FREQUENTLY ASKED QUESTIONS

No! Your monthly premium paid directly to the insurance company already includes our cost. That means you’re paying for our advice whether or not you use us, so take advantage of it!

It depends on your situation. If you're young and healthy, you can go for lower premiums and higher co-pays. But if you're older, have a chronic health condition or have young children who make frequent visits to the doctor, you're better off with higher premiums and lower co-pays. You also have to weigh the value of your health plan versus price. If you go with a cheap health plan but it doesn't pay for the benefits you need, you are not getting good value for your health insurance dollars.

There are several health-plan varieties, including traditional fee-for-service plans (FFS), health-maintenance organizations (HMOs), point-of-service plans (POS) and preferred-provider organizations (PPO). Each plan has its own features to consider before making your choice.

HMOs are usually the least expensive but also the least flexible. They require that you select a primary-care physician. You must obtain pre-authorizations for certain medical procedures in order to see specialists. In Washington, Group Health Cooperative is a great example of an HMO.

POS plans are more flexible than HMOs, but they also require you to select a primary-care physician.

PPOs are the most flexible, and give policyholders a financial incentive -- in the form of reasonable co-payments -- to stay within the group's network of practitioners. You can usually visit out-of-network specialists without pre-approval but you will most likely pay more.

The short answer is “maybe”. These days many insurance plans do cover a number of alternative treatments that were once thought to be outside normal medical procedures. This is especially true in Washington state, where alternative and homeopathic treatments are widely sought out and accepted. That said, there is no hard and fast rule governing coverage of alternative medicine, so checking into your specific plan (or the plans you’re considering) will be in order. For more information on the most commonly covered alternative treatments, as well as questions to ask before receiving alternative treatments,
click here.

Yes! The Washington Legislature passed RCW 48.44.341, which requires all individual Washington health insurance polices sold after January 1st 2008 have coverage for Mental Health and depression. These conditions must be covered the same way as for any other health condition that the particular plan covers.

There are limitations, however. Inpatient and outpatient visits are not unlimited so you need to look at your particular policy for details. Also, prescriptions for medication for these conditions are not required to be included, and will only be covered if you medical plan has prescription coverage, and then only up to the limits set on that particular plan.

Typically, in order for an insurance company to cover a plastic surgery, the surgery needs to be deemed medically necessary. Since the instances when insurance plans will pay for these types of procedures varies according to the plan, we recommend thoroughly reviewing your plan with us prior to having any procedures.

Reconstructive surgery is considered medically necessary by many insurance companies if you are receiving reconstructive surgery after an accident or an additional medically necessary surgery, for example, breast reconstruction after a mastectomy. Other examples include surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. This can include surgery to improve function or to give a normal appearance.

Cosmetic surgery, on the other hand, is the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient.

Basic Health is a state-sponsored program providing low-cost health care coverage through private health plans. If you qualify, this is a great plan with fantastic benefits. To find out more about Washington Basic Health and how to determine your eligibility, click here.

Until you reach the age of 65, you will normally still receive your insurance either via individual medical insurance purchased through My Health Insurance of Washington or through an employer’s group plan. However, once you turn the magic age of 64 1/2 you can sign up for Medicare. Why 64 ½? Medicare allows you to sign up within six months of turning 65, and we recommend you do so at the first opportunity.

Medicare is a federal government program that helps older folks and some disabled people pay their medical bills and prescription drug costs. The program is divided into three parts: Part A, Part B, and Part D. Part A is called hospital insurance and covers most hospital stay costs, as well as some follow-up costs. Part B, medical insurance, pays some doctor and outpatient medical care costs. Part D covers some prescription drug costs. What about Part "C" you ask? The government left Part "C" to private companies who offer Medicare Advantage programs, which wrap Parts A, B, and D into one package. Confused? You're not alone. Call us and we'll help you understand.

Yes! With the addition of the right Medicare Supplements to fill in gaps in coverage, it is the best coverage you can get for the least amount of money. In our opinion no one should ever pass up the opportunity to sign up for Medicare coverage.

Short term health insurance in Washington provides temporary medical insurance coverage for situations when you need coverage now, including: between employers; waiting for other coverage to begin; no longer on a parent’s plan; during college or after graduation; other short-term coverage needs.

Temporary medical insurance overage can be purchased for as short as thirty days or up to six months. A new policy can be purchased to extend the health insurance coverage for a second term in most cases. However, each extension of your coverage is a new policy and won't cover conditions treated by the previous coverage (see “preexisting condition” under Glossary of Terms). Short Term Medical Insurance Coverage ends when the timeframe of the current term you purchased runs out, unless you are hospitalized or disabled. Because of these limitations, if you will need coverage for an indefinite period of time, you may be better served by having us help you find a more permanent medical insurance policy.

Because all plans have different limitations and exclusions, My Health Insurance of Washington is here to help find the health insurance policy that fits your exact needs.

The federal law known as COBRA (sometimes called "continuation coverage") protects the health care rights of workers who are laid off, as well as spouses and dependents of those workers, in certain situations. It enables you to keep your benefits for 18 months, and sometimes up to 36 months, depending on the circumstances

While the law is pretty generous, there are several conditions that must be met for you to be eligible for COBRA coverage. For instance, your company is required to provide COBRA only if it has at least 20 employees total (full-time and part-time) and continues to offer a health plan to its existing employees. And you won't be eligible if you were dismissed for "gross misconduct" on the job.

So what’s the catch with COBRA? You will be responsible for paying the full monthly premiums that your employer previously paid, plus a slight administrative fee (up to 2 percent). For a single person, premiums could easily top $600 a month, and $1,200 or more for a family.

While those payments might come as a shock to your wallet, the alternative is trying to find an individual health plan until — or if — you can get into another group plan. An individual or family plan may be more expensive than COBRA for the same or even less benefits. These plans are medically underwritten, meaning you have to poass a health questionnaire in order to qualify for coverage. Most insurance companies will decline to offer coverage to applicants with a serious illness and will also exclude preexisting conditions from coverage. This makes COBRA an especially good option for someone with an existing illness.

When your employer went out of business, the group health insurance pool to which you belonged also ended. You're not eligible for COBRA coverage because there is no longer a group under which you could continue your group health insurance benefits.

In Washington state, anyone up to age 25 is allowed to stay on his or her parent’s or guardian’s healthcare plan, even if he/she is not a student. However, if this is not an option, or if the cost is prohibitive, there are other options for students.

Many colleges offer student health coverage plans that can be purchased along with tuition. In addition, most major health insurance companies in Washington offer affordable medical plans designed specifically for students. One of the biggest advantages to obtaining a student plan through My Health Insurance of Washington is the ability to use off-campus medical facilities and doctors. This freedom of choice allows you to research the healthcare providers around your college and choose the option that ensures you’ll receive the best possible medical care. However, some colleges have excellent and affordable health care facilities that could make your school's student medical insurance the best option. My Health Insurance of Washington can evaluate all of your options and help you make the best choice for your needs.