Understanding Costs

The first-time shopper’s guide to health insurance

Jan 6, 2016 | 5 min

If you’re shopping for a health plan for the first time, the process isn’t much different than your recent holiday shopping. Whether you’re an independent cyber-savvy consumer or would like personal help over the phone, these first-timer’s tips will help you select the best 2016 health plan for you and your family.

TIP 1: Choose a one-stop marketplace or personal shopper

Washington Healthplanfinder is Washington’s health insurance marketplace where you can compare available health plans, qualify for financial assistance and choose a plan. When first visiting the marketplace, read about coverage options and the available financial help.

If you don’t qualify for federal financial help or you prefer to work directly with a health plan, you can get personalized assistance by phone. Choose a company who can walk you through the entire process – from explaining plan coverage and cost options, to assisting you in applying for financial aid and selecting a plan.

There’s much to consider, so sometimes a representative can discuss the choices available that fit your specific budget and health situation – whether that’s making sure your plan covers specific doctors or going over your medications to help determine the best plan fit.

TIP 2: Know your “anchor stores”

As you browse online, you’ll be asked to enter in your zip code, birthdate and household income. Next, you’ll see a variety of plans, along with their benefits, costs and coverage. Look for plans from stable “anchor stores” such as Premera.

Reputable companies offer a wealth of plan choices with broad networks of doctors (both national and regional), discounts on health products and services and established customer support. Also, look for plans that allow members to balance costs and benefits – so you don’t pay for things you won’t need.

TIP 3: Know your healthcare budget

Consider your healthcare expenses and your overall health when shopping for a plan. When comparing plans online, you can select cost ranges for your premium, deductible and out-of-pocket maximum. Find a good balance between your annual premium and the costs you’ll pay as you use your plan.

For example, most Bronze plans offer the lowest premiums, but you will share costs with your health plan at a higher percentage when you get care. The opposite is true for Gold plans, which have the highest premium, but cover a higher percentage of your costs as you use benefits. A Silver plan balances these options covering approximately 70 percent of your in-network healthcare expenses with low copays.

TIP 4: When comparing plans, look beyond the premium

While shopping online, compare different plans’ details side-by-side, such as monthly premiums, prescription copays and other services you may want, such as alternative or virtual care. Look at your out-of-pocket costs as well and compare deductibles, copays and coinsurance. This is where you consider any health conditions for you and your family.

For example, if a family member on your plan has a chronic illness, you may need frequent doctor and hospital visits, and possibly need to go to a specialist. Look for plans with low copays on doctor visits. For example, many Silver plans have copays as low as $15. And some plans offer benefits that others don’t, such as Premera’s 2016 plans which offer two free doctor’s office visits on both Silver and Gold plans.

TIP 5: Where you get care can save you money

Location can impact your healthcare coverage and costs on many plans. While online, pay special attention to a plan’s additional details to see your care options (such as coverage when you are traveling). Some plans may have limited networks, but additional benefits that you may want, so you need to balance your healthcare needs with your budget. Also, ensure your preferred doctors and hospitals are in-network so you pay less out-of-pocket.

TIP 6: Apply for credit

More than half of Washington residents who buy individual health plans are eligible for federal financial assistance. Depending on your income, you might qualify for a free or low-cost health plan or be eligible for financial help.

The financial help you receive is based on your annual household income and the number of people in your household – individuals with incomes up to $47,080 ($97,000 for a family of four) may qualify. Create an account on Washington Healthplanfinder to see if you are eligible.

TIP #7: What you need while shopping

You’ll want to gather a few things to make your health plan shopping more effective:

  • Names and social security numbers of everyone on your plan
  • Your household income (have your 2015 tax return for reference)
  • Identification that you may be asked to scan and submit
  • Your preferred doctors, hospitals and prescriptions to check coverage

If you are shopping for the first time, it can take an hour or so to complete this process, but after you create an account online, you can save your progress and go back to compare plans later.

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