For Consumers

What to consider when shopping for a health plan this year

Contact Public Affairs: 360-725-7055

November 4, 2015

OLYMPIA, Wash. – Most people shopping for health insurance look at the monthly premium first, but there other factors to consider if you want to get the best cost and coverage deal. 

Fifteen health insurers are selling 210 health plans for the 2016 individual market and, while all plans must include the same essential health benefits, the plans differ greatly in deductible amounts and which medical providers are included in their networks.

“Most people are motivated to keep their premium monthly costs down when shopping for health insurance, and that’s understandable,” said Insurance Commissioner Mike Kreidler. “But paying attention to how the health plan’s deductible works and what you will have to pay to see certain providers can be just as important in keeping your costs down over the long run.”

What to consider before picking a health plan:

Deductibles (See deductible ranges for 2016)

 

  • 2016 health plans have deductibles ranging from $500 to $6,850.
  • Some plans have a separate deductible for prescription drugs.
  • Know what services are subject to the deductible. Most plans must cover preventive services at no cost to you. Also, some plans allow you to see your doctor, obtain generic drugs, and even receive some specialty care and lab tests before you’ve met your deductible.

Provider networks

  • Find out if your medical providers are part of the plan’s provider network.
  • Understand what you will pay if you use out-of-network providers.

Prescription drug coverage

  • Review the plan’s drug coverage and understand the difference in costs to you between any drug tiers the insurer uses.
  • Learn about any restrictions in coverage for preventive care. For example, most plans will not cover preventive care if you receive it from an out-of-network provider.
  • Review coverage for emergency room services.

 

See 2016 health plans and their rates by county.

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Release No. 15-47