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.
Podcast: Open Enrollment is here!
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:
And as always, you can call our Family Health Hotline at 1(800) 322-2588 for assistance.
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!
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.
All It Takes Is One Accident!
Edited by: Kari Geiger, WithinReach AmeriCorps Program Lead
The current deadline for enrollment is February 15th 2015! Create an account or log in to your account on www.wahealthplanfinder.org today to update your application and explore your options. For tips and tricks, check out some articles we wrote over the past year:
- What to consider when buying a Qualified Health Plan
- How to Apply For Health Insurance If Your Income Is Unpredictable
- Self employed? We Have Answers to Your Health Insurance Questions
- I bought health insurance through the Washington Healthplanfinder. What’s next?
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 WA HealthPlanFinder Washington Health Benefit Exchange Washington state
WA Healthplanfinder Gets a Makeover: 6 things you need to know!
WithinReach Bridge to Basics Outreach team, AmeriCorps
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.
“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.
If someone is covered by Medicare, they are likely ineligible for Qualified Health Plans and Apple Health.
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.
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.
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.
Health Insurance Enrollment: Which Dates Matter?
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.
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.