You have insurance, now what?

doctor's office

Flickr Photo by Mercy Health


Maybe you have never had health insurance. Or perhaps it has been so long since you were last covered that you don’t recall how to use your policy or what to expect when you do.

Enrolling in an insurance plan is just the starting point for your journey through the health system.

To smooth your trip through the medical complex, and to maximize the benefits of your new insurance policy, here are some tips:

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Deadline looming: What you need to know about “enrollment period”

Our “What’s in a health word?” series helps decode the language of health insurance.

Open enrollment

Open enrollment for individual health insurance ends on March 31 for 2014. Flickr Photo by espinr

Health insurance enrollment windows can seem a little foggy.

When you have coverage through your job, annual “open enrollment” is the limited time when employees can change their existing health plans.

For Washington Healthplanfinder, and all of the new health exchanges, it’s similar. Open enrollment period refers to the time when individuals may register for coverage for that calendar year. The deadlines discourage people from enrolling in an insurance plan only when they need immediate medical attention.

What’s new this year is that it applies to any individual plan, which used to be sold year-round.

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What’s in a health word: coinsurance and copay


Coinsurance and copay are two ways you pay a share of your health care costs.

Our “What’s in a health word?” series helps decode the language of health insurance.

Deductibles and monthly premiums are not the only financial terms to consider when selecting a health plan. Even after your deductible is met and your monthly bills are paid, you still may be required to pay a share of your medical expenses.

Usually these costs come as coinsurance or a copay.

Paying your share

  • Coinsurance is a portion you pay toward any medical expense, regardless of your deductible. Your policy may require that you cover 15 percent of any health bill. So if your doctor bill amounts to $200, even if you’ve met your deductible, you would still be responsible for $30 of that bill. Your insurance company would pay the remaining $170.

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Making sense of the metals – gold, silver and bronze


Different metal levels help shoppers select plans to suit their budget and health needs. Flickr Photo by Koston Photography

Like champion Olympic athletes, each of the new health insurance plans has a metal status: bronze, silver, or gold. There are no winners or losers, no first or last place finishers, but the metal tiers help shoppers compare similar plans from different companies.

As you compare the three levels, you’ll see how the pricing differs. Even within a particular category, premiums, copayments and deductibles vary.

Broadly, here is what you can expect from the three metal groups offered in Washington state. (All plans cover ten essentials: hospitalization, preventive care, outpatient care, emergency care, laboratory services, maternity and newborn care, pediatric care, mental health and substance abuse services, rehabilitation and prescriptions.)

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What’s in a health word: Deductible

Our “What’s in a health word?” series helps decode the language of health insurance.

Bronze plans have higher deductibles on Washington Healthplanfinder.

When choosing a health care plan, your deductible is a major consideration. But the word is a confusing piece of insurance jargon.

What is a deductible? And how does it affect the quality of your health insurance?

Defining a deductible

A deductible is the annual amount of money you must pay your health care providers — doctors, clinics, labs, hospitals — before the insurance company will take over your expenses. If your deductible is $2,000, you pay your medical expenses up to that amount before your insurance begins to contribute.

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