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Open Enrollment

How to choose a health insurance plan

Health insurance Washington state
Written by Cristina Cardenas, AmeriCorps Outreach & Enrollment Specialist
Open Enrollment is well under way, which means that it’s time to sign up for health insurance! But with so many options out there, how can you possibly decide? Here are a few questions to think about to help you choose the best insurance plan for you and your family!


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 “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!

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 $8,100/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

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 (800) 322-2588, we can walk you through the whole application process and help you narrow down your plan options.

Tags: ACA   health insurance   Health insurance enrollment   Open Enrollment   Washington HealthPlanFinder   Washington state   

Podcast: Open Enrollment is here!

WithinReach podcast

We’re talking about Open Enrollment for health insurance on this episode of the WithinReach Podcast. There’s a lot of information packed into this episode; here are some of the sites we referenced so you can learn more:

Washington HealthPlanFinder
Blog post on Qualifying Life Events

And as always, you can call our Family Health Hotline at 1(800) 322-2588 for assistance.

Tags: Family Health Hotline   health insurance   Open Enrollment   Washington Health Benefit Exchange   Washington HealthPlanFinder   Washington state   

Adulting: Health Insurance Style

Written by Outreach & Enrollment Specialist/AmeriCorps Member Anne Mulligan

Taking responsibility for your own health insurance when you turn 26 can be quite the daunting task. Luckily, lots of us at WithinReach feel your pain, and we’re here to help! AmeriCorps member Anne breaks it down in the universal language: a list of GIFs.





When the Affordable Care Act (ACA) passed in 2010, I breathed a huge sigh of relief. Not only did it provide access to health care for millions of Americans, but it allowed me to stay under my parents insurance until I turn 26. This meant I had a few more blissful years of having coverage and not needing to understand insurance jargon and the confusing system!


When I had my 25th birthday (and quarter life crisis) I realized that I had a fleeting year of insurance ignorance left, but was fortunate to start working at WithinReach, which provided me with a crash course in health insurance! Even with the best experts training me, I still get confused with all the terms thrown around and can imagine it is even more confusing for my peers who are not discussing health insurance like it’s their J-O-B.


While some may be lucky enough to have a grown up job and get insurance through their employer, there are many of us who are not offered benefits and must enter the world of grown up decisions regarding our health.  But where does someone even start?!?!?


If you’re like me, sitting and reading  dry materials gives you flashbacks to college days of sleep deprivation, so this helpful video and its fun graphics make things a little more manageable. Deductibles, co-insurance, and co-payment, oh my!

Also, did you know that another thing the ACA enacted was penalties for those who are uninsured?


So make sure you take care of your insurance needs or else pay a penalty at tax time.

So now you generally know what’s what in the insurance world… but what is the next step?


If you’re in Washington State, you can call our SUPER friendly Family Health Hotline at (800) 322-2588 and get immediate help over the phone signing up for insurance, or you can visit the Washington Health Plan Finder. But it’s way more fun to call us and picture this in your head as we help you:


And don’t forget that open enrollment for 2016 is over on January 31st–you don’t want to miss this deadline!

Tags: get enrolled   health insurance   Open Enrollment   

Open enrollment is here!

November 1st marks the start of open enrollment for health insurance! This is great news for many Washington families who have been waiting for the opportunity to enroll into affordable, comprehensive health insurance. Open enrollment means that you can shop for and enroll in the right health insurance plan for you and your family. If you want coverage that begins on January 1st, you must enroll by December 23rd. So don’t wait! Open enrollment closes on January 31st.The WithinReach Family Health Hotline is here to help you navigate the process of applying for and helping you enroll into the plan that will meet your needs. Here are some things to consider before selecting and purchasing a plan:

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.



Tags: ACA   Affordable Care Act   Family Health Hotline   health insurance   Health insurance enrollment   Open Enrollment   Washington Apple Health   WithinReach   

All It Takes Is One Accident!

Written by: Annya Pintak, WithinReach Community Partnership Associate
Edited by: Kari Geiger, WithinReach AmeriCorps Program Lead
“I’m healthy, I don’t need health insurance…I never go to the Doctor!” My partner Charlie said this to me during last year’s Open Enrollment for the Affordable Care Act. I am passionate about ensuring folks are aware of the benefits of getting covered, and as a WithinReach employee and a navigator for the Health Benefit Exchange, hearing him say that made my ears ring. After constantly bugging him, my partner finally allowed me to help him enroll. He was approved for tax credits and was quick to purchase the Bronze plan which was cheaper every month, but had an incredibly high deductible. As a navigator, I did my duty of showing him all of his available options ranging from Silver to Gold plans and educated him on all of the health insurance terms. Charlie was still adamant that a Bronze Plan was best for him since he is young and doesn’t foresee himself using his health insurance—the “young invincible” rationale.
Six months after he purchased his health insurance I received a frantic phone call from Charlie letting me know that he was on his way to the emergency room with a broken arm. He was admitted to the ER, his arm was put in a splint, and he was referred to an orthopedic surgeon to further assess the damage. Three days later we found out he needed surgery to ensure that the bones in his fractured arm and wrist would heal correctly, as well as reduce his risk of early onset arthritis.
The biggest lesson we both received from his accident was that health insurance was worth it, even having a plan with a high deductible. The surgery without health insurance coverage would have cost almost $25,000—including anesthesia, the surgeon’s time, x-rays, physical therapy, and other treatment-associated costs. The maximum amount we paid out-of-pocket was $5,250, which was the amount for both the deductible AND the out-of-pocket maximum. $5,250 is still a large amount, but when you compare it with a $25,000 bill, it’s a big difference.
Charlie’s decision to purchase a Bronze Plan allowed him to access the best treatment option for his fractures, as well as provided both of us with the security that we would not go into financial debt while paying his medical bills. It is hard to understand the value of having health insurance until something catastrophic happens, but it is important to think of health insurance as is, a security blanket for your health AND finances. No one purchases car insurance with the intention of getting into a car accident, and the same can be said regarding health insurance. Life happens when you least expect it, and you never know when health insurance will be incredibly beneficial to you. Get yourself and your loved ones covered!

The current deadline for enrollment is February 15th 2015! Create an account or log in to your account on today to update your application and explore your options. For tips and tricks, check out some articles we wrote over the past year:

Remember: The deadline to enroll is FEBRUARY 15th, 2015, so log on today or call us for help through our Family Health Hotline for assistance at: 1-800-322-2588!


Tags: Accident   Family Health Hotline   finances   health insurance   Health Plan   Healthcare   insurance coverage   Open Enrollment   out of pocket      Washington Health Benefit Exchange   Washington state   

WA Healthplanfinder Gets a Makeover: 6 things you need to know!

By Emma Lieuwen and Irina Verevkina
WithinReach Bridge to Basics Outreach team, AmeriCorps
Open enrollment began November 15, 2014 and will continue until February 15, 2015. If you have not yet enrolled for health coverage, now is the time! Even if you signed up last year, your options may have changed, so be sure to review your plan.
If you have any questions about your coverage, need help navigating Washington Healthplanfinder’s website, or would like help with your application, please call the Family Health Hotline at 1-800-322-2588.
If you would rather talk to someone in person, call the Family Health Hotline to find out where our team will be in the community.
Recently, Washington Healthplanfinder’s website got a new look! When you go to the homepage looks a little different. The new look was designed to make finding information about enrolling in free or low-cost health coverage easier. Here are six changes that we think are important:
Change #1: New look for the Homepage
The sign in button is now located in the upper right corner. Additionally, there is now a designated section on the homepage to directly access Apple Health Renewals and Enrollment in the middle of the page.
Forgot your username or password? Simply click the green “Sign in” button and you will be able to retrieve it, or call the Healthplanfinder Customer Support Center at 1-855-923-4633.
Change #2: New Application Questions
“Is any member on this application a child 26 or older seeking adult disabled dependent coverage?”
Answer “yes” to this question if one of your dependents is an adult child with a disability; meaning, they cannot work due to their disability and are financially dependent on you. How this question is answered won’t affect your eligibility for Apple Health.
“Is any household member on this application currently enrolled in Medicare?”
If someone is covered by Medicare, they are likely ineligible for Qualified Health Plans and Apple Health.
Change #3: Eligibility Status Screen
After submitting your application, you will be taken to the Eligibility Status screen. This page provides the following information for each member of your household:

  • Eligibility status (Approved, Ineligible, Conditional, etc)
  • The program name (for example, Washington Apple Health)
  • Coverage dates
  • Next steps


Change #4: Pending Coverage and Document Upload
If you, or someone on your application, has a “pending coverage” eligibility status, you may be required to submit documents for additional verification. You can click the “upload documents” button to upload files. If you are prompted to submit documents, do so as soon as possible to avoid losing coverage.


Change #5: Reporting Changes
If you need to report a change on your application, you can now see how the change affects your eligibility. This is an improvement from how change reporting used to go, which required you to select and purchase a plan if you tried to make a change.
Change #6: Plan-palooza
This year, there will be more Qualified Health Plans to choose from. Be sure to shop around, consider your needs, and explore your options to make sure you’re getting the best plan for your needs and budget.
More questions? Call the Family Health Hotline at 1-800-322-2588 today!


Tags: Apple Health Renewals   Family Health Hotline   Free-Low Cost Health Coverage   health insurance   Open Enrollment   Washington HealthPlanFinder   Washington state   

Health Insurance Enrollment: Which Dates Matter?

Written by AmeriCorps member, Natasha Pietila
All the new dates surrounding open enrollment for health insurance can be confusing. We have answers to some of the most common questions we have been hearing from people calling our Family Health Hotline.
I’ve heard that I need to have health insurance coverage by the end of March. Is this true?

 Yes. You may qualify for coverage that is of no cost to you, or coverage that will require you to pay a premium. The Affordable Care Act requires most U.S. citizens and legal permanent residents* to have health insurance coverage for at least 9 months of the year. Therefore, it would be best to enroll by the March 23 deadline so as to get coverage by April 1st and avoid paying a penalty on your 2014 taxes.

I have insurance through my employer at this time, but there is a chance that I will be laid off in the next few months. Will I be able to enroll in insurance after March 23rd without receiving a penalty?

Yes. Certain qualifying events like the loss of a job enable you to enroll without a penalty. For a list of other qualifying events, please refer to this list from the Federal government. Also, if you qualify for free coverage through Washington Apple Health (aka Expanded Medicaid), you need not worry since Washington Apple Health enrollment remains open, year-round.

*The Affordable Care Act mandates that Americans have health insurance, beginning in 2014. Those without insurance may be required to pay a penalty on their 2014 taxes. Some may be exempt from this mandate and will not have to pay a penalty if they do not have health insurance. For more information on these exemption eligibility requirements, please refer to this infographic from The Kaiser Family Foundation.

Tags: health insurance   Medicaid   Open Enrollment   Washington Apple Health   

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.

Tags: ACA   Affordable Care Act   Apple Health   Apple health for Kids   health insurance   In-Person Assisters   Obamacare   Open Enrollment   ParentHelp123   Washington HealthPlanFinder   

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