Shopping Tips for Open Enrollment

Open enrollment has begun! This year, customers have over 90 plans to choose from on Washington Healthplanfinder, including new dental plans. With so many options, shopping for coverage can be tough. Here are some tips to make your choices easier.

Smart Planfinder

Smart Planfinder will match you to plans that offer your personal coverage needs, including your prescriptions, doctors and health care facilities. You can use Smart Planfinder while shopping anonymously or when you’re renewing your coverage at www.wahealthplanfinder.org.

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Learn more about Smart Planfinder.

Plan Network Types

There are 3 plan network types available on Washington Healthplanfinder: Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), and Exclusive Provider Organization (EPO). EPO plans are new to Washington Healthplanfinder in 2018.

  • Preferred Provider Organization (PPO): A type of plan where you pay less if you use doctors in the plan’s network. You can use doctors, hospitals, and specialists outside the network without a referral for an additional cost.
  • Health Maintenance Organization (HMO): A type of plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care (except in an emergency). An HMO may require you live or work in its service area to be eligible for coverage.
  • Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, hospitals, or specialists in the plan’s network (except in an emergency).

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Remember to make sure your doctor is still in your plan’s network, especially if you’re shopping for a new plan next year.

Dental vs. Health: What’s the Difference?

While most health and dental plans have a monthly premium and a deductible, there are some differences when it comes to your costs. All health plans have an annual out-of-pocket maximum, while some dental plans have an annual benefit limit.

Annual Out-of-Pocket Maximum

Your annual out-of-pocket maximum is the maximum amount you’ll pay in a calendar year for health services (not including premium payments or out-of-network costs). This limit includes your deductible, co-insurance, co-pays, or similar costs.

All health plans covering adults and children have an annual out-of-pocket maximum. However, because dental coverage for children 18 or younger is considered an essential health benefit, there is only an annual out-of-pocket maximum for your child’s dental care.

Annual Benefit Limit

Your annual benefit limit is the most your dental plan will pay towards the cost of dental care within a calendar year. Annual benefit limits only apply to adult dental benefits. Once you’ve met your annual benefit limit, you’ll be responsible for all dental costs until your next benefit period begins.

Learn more about dental coverage offered through Washington Healthplanfinder.

Resources

Whether you’re a returning customer renewing coverage or a new customer shopping for the first time, we have resources available to help you get covered.

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