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.
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!
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.
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
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.
Self employed? We Have Answers to Your Health Insurance Questions
What To Consider When Buying a Qualified Health Plan
What is a QHP?
Qualified Health Plans are similar to the traditional health insurance plans that existed prior to the Healthplanfinder, with a few essential differences:
1) QHPs must cover the Ten Essential Benefits, as mandated by the Federal Government.
2) QHPs cannot deny coverage because of preexisting conditions.
3) QHP costs may be subsidized by the Federal Government, through tax credits (Health Insurance Premium Tax Credits) and cost-sharing reductions.
4) QHPs can be compared, side-to-side, on the Washington Healthplanfinder.
Please note: Dental coverage is not included in QHPs for adults but can be purchased, separately. Many plans do not offer adult vision coverage, but do offer adult hearing coverage.*
How can I narrow my search?
By medical provider:
- Click “Add”, listed under “Health Care Provider” in the “My Search” box, located on the upper left-hand side of the QHP selection screen.
- In the pop-up window, search by: your provider’s name, hospital, or zip code.
By price range:
- Cost parameters for premium, deductible, and out-of-pocket maximum, can be controlled by clicking on the price-range options in the “Customize My Search” box on the left-hand side of the QHP selection screen. For definitions of these, and other health-insurance related terms, refer to this glossary from the Federal Government.
- Another method for cost-based comparison is to search for plans based on metal level. There are three metal levels: bronze, silver and gold. These search options are located in the “customize my search” box on the left-hand side of the QHP selection screen. The Federal Government recommends considering medical needs when selecting a plan because “the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care”.
By comparison with other plans:
- To select a plan for comparison, click the “Add to Comparison” option, located in each plan’s box. You can compare three plans, side-to-side, at a time.
- Once you have selected plans for comparison, click the “View Comparison” tab, located at the top of the page.
Do I have to buy through the Washington Health Plan Finder?
No. However, you must purchase a plan through the Washington Healthplanfinder if you want to receive tax credits.
How do I enroll in a QHP?
1. Once you have, selected a plan, click “Buy”.
2. If you are ineligible for tax credits, please skip to step 3. If you are eligible for tax credits, you will be allowed to select how the tax credits will be applied. For more information about applying the tax credit, please refer to this blog entry.
3. Next, you will be required to pay for your first month of coverage. When purchasing a QHP, have an electronic form of payment ready to make the initial payment – either an eCheck , a debit card, or a credit card. For questions about subsequent payments, contact your QHP provider or the Washington Healthplanfinder customer support at: 1-855-923-4633.
What is the last day for buying a QHP?
The end of Open Enrollment and the deadline to get coverage, is March 31st, 2014 in order to avoid a penalty on your 2014 taxes. You should purchase a plan by March 23rd in order to ensure that your enrollment is processed and that your coverage is active by March 31st, 2014.
What happens after I buy a QHP?
Please to refer to this blog entry for information on what happens after purchasing a QHP.
I’m still confused. Where do I get help?
There are two types of help: Navigators and Brokers. Both services are free for you to use through the Washington Healthplanfinder. When selecting a QHP, keep in mind that Navigators are legally unable to recommend specific plans. For advice about which plan will be best for you and your family’s needs, contact a Broker – they are legally allowed to recommend plans. Brokers can be found through the Washington Healthplanfinder:
1. Click on the “Customer Service” tab in the upper right hand corner.
2. To search for a Broker in your area, enter your zip code.
Please note: Before clicking “Request Help” we recommend that you call and/or email the Broker you are interested in partnering with, to insure their availability.
*Finding Dental, Hearing, and Vision Coverage for each plan: To see whether or not a plan covers adult dental, vision, or hearing:
1. Click on the blue, “More Information on this plan” link located under the name of each plan.
2. Scroll down to the bottom of the page and click “See More Details”.
3. Scroll down to the bottom of the page, again, and click the blue, “Open Summary of Benefits and Coverage” link.
4. This will open a document that summarizes the entirety of the health plan. Search for the section titled “Excluded Services & Other Covered Services.” This will detail coverage for dental, eye, and hearing care.
‘Young Invincibles’ Helping ‘Young Invincibles’ Enroll in Health Insurance
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.