019 Marketplace plan, you’ll get Form 1095-A, Health Insurance Marketplace Statement in the mail by early February. It comes from the Marketplace, not the IRS.
   • It may also be available online in your HealthCare.gov account.

2. Check Form 1095-A for accuracy.

   • You’ll use Form 1095-A to "reconcile" your premium tax credit if you used advanced payments of the premium tax credit to lower your monthly premium payment, so it’s important the information on it is correct. If you file with an incorrect version, you may need to file an amended return later.
   • Confirm things like your coverage and household information, monthly enrollment premium, and “second lowest cost Silver Plan” (SLCSP).
   • If you find errors, contact the Marketplace Call Center. We’ll send you an updated copy. Wait to file until you have it.

3. Use your correct 1095-A to “reconcile.”

   • Now that you have an accurate 1095-A and second lowest cost Silver plan premium, you’re ready to fill out Form 8962, Premium Tax Credit.
   • See this step-by-step guide to reconciling for next steps.