Health Insurance

the basics of healthcare coverage

Health insurance protects you from unexpected, high medical costs. You pay less for covered in-network health care, even before you meet your deductible. You get free preventive care, like vaccines, screenings, and some check-ups, even before you meet your deductible.

With a massive public health issue like COVID-19 increasing the need for care and endangering many people’s ability to afford it, it is more important than ever to encourage enrollment. In this article, we will attempt to address the following topics and/or provide additional resources.

This article is a part of the Health and Safety Handbook, which is one section of the COVID-19 HANDBOOKS FOR THE CREATIVE SECTOR.  For more information about personal health and wellness, please see these other articles:

Choosing a Health Plan

Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.

  • The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
  • Your total costs for health care: You pay a monthly bill to your insurance company (a “premium”), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.
  • Plan and network types — HMOPPOPOS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.

Remember that plans also may differ in quality. Learn more about quality ratings.

Washington Healthplanfinder

When the Affordable Care Act was put in place (aka Obamacare), it invited each state to develop a “health benefit exchange.” That is basically a new marketplace of health and dental insurance coverage to individuals and families.

In Washington State, our health benefit exchange is best known as Washington Healthplanfinder, a webtool where you can navigate your options, depending on your eligibility for Medicaid, Medicare or tax credits.  In any case, if you fall below a certain income level and do not have health coverage otherwise, the odds are you’ll find assistance.

The site is relatively easy to use, but health insurance is generally complicated.  Don’t be afraid to reach out to them for help if you need it.

Enrollment Periods

Enrolling in new health insurance plans is limited to a particular season towards the end of the calendar year.  In 2020, Open Enrollment begins November 1 and lasts until January 15, 2021. During this time, anyone can sign up for a new health insurance plan.

However, even outside of the enrollment period, you may enroll in coverage through the Washington Healthplanfinder website at any time if you have experienced a qualifying life-changing event, including loss of a job.

Also, enrollment is always available year-round for free or low-cost Washington Apple Health (also called Medicaid).  See if you qualify.

New in 2020

  • During the COVID-19 pandemic you can still get help with enrollment. In-person, on the phone or online, Navigators are available to assist you.
  • King County residents can choose from seven insurance carriers offering multiple plan options on Washington Healthplanfinder.
  • Cascade Care plans are newly available for 2021 coverage. They expand access, choice and value. These plans offer more upfront services without having to meet a deductible. These plans are available through Washington Healthplanfinder.

Other Considerations

COVID-19 testing coverage for individuals that don’t Qualify for Apple Health due to immigration status. See below more information on Alien Emergency Medical (AEM)coverage and how to qualify.

In-person assistance for health insurance and ORCA LIFT on Thursdays 7:00am-1:00pm at the ShoWare Center (tent in parking lot) 625 W James St Kent, WA 98032.

Washington has required insurers to offer no co-pays or deductibles for testing for COVID-19

The City of Seattle has a resource guide on healthcare access and hygiene support.

Photo by National Cancer Institute on Unsplash

Immediate questions about your health?
King County Public Health Hotline