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Sharp Health News

5 common health insurance questions

Jan. 12, 2017

5 common health insurance questions

If you haven't used health insurance for a while or you're starting a new plan for 2017, it's best to familiarize yourself with the answers to these top five questions asked by consumers:

  1. How do I select a doctor?
    Your health insurance plan can provide you with a list of primary care doctors who will be "in-network." In-network refers to doctors and health care facilities that your health plan has negotiated a discount with, and they are part of your plan's network. You should choose a doctor that fits your lifestyle, such as one who is close to where you live or work.

  2. Are preventive services free?
    In most cases, yes. Most plans today offer free preventive services. Preventive care includes services such as annual checkups, immunizations, mammograms and screenings for conditions like diabetes and hypertension.

    Staying on top of your preventive care needs is one of the most important things you can do for your health. These services are complimentary when scheduled with an in-network doctor and separate from an appointment for other care or treatment. If you need to see your doctor for any other issue, you must make another appointment. Otherwise, you may have to pay a copay.

  3. What charges am I responsible for when I seek medical services?
    Depending on the plan that you select, you may pay one (or a combination) of the following:
      Copay: The set amount you pay for services
      Coinsurance: You pay a percentage of the cost for services
      Deductible (if applicable): The amount you pay before your plan begins paying for covered services
  4. I'm having an emergency. Should I go straight to the hospital or do I need to call my insurer first?
    In a true emergency, go straight to the closest hospital that can help you. That hospital will treat you regardless of whether or not you have insurance. Insurers can't require you to get prior approval before and can't charge you more for getting emergency room services from a provider or hospital outside your plan's network. If you need to be admitted for additional care or the hospital recommends other follow-up care after you are stabilized in the emergency room, in most cases your health insurance will need to approve that additional care.

  5. What is the penalty for not having health insurance?
    The penalty for not having insurance is 2.5 percent of your total household adjusted gross income, or $695 per adult and $347.50 per child for 2016.

"For 2017, the percentage will remain the same but the flat fee will be adjusted for inflation," says Don Truong, account executive for individual and family plans at Sharp Health Plan.

For more information on health coverage, visit healthcare.gov, where you can sign up to receive important news and updates.

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