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FAQs

Is there extra cost to use a Navigator or Broker to help me select my plan?

Not a cent! Your monthly premium paid to the insurance company already includes that cost. That means you have access to expert advice for no more cost than if you bought without any guidance!

Can I enroll anytime I want?

No. Contrary to popular belief “Just enroll when you get sick, they have to take you” enrollment in the Exchange Plans can only occur from October 1st 2013 to March 31st 2014, then on an annual basis thereafter from October 15th to December 7th of each year. If you miss those enrollment periods, you are out of luck. There are a few special enrollment periods however, if you lose other coverage, get married, have a child etc.

How much does it cost?

That depends on several factors, including the level of coverage you need, your age, whether you smoke, income, and where you live. Depending on these factors there may be Tax Credits to help pay for Copays and Premiums. Complicated? Not Really. Our dedicated team is available via phone, email, or chat to help you determine what the right plan, and cost, is for you.

What if I don’t sign up?

If you don’t have a qualifying health plan you will pay a tax penalty. However, some people are exempted from paying the penalty, those include people: In jail or prison, if they make too little money to file an income tax return ($9,500 a year for an individual), if their health insurance premium would cost them more than 9.5 percent of annual income, members of Indian tribes, those whose religion forbids buying health insurance, illegal immigrants, Americans living abroad, and members of a health care sharing ministry.

How are rates for health plans determined in Washington?

Washington individual insurance rates outside the Exchange are based on age, smoker status, and location where you reside.  Inside the Exchange they also include Household Income.  As a general rule, the older you are, the more expensive the rate will be.

In Washington State, all individual insurance rates must be approved by the Insurance Commissioner. That means that you will pay the exact same for a policy no matter where you buy it . Nobody may offer a higher, lower, or discounted rate on a policy; not a broker, not even the insurance company itself! 

Is it more expensive to use a a Broker, Agent, or Navigator?

No! Your monthly premium paid directly to the insurance company already includes that cost. That means you’re paying for the advice whether or not you use a Broker, Agent, or Navigator, so take advantage of it! 

Which is more important when choosing a plan: cheaper premiums or less expensive co-payments?

It depends on your situation. If you're young and healthy, you can go for lower premiums and higher co-pays. But if you're older, have a chronic health condition or have young children who make frequent visits to the doctor, you're better off with higher premiums and lower co-pays. You also have to weigh the value of your health plan versus price. If you go with a cheaper health plan with a corresponding higher out of pocket expense, you will pay much more when a major medical expense does happen.

What's best: an HMO, PPO or POS? And what are they?

There are several health-plan varieties, including health-maintenance organizations (HMOs), point-of-service plans (POS) and preferred-provider organizations (PPO). Each plan has its own features to consider before making your choice.

HMOs are usually the least expensive but also the least flexible. They require that you select a primary-care physician. You must obtain pre-authorizations for certain medical procedures in order to see specialists. In Washington, Group Health Cooperative is a great example of an HMO.

POS plans are more flexible than HMOs, but they also require you to select a primary-care physician.

PPOs are the most flexible, and give policyholders a financial incentive -- in the form of reasonable co-payments -- to stay within the group's network of practitioners. You can usually visit out-of-network specialists but you will most likely pay more, sometimes much more.  Be careful though, not all PPO plans are created equal.  For instance, Lifewise and Premera plans don't include every hospital or Doctor network. 

Because all plans are not created equal, we are here to Navigate you through the process, and help you find the right plan without any surprises down the road.

Will my health insurance plan cover holistic, homeopathic, or alternative medicine treatments?

The short answer is “maybe”. These days many insurance plans do cover a number of alternative treatments that were once thought to be outside normal medical procedures. This is especially true in Washington state, where alternative and homeopathic treatments are widely sought out and accepted. That said, there is no hard and fast rule governing coverage of alternative medicine, so checking into your specific plan (or the plans you’re considering) will be in order. For more information on the most commonly covered alternative treatments, as well as questions to ask before receiving alternative treatments, read more.

Are mental health and depression covered?

Yes! The Washington Legislature passed RCW 48.44.341, which requires all individual Washington health insurance polices sold after January 1st 2008 have coverage for Mental Health and depression.  In addition, the Affordable Care Act added to the requirements for this type of coverage. These conditions must be covered the same way as for any other health condition that the particular plan covers.

There are limitations, however. Inpatient and outpatient visits are not unlimited so you need to look at your particular policy for details. Also, prescription medications for these conditions can be quite expensive, and are covered differently on many plans.

If this is an area of concern for you, give us a call.  We'll make sure you end up in the right plan at the right price, that covers what you need it to.

Is cosmetic or plastic surgery covered under my medical insurance?

Typically, in order for an insurance company to cover a plastic surgery, the surgery needs to be deemed medically necessary. Since the instances when insurance plans will pay for these types of procedures varies according to the plan, we recommend thoroughly reviewing your plan with us prior to having any procedures.

Reconstructive surgery is considered medically necessary by many insurance companies if you are receiving reconstructive surgery after an accident or an additional medically necessary surgery, for example, breast reconstruction after a mastectomy. Other examples include surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. This can include surgery to improve function or to give a normal appearance.

Cosmetic surgery, on the other hand, is the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient.  This is usually not covered.

What are my options for Long Term Care Insurance?

When most people reach 65 they are eligible for Medicare Medical coverage. However, to most people's surprise, Medicare does NOT cover Nursing Home care when you cannot care for yourself!  To protect yourself and your finances, Long Term Care Insurance is a great way to provide peace of mind for when you need extra help with routine tasks such as moving around, eating, dressing, etc..  Visit  the Medicare Page and give us a call to learn more about your options.

What is Medicare?

Medicare is a federal government program that helps most people 65 and over and some disabled people pay their medical bills and prescription drug costs. The program is divided into three parts: Part A, Part B, and Part D. Part A is called hospital insurance and covers most hospital stay costs, as well as some follow-up costs. Part B, medical insurance, pays some doctor and outpatient medical care costs. Part D covers some prescription drug costs. What about Part "C" you ask? The government left Part "C" to private companies who offer Medicare Advantage programs, which wrap Parts A, B, and D into one package. Confused? You're not alone. Call us and we'll help you understand. 

Is Medicare any good?

Yes! With the addition of the right Medicare Supplements to fill in gaps in coverage, it is the best coverage you can get for the least amount of money. In our opinion no one should ever pass up the opportunity to sign up for Medicare coverage. 

What is short term health insurance and how does it work?

Short term health insurance in Washington provides temporary medical insurance coverage for situations when you need coverage now, including: between employers, waiting for other coverage to begin, outside of the Open Enrollment for the Exchange, no longer on a parent’s plan, during college or after graduation, and other short-term coverage needs.

Temporary medical insurance overage can be purchased for as short as thirty days or up to six months. A new policy can be purchased to extend the health insurance coverage for a second term in most cases. However, each extension of your coverage is a new policy and won't cover conditions treated by the previous coverage (see “preexisting condition” under Glossary of Terms). Short Term Medical Insurance Coverage ends when the timeframe of the current term you purchased runs out, unless you are hospitalized or disabled. Because of these limitations, if you will need coverage for an indefinite period of time, you may be better served by having us help you find a more permanent medical insurance policy.

Because all plans have different limitations and exclusions, we are here to help find the right health insurance policy that fits your exact needs. 

What is COBRA?

The federal law known as COBRA (sometimes called "continuation coverage") protects the health care rights of workers who are laid off, as well as spouses and dependents of those workers, in certain situations. It enables you to keep your benefits for 18 months, and sometimes up to 36 months, depending on the circumstances

While the law is pretty generous, there are several conditions that must be met for you to be eligible for COBRA coverage. For instance, your company is required to provide COBRA only if it has at least 20 employees total (full-time and part-time) and continues to offer a health plan to its existing employees. And you won't be eligible if you were dismissed for "gross misconduct" on the job.

So what’s the catch with COBRA? You will be responsible for paying the full monthly premiums that your employer previously paid, plus a slight administrative fee (up to 2 percent). For a single person, premiums could easily top $600 a month, and $1,200 or more for a family.

While those payments might come as a shock to your wallet, the alternative is trying to find an individual health plan until — or if — you can get into another group plan. An individual or family plan may be more expensive than COBRA for the same or even less benefits.  This makes COBRA an especially good option if the cost makes sense.

I lost my job — and my health insurance — when my employer went bankrupt. Can I get COBRA?

When your employer went out of business, the group health insurance pool to which you belonged also ended. You're not eligible for COBRA coverage because there is no longer a group under which you could continue your group health insurance benefits. 

What are my insurance options as a college student?

In Washington state, anyone up to age 26 is allowed to stay on his or her parent’s or guardian’s healthcare plan, even if he/she is not a student. However, if this is not an option, or if the cost is prohibitive, there are other options for students.

Many colleges offer student health coverage plans that can be purchased along with tuition. Some colleges have excellent and affordable health care facilities that could make your school's student medical insurance the best option. In addition, the Exchange can help you find a good plan with a potentially large subsidy.  We can help you evaluate all of your options and help you make the best choice for your needs. Call us, we're here to help.