All health plans offered through Washington Healthplanfinder are required to provide all 10 of the essential health benefits, which includes 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
Health plans also come in categories called metal levels. The four categories of coverage are Bronze, Silver, and Gold. 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 financial help, 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 to choose a 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
- Tetanus, Diphtheria, Pertussis
Services for Children & Youth
- Behavioral and development assessment
- Iron and fluoride supplements
- Screenings and counseling
- Vision screening
Services for Women
- Breastfeeding support
- 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 for things such as:
- Filling a prescription
- Going to the doctor
- Getting emergency care