Congressman Jeff Fortenberry

Representing the 1st District of Nebraska

Health Insurance Guidance 2017

How to navigate buying health insurance for 2017

1. Look for lower-premium health insurance:

  • For 2017, there is a new type of insurance policy available to residents of Lancaster County that offers 10-15% lower premiums in exchange for using a more restricted network of health care providers.

  • Health Savings Accounts have grown in popularity and remain a way to reduce premium costs through the purchase of a high-deductible health plan that covers the 10 essential health benefits. A deductible is the amount you pay for health care services before your insurance plan covers these costs.

  • For people under 30 years old or those who qualify for a "hardship exemption,” consider a catastrophic policy, a high-deductible health plan with lower premiums; this plan covers the 10 essential health benefits, and also offers three free doctor visits. If you have been notified that your policy has been cancelled and the individual market health plan options available are unaffordable, you are eligible for a hardship exemption.  The exemption can also be granted on the basis of financial or other circumstances that prevent you from obtaining coverage.

                          For more information:

                         https://www.healthcare.gov/catastrophic-plan-information/

  • There is a short-term medical duration plan that is not complaint with the Affordable Care Act (ACA) — which means you will pay the annual penalty — but the premiums are lower than ACA-compliant plans.The 2017 penalty will be about $695 per adult, up to $2,085 per family, or 2.5% of household income, whichever is higher.

2. Understand exactly what benefits the insurance plan covers:

  • Shop around for the best overall price when selecting a plan: Research the out-of-pocket costs until you reach the deductible (i.e., when insurance starts to cover your costs), the price of the premium, as well as the maximum out-of-pocket limit. Health insurance is unlike car insurance in that the most you will pay yearly for all your medical services may be the out-of-pocket maximum, not the deductible.

  • Know if your doctor and other medical providers (hospital, specialists, labs, etc.) are part of the health insurer’s network (i.e., they are in-network) so you do not have to pay more out-of-pocket toward an out-of-network deductible, which is separate from an in-network deductible.

  • If you want to learn the cost of an expensive procedure or specialty drug before you select a plan, you may ask insurers for the price in writing and they must respond in 10 days under the Good Faith Estimate law administered by Department of Consumer Affairs. Some pharmaceutical companies have a patient assistance plan for certain high-priced drugs: go to the company’s website and check for these cost savers.

  • Know that pediatric dental and vision benefits, and some of the 10 essential health benefits, may only be covered by an insurer once you have met the health care plan’s deductible, depending on the policy.Only some of the 10 essential benefits are offered free of charge.

                               For more information:

                               https://www.healthcare.gov/preventive-care-children

                               ​https://www.healthcare.gov/preventive-care-adults/

  • Know that prescriptions sometimes count toward the deductible for your health plan, but other policies have a separate deductible for drug coverage that typically only applies to brand-name drugs.

*Tip: After you choose a plan, shop around for the best price for in-network medical services since the price of in-network services — such as MRI, CT scans, and knee operations — vary up to 300%, and you pay 100% out of pocket until you reach your deductible.