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.
What’s it like to be on the WithinReach AmeriCorps team?
In the first-ever WithinReach podcast, our AmeriCorps Lead Emma chats with current team member Jessica about a typical day on the job, what she’s learned during her year of service, and more!
Beyond Open Enrollment: Qualifying Life Events
You may have heard that the Open Enrollment Period for health insurance closed on January 31st. You might be wondering if you can still get health insurance. The answer is yes, but only if you have a Qualifying Life Event before the next Open Enrollment Period. We’re here to break it down for you and help you figure out your next steps.
What counts as a Qualifying Life Event?
Adding a Dependent
- Foster Care
- Receipt of a court order (including child support)
Loss of Other Health Coverage
- Expiration of a non-calendar year health insurance policy (even if you have the option to renew)
- Loss of pregnancy-related Medicaid coverage
- Beginning or ending service in AmeriCorps, VISTA, or NCCC
- Loss of Employer Sponsored Insurance (ESI)
- Loss of Washington Apple Health (Medicaid)
- Loss of a Qualified Health Plan due to permanent move
Did you know?
You can enroll in a plan up to 60 days before or after the loss of other coverage. But, be sure to wait until the month your other coverage will end so you don’t have a month of overlapping coverage.
If you move and become a resident of Washington or move to a new county in Washington that results in new plan options.
Did you know?
A permanent move to Washington State is only a qualifying event if you had minimum essential coverage for at least one day within the 60 days before you moved?
Change in Citizenship or Lawful Presence Status
If you become a citizen, national, or lawfully present individual, you may qualify for a Special Enrollment Period.
Did you know?
Those with tribal membership (American Indian or Alaska Native), may enroll in a QHP or change from one QHP to another once a month (and access other benefits)!
Release from Jail/Prison
If you have at least one individual on an application that changes status from incarcerated to no longer incarcerated you may be able to open a Special Enrollment Period to sign up for coverage.
Special Enrollment Periods Only Available to Existing Customers
If you already have an account on WAHealthPlanFinder and are enrolled in a plan you can report the following events to open up a Special Enrollment Period to change your plan. You cannot get a Special Enrollment Period with the following events if you are a first time applicant.
Losing a Dependent or Dependent Status
- Legal Separation
Filed or Reconciled Taxes
If you received tax credits in the previous year, you must have correctly filed a tax return even if you do not usually have to file taxes. If you do not file a tax return and reconcile the tax credit you received, you will lose the opportunity to receive a tax credit until the IRS has confirmed that you have filed your federal taxes.
Change in Income
If your income changes, you could lose or gain eligibility for (or change the amount of) health insurance premium tax credits (help paying your monthly premium).
Did you know?
If your income is below a certain amount, you may qualify for Washington Apple Health. If this is the case, you don’t have to wait for an Open Enrollment Period– you can sign up any time!
Don’t know where to start or what you qualify for? Give the Family Health Hotline a call at (800) 322-2588!
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.
AmeriCorps Week: Language is a source of empowerment!
There was one particular client story I walked away with from this experience that enhanced my perspective of language barriers. This client helped me see the other side of this complex barrier by showing me how much language is a source of empowerment.
Mariana** is a middle-aged Latin American woman who approached me toward the end of the event accompanied by a volunteer interpreter. She sat down and prefaced the conversation by saying that she wanted to try to communicate with me independently, but she also wanted the interpreter present in case there was any confusion. Mariana told me that she had recently become self-employed and was having difficulty navigating the exchange to choose a health plan for herself. The interaction was more drawn out than my usual interactions to confirm understanding on both ends; there were occasional tangents in Spanish until Mariana remembered that I didn’t understand. Since it was the end of the day, we weren’t able to complete the interaction with the purchase of her health plan so we exchanged information in order to complete it over the phone at another time.
In the following weeks we exchanged multiple phone calls so I could complete her application, explain the terminology surrounding insurance, guide her through the process of going to Staples so she could fax me her income verification, and finally purchase a plan.
In the months of my service I’ve had a wide range of final remarks from clients after finishing an interaction with them: “Finally,” or “glad that’s over,” as if the service was something I had withheld from them that I had finally granted. However, most of the final remarks are those of gratitude: “Thank you for making this easy for me,” and “thank you for being so kind.”
On my last phone call with Mariana she said, “Noelle, before you go I want to tell you something…” She thanked me first for assisting her with her application, but then went on to thank me for taking the time to understand her. She said that she had always been nervous about speaking English in public for fear of not being understood or taken seriously. She said she truly felt that our interactions had occurred in such a way where she understood what I was telling her and that I understood what she was trying to say.
Before my work with Mariana, I had seen my AmeriCorps service as a way to tear down the general systemic barriers that prevent people from accessing the resources they need. Now, I view my interactions with clients as opportunities to build bridges to resources despite these barriers. The value in our work comes from providing assistance that is personal and empathetic to the difficulties of navigating complicated systems.
**Client name has been changed to protect privacy.
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
March Is the Time to Enroll In Health Insurance
Written by Jefferson Rose, Bilingual Community Outreach Specialist
This weekend we hosted a health fair and health insurance enrollment event at the Lynnwood Senior Center with free blood pressure screenings, kids activities, chair massages and health plan information.
The event was part of a statewide push to enroll as many people as possible before the end of March, the deadline to sign up for coverage and not be subject to the tax penalty. There have been a lot of dates and times floating around, but the Washington Health Benefit Exchange recently announced the official guidelines. For coverage to begin April 1st for a Qualified Health Plan, payment must be received by 5 PM on March 23rd.
Open enrollment does continue through March 31st, and if you enroll between March 24th and the 31st, coverage will begin May 1st. If you do not enroll by the March 31st deadline, your next opportunity to apply for health coverage will be November 15th. If you are income eligible for free coverage (Washington Apple Health Medicaid), open enrollment is year-round.
There are many events across Washington where people can sign up or get more information. Visit the WithinReach event calendar to see where we will be enrolling individuals and families for coverage or visit the Washington Health Benefit Exchange event calendar for an additional list of events across the state.
Come see us and enroll before the deadline!
‘Young Invincibles’ Helping ‘Young Invincibles’ Enroll in Health Insurance
WithinReach Starting New Health Insurance Enrollment Sites in Snohomish County
Health Insurance Enrollment Locations:
Mountlake Terrace Library
23300 58th Ave W
Mountlake Terrace, WA 98043
Thursdays, December 5th, 12th and 26th from 2:30 PM – 6:00 PM
Saturday, December 21st from 11:00 AM- 3:00 PM
6027 208th St. SW
Lynnwood, WA 98036
Fridays, December 6th, 13th, 20th and 27th
9:30 AM-1:30 PM
Bring the following items with you:
- Social security number (for all applicants)
- For household members that are not US citizens: Legal Permanent Resident Card or other immigration documentation (for LPRs we will need this AND the SSN)
- Date of birth (for all applicants)
- Tax filing status for the past year, current year and anticipated status for next year
- Information on your current health plan
- May need to bring an electronic form of payment (i.e. credit or debit card, pre-paid Visa, e-check)
Can’t make it to either location? Call 1-800-322-2588 or visit www.ParentHelp123.org