Some health coverage options you come across may look like health insurance and seem enticing because they're cheaper, but buyer beware! Plans that don't meet ACA standards, including supplemental insurance, may not cover essential health benefits, such as preventive, maternal and newborn care, and mental health services.
Comparing ACA and non-ACA health coverage
If you're looking for individual or family coverage, plans you buy through the Washington Healthplanfinder include the essential health benefits and may offer some financial assistance for buyers who qualify. These plans come with protection against surprise bills and can't deny you coverage for pre-existing conditions. You can also use the Healthplanfinder to sign up for Apple Health (Medicaid) if you qualify.
There are different types of health plans offered by employers, and understanding which type you have is important. Learn more about employment-sponsored health coverage and plans offered through PEBB/SEBB.
Some alternatives do not include important consumer protections:
- Health care sharing ministries: Organizations whose members share a common set of ethical or religious beliefs and share medical expenses consistent with those beliefs. These are not insurance plans, don't guarantee how much they pay for services they claim to cover, and don't have to include any ACA consumer protections.
- Short-term medical plans: These plans offer limited coverage, can only last for three months, and cannot be renewed. These policies do not have to include any ACA consumer protections.
- Direct health care practices: A medical provider or medical group that you pay a monthly fee to for primary care. Direct health care practices don't cover hospital stays, prescription drugs, or dental care. They don't bill your insurance either.
Here's a quick comparison of these types of health coverage options to ACA-compliant plans:
| ACA-compliant health plans | Health care sharing ministries | Short-term medical plans | Direct health care practices | |
|---|---|---|---|---|
| Are essential health benefits covered? | Yes | No | No | No |
| Do pre-existing conditions have to be covered? | Yes | No | No | No |
| Can you be denied coverage for a pre-existing condition? | No | Yes | May have exclusions, limitations, or waiting periods, | These practices typically accept patients with pre-existing conditions but only offer primary care services. You will need a separate health insurance policy or you'll pay for your own specialist care and emergency services out of pocket. |
| Is there a limit on your out-of-pocket expenses each year? | Yes, out-of-pocket limits are set each year. | No | No | No |
| Is there a maximum amount your plan pays toward benefits? | No | Not required; check the policy language, | Yes | Direct health care practice membership is not health insurance and only covers primary care services in exchange for a membership fee. |
| Do you have appeal rights? | Yes | Not required; check the policy language. | Not required; check the policy language. | Not required; check the policy language. |
| Is help with premiums available for eligible individuals? | Yes, if you buy a plan through Washington Healthplanfinder. | No | No | No |
Supplemental insurance products that aren't health insurance
Supplemental insurance is a type of limited coverage that's typically offered to complement, but not replace, your health insurance policy. Companies such as Aflac sell these types of products. They usually:
- Provide cash benefits for specific types of events that may not be fully covered by health insurance
- Pay you directly for accidents, hospital stays, or certain types of illnesses.
- Require a monthly premium for coverage.
- Fill in gaps for loss of income and additional out-of-pocket expenses.
Supplemental policies do not include ACA protections, such as coverage for preexisting conditions, guaranteed acceptance, or appeal rights. Common supplemental insurance products include:
- Hospital indemnity: This supplemental product pays you a lump sum or a set dollar amount per day for each hospital stay. It only pays you for hospital stays to supplement your income and other expenses. It doesn't cover other health care services.
- Critical illness: This type of coverage pays a set dollar amount, usually in a lump sum, when you experience a covered major health emergency such as a heart attack, stroke, or certain types of cancer. You can file a claim with your diagnosis. It's designed to cover some of the additional costs, such as deductibles, living expenses while you can't work, and transportation costs.
- Specified disease: These policies work similarly to a critical illness policy but are usually more limited in what they cover. You might choose one as a supplement to your primary health insurance if you have a strong family history or are at a higher risk of a condition such as cancer or heart disease.
- Accident only: Accident-only coverage pays you directly when you're injured from a covered accident. These policies usually cover a variety of injuries such as burns, concussions, or broken bones.
Avoid health insurance scams
Scams and pushy sales tactics are common during Open Enrollment periods. Look out for these warning signs that someone may be trying to sell you something that's a scam, isn't health insurance, or doesn't fit your needs:
- The person trying to sell you a product can't answer basic questions about it.
- You're pressured to buy right away.
- The product you're being sold is way cheaper than what other companies have offered. This may also indicate that it doesn't have the same benefits and has more limitations.
- Be wary of anyone who contacts you to talk about health insurance if you didn't contact them first.
- Beware of fake health plan marketplace websites operated by insurance brokers that look like the Washington Healthplanfinder.
Before you buy any insurance product, use our agent and company lookup tool to make sure they're licensed in Washington.