Health Insurance Open Enrollment Through January 15th 2018! | WithinReach WA
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Health Insurance Open Enrollment Through January 15th 2018!

Post originally written by Cristina Cardenas, Outreach & Enrollment Specialist.

This year’s Open Enrollment period for health insurance in Washington state through the Washington Health Plan Finder continues through January 15, 2018. For health insurance plans that are active starting January 1st, a plan must be selected by Friday, December 15th, 2017.

With the deadline for coverage coming, here are some considerations to make while you are looking to purchase a Qualified Health Plan:

Your doctor
Do you have a specific doctor’s office or clinic in mind?
What plans are currently accepted by that doctor or clinic?

While picking an insurance plan, one of the most important factors is being able to use that insurance for services at a clinic or doctor’s office with which you would like to work. If you have a specific health clinic or provider in mind, you’ll want to make sure they accept the insurance you choose. While shopping on Washington Healthplanfinder, the health insurance marketplace for Washington state, you can check which insurance plans are accepted by clicking the “Who’s Shopping” box, located on the upper left-hand side of the QHP selection screen. You will be able to search by your provider’s name, hospital, or zip code. Be sure to call the office to confirm if the plan is accepted and get the most updated information!

Medical needs
Do you have any chronic health conditions or specialty care needs?
Are any of your typical medical needs listed under the excluded services?

Although all health insurance plans listed on the exchange are required to cover the Ten Essential Benefits, you’ll want to spend some time looking into the details of the plans you are considering to see what other services may or may not be covered. This is especially important if you have any specific medical needs or services you know you will be seeking. You’ll want to make sure the plan you pick is going to work the best for you and your health.
To see more details about the plan, click the link that says “More information on this plan,” located under the name of each plan option on the shopping page of Washington Healthplanfinder.

Cost considerations
What is your monthly budget for health insurance?
Are there any tax credits and/or cost-sharing available to you?

There are many factors to consider when deciding which health insurance plan might be most affordable for you or your family. Every plan has a different amount for what you must pay from your own pocket before the insurance company will help you pay for your healthcare. There are five insurance payment terms to keep in mind:

  • Premium—the monthly payment you make to ensure you have coverage.
  • Deductible—the amount you will need to pay yourself for healthcare services before the insurance company starts to pay for healthcare costs.
  • Copayment—An amount you pay for a covered healthcare service after the deductible has been met. This may vary depending on the service.
  • Co-Insurance—the percentage of the bill you are responsible for before the deductible is reached. For example, a 20% co-insurance means that you pay 20% of the bill and the insurance company pays 80%.
  • Out-of-Pocket Max—the maximum amount you can pay in a year. After this is reached, all covered services will be paid for by the insurance company

At first glance, a low monthly premium might seem like the most affordable option, but these plans tend to come with a higher deductible. That means that if you have an unplanned medical need or accident, you may end up paying more out of your own pocket since the deductible needs to be met before the insurance company will help you pay.
You might also qualify for help paying for your insurance through government subsidies. If your income is under 400% of the federal poverty level (or $8,200/month for a family of four), you may qualify for tax credits that help pay for the monthly premium, or cost-sharing reduction to help reduce your out of pocket expenses!
On Washington Healthplanfinder, you are able to customize your search using the categories on the left-hand side and narrow your selections to plans within the range of what you may be comfortable paying. You can also see more detailed information about the cost

Plan flexibility
What is the size of the network for this plan?
Do I have to stay “in-network?
Will I need a referral to see a specialist?

Another aspect to keep in mind while picking a health insurance plan is the type of network available to you. The plan network includes physicians, hospitals, and other healthcare providers that have agreed to provide medical services at pre-negotiated prices and rates. There are three different categories:

  • Health Maintenance Organization (HMO)—This type of plan limits coverage to care from doctors who work for the insurance organization. Services by providers outside of the network will most likely not be covered. Your doctor, or primary care physician as they are usually called, will help to coordinate your care and provide referrals to see specialists.
  • Preferred Provider Organization (PPO)—In this type of plan, you will save more money seeking services from providers who are part of the plan’s network. You can see doctors, hospitals, and/or specialist outside of the network without a referral, but they may end up costing you more.
  • Exclusive Provider Organization (EPO)—This plan will require you to see providers within the network to have your services covered. Any services by out-of-network providers will not be covered.

Each of these types of plans have their pros and cons, so to help you make a decision, you’ll want to ask yourself how flexible you would like your health insurance plan to be.

Even with a list of questions to help you find the best plan, we here at WithinReach realize that it can still be overwhelming to sift through all the information. That is why we are here to help! By calling our Family Health Hotline at 1 (800) 322-2588, we can walk you through the whole application process and help you narrow down your plan options! 

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