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Coverage Basics

Here’s some coverage basics you should know about every health plan available through Washington Healthplanfinder.

Standard Plan Benefits

All health plans offered in Washington Healthplanfinder and Washington Healthplanfinder Business are required to provide all 10 of the essential health benefits, which include the following:

  • Doctor visits and hospital stays
  • Trips to the emergency room
  • Care before and after your baby is born
  • Mental health and substance use treatment
  • Prescription drugs
  • Services and devices to help you recover if you get injured or if you have a disability or chronic condition
  • Lab tests
  • Preventive services including counseling, screenings and vaccinations
  • Management of a chronic disease, like diabetes or asthma
  • Pediatric care

Levels of Coverage

Plans through Washington Healthplanfinder come in categories, called metal levels. The four categories of coverage are Bronze, Silver, Gold and Platinum.

Metal levels differ based on how you and your plan share the costs of your care. All plans offer the standard health benefits listed above, no matter what metal level you choose.

Often, if your monthly premium payment is low, the cost of getting care when you go to the doctor will be higher. Higher premiums mean paying lower costs out of your own pocket for things such as drugs or hospital stays.


Things to Consider Before Choosing a Metal Level

If you don’t go to the doctor or use prescriptions often: You may want to choose a Bronze plan. These plans costs you less per month, but pay less of your costs when you need care.

If you expect a lot of doctor visits and qualify for lower costs: You may want to choose a Silver plan to get lower out-of-pocket costs on your health care.

If you expect a lot of doctor visits or use prescription drugs regularly: You may want a Platinum or Gold plan. These plans often have higher monthly premiums but the health plan pays more of your costs when you need care.

Free Preventive Services Available

Most health plans cover a set of preventive services such as shots and screenings at no cost to you.

Screenings and Counseling

  • Depression screening
  • Diabetes (Type 2) screening
  • Drug and tobacco counseling
  • Cholesterol screening
  • Colorectal cancer screening
  • Obesity and diet counseling
  • STDs and HIV


  • Hepatitis A & B
  • Herpes Zoster
  • Human Papillomavirus (HPV)
  • Influenza (flu shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella

Services for Children & Youth

  • Behavioral and development assessment
  • Iron and fluoride supplements
  • Screenings and counseling
  • Vaccines
  • Vision screening

Services for Women

  • Breastfeeding support
  • Mammograms
  • Contraceptives
  • Domestic violence screening
  • STDs and HIV
  • Wellness visits

Common Coverage Questions

Once you’ve enrolled in a health plan, you can begin using your coverage to cover your health care costs, such as:

  • Filling a prescription
  • Going to the doctor
  • Getting emergency care

If you want to learn more about how health insurance works or key terms about health insurance, see

A few weeks after you enroll and make your first payment to your insurance company (if applicable), you’ll receive your insurance card in the mail. If you haven’t received your card yet, contact your new health insurance company.