2017 Individual & Family medical insurance plans

King and Pierce County

Apple HealthON ExchangeOFF Exchange (Direct)
MedicaidQualified Health PlanQualified Health Plan
No cost if income eligiblePremium Tax Credit may reduce premiumPremium Tax Credit not available
All Narrow Network PlansAll Narrow Network PlansOnly one carrier offers a Board Network Plan
Amerigroup
Bridgespan - ACN, EPO
Community Health
Coordinated CareAmBetter - HMO
Kaiser Permanente - HMOKaiser Permanente - HMO
LifeWise - EPO
MolinaMolina Marketplace - HMO
Premera - ACN
Regence - ACN, EPORegence - ACN, EPO, PPO
United Healthcare

2017 WA Networks

  • AmBetter – HMO
  • Bridgespan + Regence
    • PPO – Regence Preferred
    • EPO – Bridgespan Real Value, Regence EPO
    • ACN – Accountable Care Network – Bridgespan and Regence➡Select at application
      • Everett Clinic
      • EvergreenHealth Partners – Virginia Mason
      • Multicare
      • Providence – Swedish (On Exchange Only)
      • UW Medicine
  • Kaiser Permanente
    • HMO Clinics and Community Providers in outlying areas
  • Molina – HMO
  • Premera
    • ACN – Accountable Care Network – Premera Personal Care Plan➡Select after application
      • Evergreen Health Partners
      • Multicare
      • Northwest Physicians Network
      • UW Medicine
      • Virginia Mason

PPO (Preferred Provider Organization): With a PPO, you receive more comprehensive benefits by using network providers – doctors, hospitals and other health care providers – that participate in the plan. You have the option of using non-network providers, but with a lower level of benefits and higher out-of-pocket costs. Because PPOs usually have broader networks, they are generally more expensive – have higher premiums – than HMOs and EPOs. With a PPO, you do not need to select a Primary Care Physician.

EPO (Exclusive Provider Organization): Similar to an HMO, with an EPO you must use network providers – doctors, hospitals and other health care providers – that participate in the plan. The only exception is for emergency care. Unlike an HMO, you do not need to select a Primary Care Physician, nor do you need to contact your PCP for referrals to specialists.

HMO (Health Maintenance Organization): If you are in an HMO, you must use network providers – doctors, hospitals and other health care providers – that participate in the plan. The only exception is for emergency care. An HMO generally requires the selection of a Primary Care Physician (PCP) to manage your care. Referrals are usually needed from your PCP to see a specialist, who must also be in the network.

Accountable Care Organization/ Accountable Care Network: An ACO/ACN is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients. In our area the ACO/ACN is organized by Hospital and Clinic Systems. Such as Swedish, Virginia Mason, University of Washington, Multicare or Evergreen. Similar to an HMO, with an ACO/ACN you must use network providers – doctors, hospitals and other health care providers – that participate in the plan. Your network is limited to the Hospital and Clinic System you elect. The only exception is for emergency care.

These are general terms and the plan you select may be organized differently. Read the Insurance Carriers’ summary of benefits for plan specifics.

Family size2016 household
income less than
2016 household
income between
2016 household
income between
1$16,394$16,394 - $29,425$29,426 - $47,080
2$22,108$22,108 - $39,825$39,826 - $63,720
3$27,821$27,821 - $50,225$50,226 - $80,360
4$33,534$33,534 - $60,625$60,626 - $97,000
5$39,247$39,247 - $71,025$71,026 - $113,640
6$44,960$44,960 - $81,425$81,426 - $130,280
7$50,687$50,687 - $91,825$91,826 - $146,920
You may qualify for…Apple HealthMarketplaceMarketplace
MedicaidQualified Health PlanQualified Health Plan
With premium tax credits
and cost sharing subsidies
With premium tax credits

Income guidelines are based on Federal Poverty Levels. These numbers are estimates and may change.