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Washington Health Benefit Exchange

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
ParentHelp123.org

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   

Estoy inscrito en Washington Apple Health ¿Qué sigue?

Traducido del blog original escrito por Maritza Cazares, Especialista Bilingüe en Inscripciones & Asistencia Social.
Si usted ha solicitado un seguro de salud y está recibiendo cobertura médica por medio de Washington Apple Health (también conocido como Medicaid)  se ha de estar preguntando ¿qué sucede después? Nosotros tenemos las respuestas a algunas de las preguntas más comunes que hemos estado oyendo de personas llamando a nuestra Línea de Salud Familiar.
Tengo seguro por medio de Washington Apple Health. ¿Qué pasa ahora?
¡Felicidades! Casi dos semanas después de inscribirse usted recibirá una tarjeta de servicios azul (también conocida como la tarjeta ProviderOne) en el correo. Conserve bien a esta tarjeta, ya que comprueba que usted está inscrito en Washington Apple Health y querrá mostrarla para sus citas al doctor y para recoger recetas.No es necesario activar su tarjeta, ya que su cobertura y la tarjeta estarán activas el día después de su inscripción. La tarjeta se ve así:

providerone

 

 

 

 

 

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.

Tags: ACA   Affordable Care Act   health insurance   Washington Apple Health   Washington Health Benefit Exchange   Washington HealthPlanFinder   Washington state   

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 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:

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   

‘Young Invincibles’ Helping ‘Young Invincibles’ Enroll in Health Insurance

Written by AmeriCorps members Kari Geiger and Natasha Pietila
On Friday, December 13th, a few of my colleagues and I left the city and headed off to Stevens Pass Ski Resort for a special health insurance enrollment event. Although Friday the 13th is often considered unlucky, we experienced no ill luck. It was a beautiful, snowy day – particularly exciting for me, a California-girl, who had never played in the snow. As certified In-Person Assisters, we had the opportunity to join the event with the Washington Health Benefit Exchange at Stevens Pass Ski resort to help enroll some of their 600 seasonal and part time employees in health insurance.
After crossing the resort’s quad, a slippery journey for my first time in snow (and lack of snow boots), we joined a large group of In-Person Assisters and Insurance representatives in the cafeteria and started talking to and helping enroll the ski instructors, emergency rescuers, and ski enthusiasts. Stevens Pass was generous enough to set up a hot drink and snack station, as well as providing a hot lunch of chili and grilled cheese. Whenever we were available, a new client would swish up in their snow gear and sit down with us to navigate through the Washington Healthplanfinder. While I got to teach about the healthplanfinder and how to use it, my clients taught me the difference in snow sport climates and conditions. One ski instructor, Clayton, pointed out the differences between the rain and snow falling on the mountain, and how it affects the mountain and skiing conditions.  Another one of the clients I talked to that day was a ‘young invincible,’ who at 27 was no longer covered by her parent’s health insurance, and was nervous about using the free ski pass (a perk of being employed at Stevens Pass) without health coverage.
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At the end of the day we enrolled several people in Washington Apple Health, others selected a Qualified Heath Plan, and others went home to discuss the intricacies of their cases with their families and finish their application on their own. It was a great asset to have access to the knowledge of other the In person assisters from King County Public Health and other organizations. Overall, it was a lovely day of watching skiers and snowboarders race down (and sometimes fall down) the mountains, hot chocolate, and connecting people to healthcare.

Tags: Health insurance enrollment   Stevens Pass   Washington Health Benefit Exchange   Washington HealthPlanFinder   Young Invincibles   

Five FAQ’s About Health Care Coverage in Washington

Written by WithinReach AmeriCorps member, Lisa Andersen

There’s been no shortage of questions during Washington’s first month of health insurance open enrollment. Here are some questions we’ve heard from lots of people who want to sign up for health insurance coverage:

1. This is confusing – where can I get help with my application?

There are lots of ways to get help! The Washington HealthPlanFinder has a list of assisters who can help you: click the “customer support” tab in the top right corner of the page, and then click “find a navigator” on the drop-down menu. You can search by zip code for a navigator in your area. I suggest calling or emailing the navigator before partnering with them, just to explain the basics of your application and ensure that the navigator will be able to help you in a timely manner. If you live in King County, you can also search for enrollment events near you where navigators will be present to help you with your application in person. A list of enrollment events in King County is available here: http://www.kingcounty.gov/healthservices/health/personal/coverage/calendar.aspx.

At WithinReach we are also certified as “in-person assisters” by the Washington State Health Benefit Exchange, and regardless of your financial situation, we are here to guide you through this new system and help you understand and apply for health insurance. Visit our ParentHelp123 Benefit Finder or call the WithinReach Family Health Hotline at 1-800-322-2588 today to get started.

2. When do I need to sign up by, so I don’t have to pay a penalty fee?

There are several dates floating around that can be confusing for people who want to sign up for health care. We are often asked if people will be penalized for not signing up for health coverage by January 1st. Everyone should know that you have a lot more time than that to sign up for coverage before you have to pay a penalty fee. Coverage starts on January 1st, 2014, but you don’t have to send in your application before March 31st, 2014, if you don’t want to. You won’t get coverage until you sign up, but you can sign up at any point between now and 31 March without having to pay a fee.

3. What if I submit my application for health care, and then my financial situation changes drastically? What if I get a raise, or lose my job? Will I have to pay the same premium for the rest of the year?

Not to worry: if something in your life changes drastically after you submit your application, you are allowed to change your application without a penalty. Simply log in to your HealthPlanFinder account and click on the “Report a Change in Income or Household” link. The HealthPlanFinder will be able to calculate your premiums based on your new situation, and will prompt you to scan documents to verify your new situation if needed.

4.  Will Medicaid pay for visits to the dentist?

Dental coverage is undoubtedly a huge concern for many Washingtonians who haven’t seen the dentist in months or even years. If you are eligible for Medicaid, you WILL HAVE dental insurance starting 1 January 2014.  Dental coverage is being re-instated for Medicaid patients, so Medicaid patients who have not previously been able to see the dentist will be able to this January.

5. What about dental care for people who don’t qualify for Medicaid? Do the health plans on the Health Benefit Exchange cover dentist visits for adults or kids?

Health insurance plans purchased through the exchange are NOT required to include dental coverage, so be sure to read the details of the plan you want to sign up for to find out if dental coverage is offered or not. If you have kids under the age of 19, you will be required to have pediatric dental coverage for them, even if the health insurance plan you bought through the exchange does not offer it. That means you will have to purchase a pediatric dental plan in addition to your health plan.

Tags: Affordable Care Act   HealthPlanFinder   In-Person Assisters   Navigators   Washington Health Benefit Exchange   

“Luck Is What Happens When Preparation Meets Opportunity”

This quote, attributed to the Roman philosopher, Seneca reminds me that there is more to luck than being at the right place at the right time, and that preparation is often the key.  I just returned from my big family vacation. My extended family gathered to watch my brother-in-law compete in the Iron Man (an Ironman Triathlon is a grueling race that starts with a 2.4 mile swim, then a 112 mile bike ride and ends with a marathon). As we watched the athletes finish I was struck by the level of preparation and commitment that is required to finish. It was truly amazing.

As I was wading through the emails I missed while I was gone, I was delighted to see how WithinReach’s preparation for the upcoming launch of the Washington Health Benefit Exchange is paying off.  Over the past month, our agency has finalized several partnerships that position us well to assist the 330,000 of families who will now be eligible for health insurance under the new Medicaid guidelines. We are excited to be working with King County Public Health and the Whatcom Alliance for Health Advancement as in-person assisters. We have committed our AmeriCorps team to sign up 2,700 families for health insurance in the next year. Starting on October 1, our team of 8 AmeriCorps members will be out in the community with their iPads, ready to connect our most vulnerable families with health insurance and other important support services. We are feeling confident that we can reach that number of families. We would not be able to reach as many people without the financial support from the Verdant Health Commission and the Paul G. Allen Family Foundation. We are proud of the trust they have put in us to make an impact on our community.

We have been prepping for this once in a generation opportunity to support the health of families and communities for the last 25 years. I cannot believe it is finally here.

It is race day folks–let’s make it happen!

Tags: Medicaid expansion   Washington Health Benefit Exchange   

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