How to choose a health insurance plan
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 “Add”, listed under “Health Care Provider” in the “My Search” 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!
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.
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 $8,100/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
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 (800) 322-2588, we can walk you through the whole application process and help you narrow down your plan options.
Estoy inscrito en Washington Apple Health ¿Qué sigue?
Dentro de un mes de inscribirse en Washington Apple Health, también recibirá una tarjeta blanca con el nombre de su plan de salud, que es la compañía de seguros por la cual recibirá su cuidado médico.
He oído a gente hablar de ProviderOne. ¿Qué es ProviderOne?
ProviderOne es el sistema computarizado que coordina sus planes de salud también conocido como “Managed Care”, que están disponibles bajo Washington Apple Health (Medicaid) . Si usted está inscrito en Apple Health, usted puede manejar su cobertura a través del Portal del Cliente ProviderOne . Los proveedores de salud también pueden utilizar el Portal del Cliente ProviderOne para comprobar y ver si está inscrito en Washington Apple Health.
Han pasado dos semanas y no he recibido mi tarjeta ProviderOne. ¿Qué debería hacer?
Si usted no ha recibido su tarjeta dos semanas después de que se haya inscrito, puede llamar a servicio al cliente por medio de línea de la Autoridad de Salud al 1-800-562-3022. La buena noticia es que todavía puede ir al médico y recoger las recetas antes de tener sus tarjetas. Usted sólo tendrá que ir a una clínica o farmacia que acepte Washington Apple Health (Medicaid) y su plan de salud. La clínica o farmacia puede buscar su Identificación de cliente ProviderOne sin la tarjeta y le preguntaran por su nombre, fecha de nacimiento y número de seguro social.
¿Cómo puedo saber a qué plan de salud me he inscrito?
Después de entregar su solicitud de Washington Apple Health usted tiene la oportunidad de elegir en cuál de los seis planes de atención administrada desea inscribirse. Si usted no sabe en qué plan desea inscribirse, no se preocupe; se le asignará un plan automáticamente durante la noche del día en que su solicitud es recibida, sin embargo, usted puede cambiar su plan si resulta que no es el que desea.
También recibirá un libro Medico de Beneficios llamado Healthy Options, con información sobre sus beneficios y planes disponibles en su área. También puede ver esta publicación como un archivo PDF.
¿Qué plan de cuidado administrado debería elegir?
Se requiere que todos los planes de cuidado administrado proporcionen un conjunto de servicios básicos, por lo que a la hora de elegir un plan de atención administrada puede ser útil tener dos cosas en cuenta:
● ¿Qué planes acepta su médico?
- Algunos médicos aceptan algunas coberturas de Washington Apple Health de cuidado administrado y otros no. Por lo tanto, es importante que llame a su médico o clínica para ver primero si aceptan Washington Apple Health, y si es así, qué planes de cuidado administrado toman.
● Beneficios Adicionales
- Además de los servicios básicos ofrecidos por todos los planes de atención médica administrada, los planes también proporcionan beneficios únicos adicionales que pueden ayudarle a tomar su decisión.
¿Cómo puedo cambiar los planes?
Hay maneras diferentes en las que usted puede cambiar los planes de cuidado administrado. Usted puede acceder a su ProviderOne Portal del Cliente, por correo o fax (1-866-668-1214) el formulario de registro incluido en el folleto de beneficios médicos Healthy Options, o llame a línea de Apple Health de Servicio al Cliente (1-800-562-3022).
¿Puedo seguir viendo a los mismos proveedores de atención médica con mi nuevo plan?
Su proveedor de atención médica sólo podrá aceptar ciertos planes de cuidado administrado, aunque generalmente aceptan Washington Apple Health (Medicaid). Llame a su médico para ayudar a determinar cuál es el plan que elegirá.
También puede llamar a su plan de atención administrada o visite su sitio web para obtener una lista de proveedores de cuidado de la salud en su área.
Open enrollment is here!
What do you need out of a Health Plan?
Health Plans are not one size fits all. If you plan on using your coverage only for preventive care, you may think that the cheapest plan is the best fit. But accidents happen—and they can lead to hefty out-of-pocket costs depending on the type of plan that you purchased. If you have existing health conditions or take prescription drugs, there are certain plans that can help keep your money right where it belongs: in your pocket. It can be helpful to think through all that you need from your health insurance before beginning the enrollment process so you end up with the best plan for you.
You may be eligible for subsidies to help you pay your premiums.
Worried about how having health insurance would impact your budget? You may be eligible for tax subsidies (also known as tax credits). Tax subsidies can help lower the cost of your monthly premium. You can apply these credits to your premium amount right away so that your monthly health insurance payment is affordable.
More plans means more competition–and that is a WIN for you and your budget!
There are a lot more plans to choose from this open enrollment period. Competition between these plans means that many plan premiums are lower that they were at last open enrollment. You should shop around even if you are already enrolled in a Health Plan. Even if you think your health plan is great, check out the other plans that are out there. Chances are, you will find a plan that is better and at a lower cost than the amount that you are already paying.
Avoid getting fined for not having health insurance.
Don’t pay a penalty for not having insurance coverage for you and your family. The fine for not having insurance in 2016 can cost you as much as $695 per uninsured person in your household or 2.5% of your yearly household income. That means that when you file your income taxes, the amount that you pay the IRS could increase fast! And if you anticipate a refund at tax time, the penalty can lower the amount that would otherwise go back into your pocket.
You may be eligible for free coverage today!
Depending on your income and other factors, you could qualify for immediate coverage. Washington Apple Health coverage is comprehensive and free, and will cover you today!
How can the WithinReach Family Health Hotline help?
Enrolling in a health plan can be confusing. Our friendly and knowledgeable staff can help you make sense of your options and apply for coverage for you and your family. Not only can we get you enrolled into affordable medical coverage over the phone, but we can also help you access other programs that can help you and your family stay healthy. Don’t hesitate to call the Family Health Hotline at 1-800-322-2588.
Breastfeeding: Your rights in the workplace
A couple of months ago I got a call on our Family Health Hotline from a woman who was approaching the end of her maternity leave and was trying to better understand her rights in going back to work as a breastfeeding mother. She was returning to work at a large tech company and her expectations were low that her employer would be accommodating of a flexible schedule that would allow her to breast-pump. As I scrambled to locate and articulate the legal jargon around this topic, I was glad to discover that the law does protect women in this situation, but I also craved more detail to better guide callers in the future and provide women with confidence to advocate for themselves in the workplace.
It’s recommended by the American Academy of Pediatrics that mothers give their babies nothing but breastmilk for the first six months of life, and continue giving breastmilk for at least one year or longer. The reasoning behind this is worth celebrating! Breastfeeding provides significant cost-savings and strengthens the trusting, loving bond between a mother and her baby by increasing levels of oxytocin, also known as the “love hormone.” The cells, hormones, and antibodies in breastmilk make it easier for babies to digest than formula and reduce their incidence of developing respiratory infections, asthma, diabetes, and obesity, among other health conditions. From a mother’s perspective, breastfeeding has also been shown to reduce the risk of breast and ovarian cancer as well as postpartum depression. Employers also have reason to encourage breastfeeding as research supports it contributes to lower health care costs and absences from work due to caring for a sick child. For more information on the benefits of breastfeeding as well as tips for making the transition back to work while breastfeeding, please visit our “Work and Breastfeeding” resource.
The Affordable Care Act (ACA) advanced the rights of mothers in the workplace and the benefits that breastfeeding mothers are required to receive. New health insurance plans (since March 2010) are now mandated to offer women full coverage of a breast pump as well as a range of preventative services and lactation counseling. Breastfeeding is now more accessible to a majority of employed women as most employers are required to provide a space and “reasonable break time” for women to express breast milk or pump during the workday. The space provided must be “shielded from view and free from intrusion from coworkers and the public.” A bathroom, even if private, is not considered an acceptable location under the Act. Employers can find cost-effective tips on providing time and space to support nursing mothers in a variety of work settings on the Office of Women’s Health Website.
While the Affordable Care Act established a new and improved standard for the affordability and accessibility of breastfeeding, there are still barriers to breastfeeding supplies and support that need to be addressed. For example, while most women can now receive full coverage of a breast pump and lactation consulting through their insurance, this may not apply to Medicaid-recipients in certain states, mothers who are most in need of extra assistance. In this case, it’s likely that the Women, Infants, and Children (WIC) program can pick up where the law left off and provide women with these resources. Increasing awareness of how the law protects nursing women and how to navigate health and legal systems can help bring our workplaces and communities forward in recognizing the importance of breastfeeding in fostering healthy, happy mothers and babies.
Here are a few additional resources to learn more about breastfeeding and how to access WIC and other food and health programs:
Being Prepared Over Feeling Invincible: Why Medical Insurance Is Important While You Are Young
Not Having Health Insurance Might Impact Your Family’s Finances!
Health insurance is a very broad term and could encompass a variety of health insurance plans. For the purposes of the Affordable Care Act health insurance coverage is determined by a standard called “minimum essential coverage”. If a health plan has this label, it means that it has met the federal standard of a quality health insurance plan. For many people the establishment of minimum essential coverage plans now provides a higher quality and broader scope of service from their health insurance providers than what was available prior to the Affordable Care Act. All minimum essential coverage plans must cover 10 essential health services that are outlined here. For a large number of people, the minimum essential coverage requirement has been met through their existing health plan. If not, the Affordable Care Act has created new health plan options.
Common types of minimum essential coverage:
- The vast majority ofemployer-sponsoredhealth plans
- All of theprivate health plans offered through the Washington HealthPlanFinder
- Apple Health plans offered through the Washington HealthPlanFinder
- TRICARE plans offered through the US Military
For some people, there will be no changes in their health plans or how they apply for health insurance. But for 41 million uninsured Americans , the enactment of the Affordable Care Act has opened new doors to affordable, accessible and quality health insurance coverage. In Washington State, new health insurance plans are now offered through the Washington HealthPlanFinder with government subsidies such as tax credits and cost sharing reductions to make the insurance more affordable for most individuals and families. Other programs, like Washington Apple Health, have expanded to allow more people to enroll in free and low-cost health insurance. These new options present viable opportunities for health insurance that have not existed in the past.
What happens if I did not get health insurance?
If an individual or family was not able to enroll in a health insurance plan in 2014, they could face a fee when they file their 2014 taxes. This fee acts as the enforcement piece of the Affordable Act Care and it is commonly referred to as the individual responsibility requirement. In order to make health insurance affordable and accessible to everyone, the majority of people need to participate. Fees acts as a way to hold each other accountable and keep the overall cost of health insurance low. The amount of the fee will vary by household. The basic fee schedule for not having health insurance in 2014 and 2015 is:
Are there any other options?
The fee is not designed to punish people that cannot afford health insurance or have experienced hardship. There are a number of reasons why someone may not have been able to enroll in health coverage over the past year. In response to the unique needs of individuals and families, the federal Health Insurance Marketplace offers exemptions that allow people to go insured for short periods of time or to be completely exempt from the individual responsibility requirement and therefore exempt from paying any fees associated with not having health insurance.
To find out more about the exemptions offered through the Health Insurance Marketplace and how to apply for them, call the Family Health Hotline at 1-800-322-2588 or contact us through our website: ParentHelp123.org
2015 Open Enrollment for the Washington HealthPlanFinder is happening now to February 15th. Call the Family Health Hotline to speak to a Health Insurance Navigator about your options: 1-800-322-2588.
 Kaiser Family Foundation. Key facts about the uninsured population. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Tags: ACA Affordable Care Act Family Health Hotline fee exemption options Health Coverage Health Fee health insurance Health insurance enrollment marketplace ParentHelp123 TRICARE uninsured Washington Apple Health Washington HealthPlanFinder Washington state
Mohamed Ali: A True Champion of Change
I am a refugee from Somalia, who swore to devote his personal and professional life to bettering the health and lives of Americans in 2004. I am someone who invested his entire education in health sciences and public health on two continents. I studied tropical medicine and researched solutions for curative tools for devastating pathogens in prestigious research laboratories. I never stopped following my dreams, and I changed my career path to population health, recognizing the unmet needs faced by many of my fellow Somalis in America and elsewhere.
Somalis in the United States confront many challenges accessing healthcare as well as in understanding and receiving health services and information. Health issues can be daunting, and few organizations are well equipped to handle the customs and language of my community. As a result, my people sometimes suffer. I decided to advocate and fill the gap in refugee health services, and I wanted to do something to ensure my community had access to information that would protect them. When a major storm headed for King County in 2012, I knew from experience that many immigrant communities may not be prepared. People had died from carbon monoxide poisoning in past storms when they tried to heat their homes with grills and other unsafe sources. This time, I worked with partners at King County and a local mosque to send a phone message to Somalis with information about storm preparedness and hotline number. We also set up a warming shelter and rented vehicles to bring meals to families. This time, nobody died.
Fortunately, good work sometimes gets rewarded, and mine was noticed by the White House! In September, I was was recognized as a Champion of Change at the White House. On September 24th, the same day I was honored as a Champion of Change, there was something else taking place in the capitol: Ted Cruz made his historic stand on the chamber floor, speaking for 21 hours about the need to defund the Affordable Care Act (ACA) in exchange for avoiding a government shutdown. He made his point, but as an immigrant who advocates for healthy equity and social justice for all Americans, I could not sit and let it go unaddressed. I got a pen and paper and expressed my opinion on the new law. It read “ YES ACA.”
It might not seem like much, but it was a monumental statement for me, the 2013 Champion of Change who was recognized for protecting his community from a potentially deadly winter storm.
I stood up with my sign in front of the Capitol Hill where Senator Ted Cruz made his speech. I choose to say ‘YES!’ to the Affordable Care Act, I choose to represent Americans who could not be there, and I spoke for millions of Americans who are voiceless and uninsured. I did it because health insurance companies should not be allowed to take advantage of us anymore and turn away million Americans with pre-existing conditions. I support the marketplace for all insurance providers to compete on behalf of consumers, hopefully leveling out uncontrollable premiums. I spoke for those tens of millions who are underinsured, the many who had coverage but were afraid of losing it, and the 50 million Americans who had no insurance at all. We are not asking government handouts here, but a fair system.
I believe all American families deserve to be healthy. That’s a big statement, I know. Let me explain how we think about it at WithinReach. To us, a healthy family knows they can see a doctor before there’s a crisis, not only when they are in crisis. They don’t have to decide between paying for groceries or paying the bills. They have a community that can support them and as a result they, in turn, can support others. Being healthy in these ways positions families for success in all ways. Unfortunately, there are thousands of families across Washington state who want to be healthy and could be healthy, but currently are not. Health must be seen as a central element of a thriving society and not something that causes constant anxiety and fear for our families. Let’s work together to make health a reality for all families.
Big Changes Lead to Big Rewards
At WithinReach, we are on the forefront of health care reform and are excited about the future of health insurance enrollment in Washington State. We believe that with investments in people and technology and respectful engagement with folks, health insurance for all can be a reality.
The launch of the Washington HealthPlanFinder website represents big changes for our state, and for how all of us access coverage. It has also meant changes here at WithinReach. We have grown our team and increased our capacity to reach the thousands of Washingtonians who are newly eligible for health insurance. We welcomed 14 new people to WithinReach in the last two months and our total staff team count is over 50. This is more than double the size of our team from two years ago. Our office is literally busting at the seams as we shift space to accommodate new staff and move teams together. We have broadened our work into additional communities and expanded our skills—all while maintaining the personal and friendly culture that make this a great place to work!
Of course with all this change and growth, come some growing pains. We experienced some of those growing pains first hand, with the technical glitches of the HealthPlanFinder website earlier this week. Health exchange websites around the country experienced many of the same glitches and delays due to the large numbers of people trying to apply online at the same time. Despite the technical issues, our team of In-Person Assisters was out in the community talking to Washingtonians at 14 sites in King and Snohomish counties. Our team talked to over 1,000 people about health insurance at these sites, and have also received close to 100 inquires for health and food assistance through ParentHelp123 this week alone.
Because of the challenges with the Washington HealthPlanFinder tool, we focused our outreach on education about what to expect next and creating appointments with individuals to sign them up for health insurance within the next few weeks. Despite some of the technology glitches, we have already seen the positive impact of the Affordable Care Act on our families. Last evening one of our outreach and enrollment specialists, Benito, enrolled a single mother and her daughter in health insurance plans through HealthPlanFinder. The mother called in with the intent of getting her daughter covered. She was skeptical about finding affordable health insurance for herself, and anxious about what ‘Obamacare’ meant for her family. Benito explained that there were likely affordable options for her as well as her daughter, and encouraged her to explore those options. After entering her application in HealthPlanFinder Benito learned that her daughter was eligible for Free Apple Health for Kids effective October 1, 2013 and that she was eligible for a tax subsidy for herself for coverage effective January 1, 2014. She was excited that her daughter was covered, but was still apprehensive about what kind of coverage she might be “forced to purchase”. Benito found a SILVER level plan that was free after a $559 tax credit.
Stories like this one make our day, and fuel our desire to do more. This mother came to us looking for health insurance for her daughter and she finished the call with free health insurance for both herself and her daughter. We are ready for action and encouraged by the numbers of people we have already been able to help in the first week of open enrollment. We will continue to provide in-person outreach, schedule appointments, take calls and provide the education and outreach that is so crucial to getting families successfully enrolled in affordable health care.
I Love September
This powerhouse crew is changing the way people connect to benefits. As I’ve talked with our partners, elected officials, Exchange staff and board, I’m so proud to say that we have a model that builds on 25 years of connecting families with resources. We know the importance of meeting people where they are at‐‐whether that’s the food bank line, over the phone or online. We know our greatest impact will be in developing a trusting relationship with families so that we can connect them with the right resource and suggest other resources they might need. We know that when parents have access to quality health care, it improves the health of their kids. As we get close to launch, it’s also important for us to keep our eyes on the prize‐‐ Health Insurance for All! This isn’t going to be an easy process. It’s going to be frustrating and tiring. We will now be able to respond to clients who “sheepishly”ask after we’ve signed their kids up for Apple Health for Kids if there is anything for them, with a resounding YES! This is the pay off.
Over the last few weeks I’ve started to think about what is next. What happens after we’ve signed up folks? Having insurance doesn’t mean you’ll be healthier. Having healthy behaviors makes you healthier. This is where I see our work with breastfeeding, immunization and developmental screening massively growing our impact on family health. This is going to be fun, challenging and rewarding work. But first things first‐‐let’s go get those million Washingtonians that aren’t insured, insured.
The Importance Of a Full Spectrum of Healthcare Insurers
This past week the Office of the Insurance Commissioner approved four insurance carriers for the individual market on the Washington Health Benefits Exchange, noticeably absent from this list were any Medicaid plans.
This stopped many of us in our tracks.
One of the biggest challenges and opportunities with the implementation of the Affordable Care Act is the chance to cover more low income families–not just kids, as we’ve done very successfully with Apple Health for Kids. However, unlike typical middle class families, low income families are more likely to have fluctuations in their monthly income, which creates an additional hurdle for these families when applying for income based insurance programs.
Based on how the current system is supposed to work, if you are Medicaid eligible (adult with an income level below 138% of the Federal Poverty Level, at or below $32,499 for a family of four) when you sign up for insurance coverage through the Washington Benefits Exchange you would be assigned to one of five Medicaid plans. However, if you got a better paying job and your income level rose above the 138% of Federal Poverty Level, then you would have to go onto the Exchange to select a new plan and pay the premium. That new plan may or may not have your doctor in their network. If the Medicaid plans were in the Exchange, it would be a seamless shift for the person because they would keep their current doctor and pay the difference after their subsidy went into effect. Without any of the Medicaid plans in the Exchange, the burden of making those changes rests with the consumer. For those of us tracking this closely, we call it call it “churn.” From our perspective, one of the biggest promises of the Affordable Care Act is to ensure continuity of care for our most vulnerable populations and minimize the impact of churn on a family receiving health care.
I don’t know about you, but I think insurance and health care are already pretty complicated. The thought of having to switch my insurance plans when my income level changes would be overwhelming especially if I was new to having insurance, struggling to pay rent or feed my kids and make good parenting decisions.
I know that the launch of the Health Benefits Exchange is hard work and there will be some bumps along the way but I sure hope the Insurance Commissioner’s office will revisit this decision for the sake of the most vulnerable families in our community.