If you live in Washington and aren’t happy with your health insurance or need to sign up, you’ve got a big decision to make. There are hundreds of insurance companies to choose from, but how do you know which one is best for you? We’ve researched health insurance providers in Washington and have valuable information to share to help you find affordable health insurance.
Quick Look - Best Health Insurance in Washington:
Best Health Insurance Providers in Washington
Every year, the National Committee for Quality Assurance (NCQA), an independent, non-profit agency focused on improving health care, rates private insurance plans in the areas of prevention, treatment and customer satisfaction. Based on their 2018 findings, here are their top picks for health insurance plans in Washington:
1. Kaiser Permanente
Kaiser Permanente is recognized for getting care quickly and easily, overall services and preventive services, and is among the top 5% in the nation in the quality category.
2. Providence Health Plan
Providence Health Plan’s PPO plan received a 4.0 out of 5 in NCQA’s survey, noted for outstanding specialists, handling of claims and quality of care. Providence’s plans also received high marks from J.D. Power in the 2019 Commercial Member Health Plan Satisfaction Study for communication, provider choice, billing, customer service, coverage and benefits, and cost. Providence offers group plans, individual and family plans and Medicare plans.
3. Regence BlueShield of Washington
Regence BlueShield of Washington’s PPO plan was rated 3.5 out of 5 for customer satisfaction in NCQA’s survey and ranked 4th overall. Regence ranked 4th in J.D. Power’s study, recognized for outstanding provider choice, billing, customer service, coverage and benefits. Its website features links to help you find dental providers, behavioral health facilities and useful plan information.
Aetna’s PPO plan, ranked 5th in NCQA’s survey, received high marks for treatment and prevention. Aetna also placed 8th in J.D. Power’s study, recognized for overall satisfaction, provider choice and customer service. Focused on health and wellness, Aetna offers members an app combining your health history and personalized goals so you can track your accomplishments. You can earn rewards such as gift cards from popular retailers if you reach your goals.
What is Health Insurance?
You don’t plan on being sick or going to the hospital, but you need to be prepared. Health insurance plans, provided by private or government health insurers, cover everything from doctor and hospital visits to behavioral health care, physical therapy, and medical supplies. You pay a monthly fee, called a premium, for your policy as well as other out-of-pocket costs such as:
Deductible: A fixed amount you pay before your insurance provider starts paying for health care costs
Coinsurance: A shared amount you pay along with your provider toward an insurance claim
Copay: A fixed dollar amount you pay each time you go to the doctor or receive a prescription
The amount you pay for health insurance varies based on factors such as:
- Smoking habits
- Body mass index (BMI)
- Overall health status
- Preexisting conditions
If you are 65 and older or under 65 and disabled according to the Social Security Administration and are eligible for Medicare, your rates are regulated by the Centers for Medicare and Medicaid Services (CMS), a government agency that oversees these plans. Here are the different types of plans available depending on your situation:
- From your employer
- From your spouse’s employer
- Through COBRA (an insurance plan that you pay for after you leave a job)
Individual or Family plans:
- Healthcare.gov (insurance marketplace)
- Contacting a health insurance company directly
- Medicaid (for low-income individuals or families)
- Medicare (for those 65 and older or disabled and eligible for Social Security Disability benefits)
Types of Health Care Plans
You have 2 types of health care plans you can choose:
Health Maintenance Organization (HMO) Plans
HMO plans consist of a network of doctors, specialists and hospitals that you must use — if you choose a provider outside the network, you’ll pay full price. Also, you’ll need to choose a primary care doctor for all regular visits. If you need to see a specialist, your doctor must give you a referral. HMO plans are focused on health and wellness and encourage optimal health.
To help you reach your goals, HMO plans offer fitness and weight loss programs, smoking cessation programs and blood pressure medication. HMO plans typically cost less than PPO plans, but they’re more limiting regarding where you can go for care and which doctors you can see.
Preferred Provider Organization (PPO) Plans
PPO plans are comprised of a large network of hospitals, specialists and doctors you can choose for care. You don’t have to choose a primary care doctor but you’re encouraged to do so. You’ll pay less if you choose providers within your PPO network because those providers and hospitals have agreed to charge established amounts for care.
Referrals aren’t required with PPO plans and you can switch doctors anytime. You’ll pay less for prescription drugs if you choose drugs on their preferred drug list and use a pharmacy on their preferred pharmacy provider list. PPO plans give you more freedom and they’re typically priced higher.
Health Plans if You’re 65 and Older or Under 65 and Disabled
If you’re about to turn 65 (including 3 months before and 3 months after), you can sign up for Medicare, a government health insurance plan. You can also enroll in Medicare if you’re under 65 and disabled. Medicare consists of 4 parts:
- Part A: Covers inpatient hospital care, skilled nursing care and some home care.
- Part B: Covers outpatient care, doctor and specialist visits, and medical equipment and supplies.
Part A and Part B combined are known as Original Medicare.
- Part C: Also called Medicare Advantage plans, covers everything Part A and Part B covers and includes extras such as vision and hearing coverage, fitness programs and wellness incentive plans. Offered by private insurers, you can choose either an HMO or PPO Medicare Advantage plan.
- Part D: Covers prescription drugs and are offered by private insurance companies; bought as standalone plans in addition to Original Medicare plans or as part of a Medicare Advantage plan.
You can also buy a Medicare Supplement plan to fill in the gaps not covered by Original Medicare. These plans, also called Medigap plans, are offered by private insurers. You can find a Medicare Advantage or Supplement plan by using the government’s plan finder tool at Medicare.gov.
Average Cost of Health Insurance in Washington
The average monthly cost per individual per month is $449, according to the Washington Office of the Insurance Commissioner. That figure could vary depending on factors such as your age, health and income. Also, you’ll pay more if you choose a PPO plan that includes more benefits than an HMO plan. If you receive your coverage through your employer you’ll probably pay a much lower monthly cost if your company contributes a large portion.
What Does Health Insurance Cover?
Most insurance plans cover costs such as doctor visits, inpatient and outpatient stays, specialist visits, skilled nursing care, physical therapy and some medical supplies. When you sign up for a health plan, you’ll receive an Evidence of Coverage document that spells out what is covered.
What Does Health Insurance Not Cover?
Health insurance doesn’t cover everything. Most plans don’t cover:
- Medical costs you incur while doing something illegal
- Care you receive if you file a false claim or used another person’s health card
- Care you receive while traveling abroad unless your policy includes it
- Most nursing home care
- Certain vaccinations
- Extremely expensive treatments or experimental drugs or treatments
Call your plan’s customer service number if you have any questions about exclusions.
When Can You Sign Up for Health Insurance?
If you need to know how to get health insurance, there are some important dates you need to know. Open enrollment runs from November 1 to December 15 each year for non-Medicare enrollees. You can sign up for a Medicare Advantage plan during your Initial Enrollment Period. This runs 3 months before you turn 65 and 3 months after. You can also sign up or switch plans every year from October 15 to December 7. In both cases, your new health plan becomes effective January 1.
Take Extra Time Before Signing Up
The health insurance plan you choose has a big impact on your health and finances. It’s smart to make a health plan wishlist and ask some questions before you shop for a plan. Is a fitness program important to you? Do you want to be able to keep your current doctor? Do you take more than a few prescription drugs? How much can you afford in terms of a monthly premium and other out-of-pocket costs? The answers to questions like these will help you narrow down your list of top contenders.
By taking extra time to consider your options, you’ll choose the best health insurance plan for you and your family.