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If this is the first time you are enrolling for an Individual/Family medical insurance plan –
Step 1 – You will most likely need to create an account on the WA Health Plan Finder (WAHPF). Also Known as the WA Exchange or WA Marketplace.
Step 2 – Once your account is set up you can shop for medical and dental insurance plans.
Before you start…
A few things to know about your medical insurance options and setting up an application for the first time.
- Individual & Family (I&F) medical insurance plans will have a different Network of contracted Providers compared to Employer Group Health plans – with the same Insurance Carrier.
- Most I&F medical insurance plans have a limited Narrow provider Network. Either a Health Maintenance Organization (HMO) or an Accountable Care Organization (ACO). Only emergency care out of area will be covered (Except for Kaiser and AmBetter plans)
- The only PPO plans available are with PacificSource in just a few counties.
- The rates are about the same for both ON and OFF Exchange.
- The Annual Open Enrollment deadline is December 15 for a January 1st start date. This is a much shorter time period than prior years. It’s only 45 days long.
- If your current Medical Insurance plan is terminating, you have 60 days to enroll in a Qualified Health Plan. If you wait longer than 60 days, you will need to wait until the next Annual Open Enrollment.
- Exception to 6) If your household income is lower than 250% of the Federal Poverty level you can apply for coverage any month of the year.
- Go to www.wahealthplanfinder.org to view all your WAHPF options using the ‘Browse Plans’ link – and then when you are ready to move forward set up a WAHPF account using the ‘Sign In’ link or ‘Apply Now’ link. If you or a family member has set up an account at the WAHPF in the past do not set up a new account (contact me).
- You will need to list every member in your tax filing household on the WAHPF application. You will then select seeking coverage – Yes or No – for each family member.
Step 1 – Create an application by clicking the button below.
Application Hints:
Do you want to apply for Apple Health (Medicaid/Healthy Options) or a Premium Tax Credit to reduce your monthly premiums?
- Mark the Box YES – If you want to know if you are eligible for Apple Health or Premium Tax Credit. You will need to provide income information for each household member on the application.
- Mark the Box NO – If you know that your household income is above the amount to be eligible for a Premium Tax Credit. If you answer NO, then you will not need to provide income information on your application. Taking this step will simplify your application. If you answer NO – You may still be eligible for a Premium Tax Credit at the end of the year when you file your Federal Tax report
After you set up your application and before you log out, please go to your home page. On the Left side of the home page under – Quick Links – select – Request help from a Broker. Look me up with just two items – Last Name Johnson in zip code 98092. Then agree to the next two or three prompts. There is no charge for my services. Now you can go shopping and enroll in a plan, anytime up to the open enrollment deadline, after you finish setting up an account.
- You must select a plan and then go through checkout to finalize your choice.
Step 2 –
I can help you with selecting a plan and assist you with looking up providers in the limited networks. I’m available for a telephone and computer screen sharing appointment. Please call or send me an email requesting an appointment and provide me with a few dates and times that will work with your schedule, and I will email you back with a confirmed appointment time.
Remember I’m here to help. I will return your email or phone call, but it may take several days. I generally get caught up by the end of the weekend. So please be patient.
I help anyone at any age with
Individual & Family Medical and Dental Insurance options
as well as Medicare
Dental insurance plans available from the WA Exchange – WAHPF https://www.wahealthplanfinder.org/
Delta Dental is removing major services (crowns, bridges, root canals) from their Adult WAHPF plan in 2019. So, I cannot recommend that plan any longer for Adults.
If you want dental coverage that includes major services in 2019, I recommend going to my website and enrolling directly with Delta Dental on the Premium plan ($2,000/y maximum benefit) or the Enhanced plan ($1,000/y maximum benefit). You will be given credit towards the 12-month waiting period for major services with the amount of time you were on the WAHPF/Delta Dental plan or the time you were on a group dental insurance plan prior to enrolling. In other words, if you were on the WAHPF/Delta Dental plan for the entire year of 2018 and you enroll directly with Delta Dental with no more than a 60-day break in coverage you will not have to satisfy the 12-month waiting period for new enrollees.
If you cancel your WAHPF Delta Dental plan in November, then coverage will end November 30.
If you cancel your WAHPF Delta Dental plan in December, then coverage will end December 31.
Both the Dentegra Dental and the Delta Dental plans available through the WAHPF do not cover major services for Adults. These insurance plans cover preventive care – exams and cleanings and fillings, but not major restorative services like crowns, bridges and root canals.
Dentegra Dental $26.43/m/Adult Preventive care, fillings, NO major services.
Delta Dental $38.08/m/Adult Preventive care, fillings, treatment of gums, NO major services. This benefit with major services covered and a $1,000/y maximum benefit was available in 2018 for $41.41/m/Adult
Delta Dental plans available directly from Delta Dental – http://https://jbjinsurance.com/dental/
Think of dental Insurance as a way to budget your expenses over the year on a monthly basis with just a little bit of insurance thrown in. I only offer Delta Dental for insurance coverage. It’s a reasonable price in my opinion and has the largest network (its Nationwide). Member dentists can not bill you for charges above the contracted amount. This feature has saved me 25% off the billed rate from my dentist.
Delta Dental Premium $58/m/Adult Preventive care, fillings, treatment of gums, major services. $2000/y maximum benefit.
Delta Dental Enhanced $48/m/Adult Preventive care, fillings, treatment of gums, major services. $1000/y maximum benefit.
Billed rates are based on age and can change at anytime.
You can apply for coverage right now with a start date of 1/1/2019
| Family size | Monthly / Annual household income less than | Monthly / Annual household income less than | Monthly / Annual household income greater than |
|---|---|---|---|
| 1 | $1,436 / 17,232 | $4,046 / 48,560 | $4,046 / 48,560 |
| 2 | $1,945 / 23,340 | $5,486 / 65,840 | $5,486 / 65,840 |
| 3 | $2,453 / 29,436 | $6,926 / 83,120 | $6,926 / 83,120 |
| 4 | $2,961 / 35,532 | $8,366 / 100,400 | $8,366 / 100,400 |
| 5 | $3,470 / 41,640 | $9,806 / 117,680 | $9,806 / 117,680 |
| 6 | $3,978 / 47,736 | $11,246 / 134,960 | $11,246 / 134,960 |
| You may qualify for… | Apple Health for Adults | Marketplace / Exchange | Marketplace |
| Medicaid | Qualified Health Plan | Qualified Health Plan | |
| There is no cost for Apple Health (zero monthly premium) | Premium Tax Credits and possible cost sharing reductions to reduce your monthly premiums and out of pocket expenses | You will pay the full premium without any Premium Tax Credit reductions |
|
| Federal Poverty Level | Under 138% | Between 138% and 400% | Above 400% |
Income guidelines are based on Federal Poverty Levels. These numbers are estimates and typically change annually. This chart was updated April 2019.
When you apply at WAHealthPlanFinder.org your household size and income will determine if you are eligible for Apple Health or a Qualified Health Plan. You can apply during the annual open enrollment from November 1 to December 15. Or within 60 days of loss of Employer/Union Group Health Plan Medical Insurance coverage, moving from another State (with proof of prior coverage), Marriage, Divorce and other qualifying events.
All household members expected to be listed on the current year’s Federal Income Tax report must be entered on the application with their income. Household members can be listed as not seeking coverage on the WAHealthPlanFinder application.
Eligibility for Apple Health is based on income going forward. In other words, income prior to being laid off is not reported. So, unemployment income (or zero income) going forward would be reported as current income.
Eligibility for a Premium Tax Credit is based on expected income (MAGI) for the entire calendar year. So, you may have to calculate your average monthly income on the application. The Premium Tax Credit is not available for any household member who is offered Employer/ Union Group Health Plan Medical Insurance (even if the offer is refused).