What are the Best Health Insurance Options in Washington?
No company offers the best health insurance plans. Choosing the best health insurance coverage for you or your family is subjective. It is based on what is available in your area, the type of health plan that will best suit your needs and your budget of course. Before choosing a health insurance company to ensure that you take a few factors into cognizance – plan pricing, policy offerings, coverage area and benefits, the company's financial viability, service for claims, and its customer rating.
Whether you buy health insurance directly from a company or purchase it through a broker, the price stays the same. From the financial year 2019 - 2020 going forward, you do not have to pay a tax penalty for not purchasing insurance. In Washington, individual health insurance is divided into – catastrophic and comprehensive health care. The previous coverage constitutes higher deductible plans with some advantages excluded, like maternity. The latter cover has lower deductibles and more comprehensive benefits options. In both categories, after you have paid the deductibles and your share of the expenses (co-insurance), the provider takes on all the risk. Family insurance is just one plan with two or more family members included in the application and coverage.
Similarities across plans
In Washington, most health insurance options are the Preferred Provider (PPO) plans. These health plans care plans, where the insured use physicians, hospitals facilities attached to the provider network. If you stay within this network, you will receive maximum benefits. Using healthcare services outside the system is allowed for the most part, but you have to pay an additional charge.
Specific plans also may need you to choose a Primary Care Physician (PCP). A PCP is a doctor who oversees all your care, and you will require a written reference from him or her before you visit a specialist. Besides provider networks, all health plans cover pretty much the same health care services. Factors that may vary between providers are networks, premiums, additional costs, and prescription drug coverage.
Premiums – All plans offer the same essential benefits, but the higher premium you pay doesn't necessarily equate to better profits. People employed by the school district, educational service district, charter school, city, county, tribal government, port, water district, hospital or other employer groups should check with their benefits office regarding their premium details.
Plan Benefits – A plan's Summaries of Benefits and Coverage and the certificate of coverage will lay out what is specifically covered and the cost of care.
Out-of-pocket costs – The annual out-of-pocket limit is the maximum you pay in a calendar year for benefits covered. For example, the UMPS Classic plans, have an out-of-pocket limit for prescription drugs. Once you have paid the cut-off, the plan pays the rest. Usually charges like annual deductibles, coinsurance and copays are included in the out-of-pocket limit. Some of the costs not involved are monthly premiums, any charges above what the plan pays for a benefit and charges for services or treatments the policy does not cover.
Deductibles – Before providers pay for covered services, the insured will have to pay an annual deductible. SoundChoice, UMP Classic Kaiser Permanente WA Classic, and Value also have an additional yearly deductible for prescription drugs.
Copays and coinsurance – Copay is the fixed amount you have to pay on specific plans. Coinsurance, on the other hand, is when you receive care and pay a percentage of an allowed fee.
Your provider – For those of you who already have a trusted go-to doctor, find out if she or he is part of the network's plan.
Online and after-hours resources – Plans that provide a 24/7 medical helpline are more accessible.
Referral – Certain plans permit you to refer yourself to any network provider. In some plans though, you may be required to produce a reference from your primary care provider. All plans permit self-referral to a participating provider of women's health care services.
Gold, Silver, and Bronze/Catastrophic Plans
Health insurance plans are categorized into metal tiers (Gold, Silver, Bronze, Expanded Bronze and Catastrophic). These tiers and age are the two major factors that determine how much monthly premium you pay. Lower metal tiers offer less of a comprehensive cover. You pay a lower premium but might have to shell out more in out-of-pocket expenses like deductibles, coinsurance, and copay. Besides, the premium goes up in direct proportion with age. The older a person is, the more likely the risk of using health insurance, hence the higher the premiums.
Washing state has an official portal for purchasing health insurance - The Washington Health Plan Finder. It compares current market rates and offers so that you can find a plan tailored for your needs.
To check your eligibility for a consumer-directed health plan (CDHP) with a health savings account (HAS) click on https://www.hca.wa.gov/employee-retiree-benefits/public-employees/health-plans-health-savings-accounts-hsas#Who-is-eligible.
UMP Plus is coverage offered by the Public Employees Benefits Board (PEBB) Program. The options are limited and based on specific criteria like the area you live in. To check if your eligibility visit https://www.hca.wa.gov/ump/ump-plus/ump-plus-faqs
And remember, the cheapest health insurance might not always be the best health insurance for you. Find a policy that will adequately meet your family’s health insurance needs.