Does Insurance Make You Blue? Part 2: The Exchange


This is the second post in a series on Health Insurance Basics. Since open enrollment starts on November 1, we are taking a look at the Washington HealthPlanFinder, otherwise known as the Exchange.

Exchange:

There are many definitions of ‘exchange’, but when it comes to health insurance, we are talking about ‘a store or shop specializing in merchandise usually of a particular type’ (Merriman-Webster). In particular, for Washington residents it’s the Washington HealthPlanFinder. You can find it at WAHealthPlanFinder.org.

The Exchange tends to foster feelings of fear and anxiety in many people. It’s hard to use, it’s complicated, it’s overwhelming….and if you logon only once or twice a year, who can expect you to remember your password?

And don’t get me started on passwords. The Exchange makes crazy demands when it comes to passwords, but if you can get past that hurdle you might just be home free. Well, home free if you are single, have a W2 job, don’t have any deductions, and never see the doctor. Jobs, families and medical needs don’t fit into neat boxes for most of us. If you manage to complete your application successfully, you will then need to pick one plan out of 100. Yikes!

Why the Exchange?

Now that I’ve painted such a rosy picture of the Exchange, why would you possibly want to use it to buy your insurance?

  • Money: Advance tax credits are available for many people to help reduce the cost of their insurance. The Exchange is the only place to get these credits.

  • Options: The Exchange is a good place to compare plans from different companies side by side.

  • Doctors: The Exchange allows you to input your doctor’s name and search for plans that cover your doctor.

  • Preference: Many companies use the Exchange as their only method of selling their plans. Want a Premera policy? In 2017 the only place to get Premera individual coverage is on the Exchange.

  • Necessity: If your family income is under 138% of the Federal Poverty Level, you must apply on the Exchange to receive Washington Apple Health (free and low cost coverage through Medicaid).

How do you Apply on the Exchange?

Once you have decided that you need to use the Exchange, what do you need to do? First you need to gather the personal information for everyone in your (tax) household. If you are a grad student living with 6 other people in a house, they don’t count. But if you are divorced and your son is your tax dependent he counts, even if he doesn’t live with you.

  • Names, birthdates, and social security numbers

  • All income related information (wages, employers, addresses)

  • Doctors and providers you want to maintain a relationship with

  • Any prescriptions you take

What income are you supposed to report? Last year’s? This year’s? The tax credits are advance tax credits, so that means the Exchange wants your income for the current year. So if you are applying for coverage in 2017, they want your 2017 income.

Not sure what your income is going to be in 2017? You can use the previous year as a starting point. Self-employed with a fluctuating income? Use your income from the previous year if it seems in line with your current income. And it’s ok to use an average – if you get paid $6000 every 3 months, you can report $2000 per month. You can update your income at any time, so use the most accurate information you can.

How do you Pick a Plan?

Congratulations, now you’ve made it through the application! Now what!?! You may have over 100 plans to choose from. What should you do?

The quick and easy answer: Call your AGENT! Yes, we still exist, and yes, we can help you for free! Agents are paid on commission, so it costs nothing to talk to an agent and get their help.

Here are some things that will help your agent figure out which plan makes the most sense for you:

  • Who are your doctors? Both those you want to keep, and those you would be willing to switch.