Smart Planfinder FAQs

Q. Why did Washington Healthplanfinder introduce Smart Planfinder?

A. Health insurance options change from year to year. Even if you stay in the same plan, benefits and costs you share with your insurance company may change from one year to the next. Washington Healthplanfinder introduced Smart Planfinder to help customers navigate the health plan options available to them and find a plan that best fits their needs.

Q. What does the Smart Planfinder do?

A. Smart Planfinder will help you identify plans that are a “Smart Choice” based on your needs and preferences. Using the tool, you can easily compare plans based on your provider preferences, prescription drug coverage, and costs. All “Smart Choice” health plans are identified by a green “Smart Choice” icon on the health plan shopping screen.

Costs

Smart Planfinder calculates an estimate of the costs that you might pay in a 12-month period for a health plan. This estimate is based on your household’s projected doctor visits and prescription drug usage for the year. Estimates include premiums and deductibles, as well as co-payments, co-insurance, and other costs. This estimate is shown in the “Estimated Yearly Cost” section of the shopping screen.

We categorize the “Estimated Yearly Cost” prices into three categories:

$$$ Lower estimated yearly cost

$$$ Average estimated yearly cost

$$$ Higher estimated yearly cost

These are relative based the plans available to you and the range of costs you might see with these plans. You can sort plans on the shopping screen by the “Estimated Yearly Cost.” You can view the actual dollar amount of the “Estimated Yearly Cost” in the “More information on this plan” section or when comparing plans side-by-side.

Providers

You can quickly look up your providers and facilities in Smart Planfinder to see if they are covered, or “in-network,” by a health plan. Identifying whether your provider is in-network is important to see if your costs will be covered by the health plan when you see your provider. You can add up to 5 (five) providers or facilities in Smart Planfinder.

Individuals who don’t have currently have a provider can go to our Provider Directory search tool to browse a list of providers based on their preferences. This tool will show providers in your area as well as important details such as whether the provider speaks your language. Any providers or facilities added from this tool will show up when you return to Smart Planfinder.

Washington Healthplanfinder makes great efforts to check the accuracy of the provider data in our tools. However, provider data changes rapidly and we cannot guarantee the accuracy of the data. If you are choosing a plan based on provider participation in that plan, always call your provider to confirm that they are “in-network” with the health plan you are considering.

Prescriptions

You can also look up your prescription drugs in Smart Planfinder to see if they are covered by a health plan. After entering in the drug name, you will need to indicate what dose of the drug you use. This is important because some dosages may be covered by your plan while others may not. You can add up to 5 (five) prescriptions into the tool at a time.

You can search both brand name and generic prescription drugs in Smart Planfinder. The shopping screen will indicate whether any version of the drug is covered by the plan. To see whether the brand name, generic, or both brand name and generic are covered, go to the “More information on this plan” screen or compare plans side-by-side.

Smart Planfinder does not take specific drug costs into the total out-of-pocket cost estimates for the year for a particular plan. The out-of-pocket cost estimate is an average of estimated costs based on the consumer’s expected utilization of both prescriptions and health care services. For consumers who have very expensive drugs, the actual costs may be higher than the out-of-pocket estimate given.

Prescription drugs entered into the tool are used to check a plan’s coverage of the prescription.

The prescriptions entered into the tool do not change the answer of how many prescription drugs are used each year. These questions should be considered separately when completing the Smart Planfinder.

Q. What goes into a “Smart Choice” suggestion?

 A. “Smart Choices” are assigned to health plans that are most likely to meet your needs. “Smart Choice” plans are a set of recommended plans that minimize your costs. We also use your provider and prescription drug preferences when calculating “Smart Choice” plans so we can recommend plans that fit all your needs.

Cost is the main factor in assigning a “Smart Choice” plan so you may find a plan with the “Smart Choice” badge even though it does not cover your providers or prescription drugs. While we try to factor providers and prescription drugs into our recommendation, these are individual preferences should be considered separately to make the right decision for you and your family.

 Q. Where can I use Smart Planfinder?

A. Smart Planfinder is available in Washington Healthplanfinder’s shopping screens for both anonymous browsers and users who are signed in.

Q. How should families fill out the questions in Smart Planfinder?

 A. Smart Planfinder asks a single question about doctor visit usage and prescription drug usage. Families should consider the average member of their household when answering these questions. We encourage all users to think about their past year’s health care usage when answering these questions as well as any expected procedures or changes in health status.