Overview of the Available Plans
Inside or Outside of the Exchange? Most plans are only available inside the exchange, some outside, and some are in and out. If you believe you are subsidy or Apple Health eligible (see calculator), your only option is exchange enrollment. If you are not subsidy eligible, avoiding the exchange and enrolling directly with carrier is usually preferable. Please use links for direct enrollment as there is no added cost inside or outside of the Exchange when using a broker for assistance.
Three Types of Individual Plans:
Cascade Plans: If a carrier is offering plans on the exchange, they must offer Cascade plans (Gold, Bronze & Silver). Benefits are established by the state and are identical regardless of carrier. For example, a Cascade Gold plan from Premera is identical in benefits to a Cascade Gold plan from Kaiser, the only difference is rate and provider access. Cascade plans are not considered competitively priced.
Public Option Plans: There is at least one Public Option Plan available in each county. These plans only reimburse doctors and hospitals at 160% of Medicare rates making them very unpopular with providers. It is presumed few facilities will be accepting this insurance. Rates are not competitive and enrollment is anticipated to be minimal.
Traditional Plans: All other plans are considered traditional and vary in benefits, networks and pricing. The vast majority of enrollees will be enrolled in traditional plans that are available inside and outside of the Exchange. The range of benefits is broad, from low deductible/copay plans to high deductible HSA plans.
Not available in Snohomish/Pierce
Hospitals Include: Swedish, Evergreen, Overlake, UW Medicine, Multicare, Providence, Children's, Highline, Overlake, UW Medicine, Virginia Mason, Harborview, SCCA)
Of the available individual plans, Premera offers the broadest access to providers (details on provider lookup). Unfortunately, Premera is only available in King and a few rural counties. For King County, although it has the largest network, it's also the most expensive plan.
Kaiser has plans available INSIDE and OUTSIDE of the state exchange.
The Kaiser Permanente plans are HMO (Health Maintenance Organization) health Plans. Kaiser acquired Group Health Coop in 2017. Typically, the Kaiser plans are the least expensive option. You must select a primary care provider and then receive a referral to see a specialist. Most care is received at the Kaiser owned facilities (formerly GHC), however, there are circumstances where Kaiser providers perform services at outside hospitals. If you are not subsidy eligible and would like an HSA plan or other Kaiser plan, Enroll Here.
Hospitals Include: Swedish, Overlake, Evergreen, Providence, Virginia Mason, Children's, CHI Franciscan, Highline (NOT: Everett Clinic, UW, SCCA)
The Ambetter health plans are HMO (Health Maintenance Organization) health plans. You are required to establish a PCP, also known as a primary care physician. However, you are not required to receive a referral from your PCP to see a specialist. Ambetter is the only plan in Snohomish county that does offer access to Swedish & Providence.
Hospitals Include: Molina covers most hospitals.
The Molina plans are HMO (Health Maintenance Organization) health Plans. Molina offers a Gold, Silver and Bronze plan. Your PCP, also known as your primary care physician, is the main doctor you will see for most of your medical care. This includes your checkups, sick visits and other basic health needs.
Hospitals Include: Swedish, Everett Clinic, Providence, CHI Franciscan (NOT: Overlake, Evergreen, UW, Multicare, Virginia Mason or SCCA)
Lifewise is an EPO (Exclusive Provider Network) plan, and requires a PCP, also known as a primary care physician. Your PCP is the main doctor you will see for most of your medical care. This includes your checkups, sick visits and other basic health needs.
Direct Online Enrollment (Easier than exchange, but no subsidy available if enrolling direct)
Regence is offering plans both inside and outside of the Exchange, and is an EPO (Exclusive Provider Network) plan, which offers one of the broadest network of providers in the market. You also have access to all of Oregon, much of Idaho and Utah as part of the 4-state Individual and Family network contract. Regence does not include Providence, Swedish, Proliance, Virginia Mason or Polyclinic
PacificSource is only available through the Exchange in Clark, Pierce, Spokane and Thurston counties. It is one of the few plans that offers an out-of-network benefit in the individual WA market. No referral needed to see a specialist.