Health Insurance Northwest

Serving Northwest Washington since 2002

Frequently Asked Questions

Most health insurance questions pertain to the “Exchange” benefits available through

I am licensed to represent the HealthPlanFinder and can answer your questions or help with your application.  I recommend most of my clients DO apply through the HealthPlanFinder to take advantage of possible tax credits.

The following information is taken from the WA Health Benefit Exchange website or other insurance glossaries.  If you have a specific question not addressed here, please call Lori at 360.468.3998.

What are metallic plans?

Health Plans in Washington state are categorized based on actuarial value and cover a percentage of your costs in network:  Gold (80%), Silver (70%) and Bronze (60%). They all have deductibles, co-pays, coinsurance and annual out-of-pocket maximums.

What are deductibles, co-pays, coinsurance and annual out-of-pocket maximums?

A deductible is a specific dollar amount that you pay each year before your insurance begins to make payments for claims.  A co-pay is a payment for a service, paid at the time of service – usually $10-$45.  Coinsurance is the amount you pay for services after any co-pay or deductible is met, typically described as a percentage.  Annual out-of-pocket maximum is an annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This limit does not apply to premiums, balance-billed charges from out of network health care providers or services that are not covered by the plan.

Will I qualify for subsidies?

To qualify for the federal subsidy, income will be based on modified adjusted gross income and verified through federal tax returns.  If you earn up to 400% of the national poverty level, you may qualify.

How does the Health Insurance Premium Tax Credit work?
Also known as an Advanced Premium Tax Credit, this tax credit can be used to lower the health insurance premium costs of Washington Healthplanfinder Qualified Health Plans (QHP). This tax credit provides you the option to either reduce the amount of your monthly health insurance premium or have a lump sum deduction when you file your annual income tax return. You can determine your tax credit qualification here:

Health Insurance Marketplace Calculator

You can use your Health Insurance Premium Tax Credit in one of the following ways:

Monthly – You can use some or all of your tax credit in advance to lower the cost of your monthly premium.
Pros: Your health plan costs will be less each month.
Cons: You may owe money at tax filing time if your current household income increases.

Annually – You can claim your tax credit on your annual tax return, which will reduce what you owe or increase your refund.
Pros: You have no risk of having to repay at tax filing time.
Cons: Your health plan costs will be more each month.

Your Health Insurance Premium Tax Credit will be sent directly from the Internal Revenue Service (IRS) to the health plan carrier. If you choose to take advantage of this tax credit, you are required to file taxes. The Exchange will issue an IRS form 1095A to you directly to be filed with your tax return.

What is open enrollment? When is open enrollment?
Healthplanfinder open enrollment is the time period that you can sign up for health insurance for yourself and your family. Open enrollment for January 1, 2021 is Nov. 1-December 15, 2020. Washington Apple Health enrollment is year-round.

Under what circumstances can I sign up after the open enrollment period? Are there any special enrollment periods? How do I add a child to my health insurance plan? How do I add my husband or wife to my health insurance plan?
If you have had a change to your household composition such as a birth, adoption, or death, you may be eligible to change your health plan. You’ll need to sign in to your Healthplanfinder account and submit the change to redetermine your eligibility. You can submit a change at any time; however, eligibility for a special enrollment period requires an individual to report a change within 60 days of the event. I can help you do this – just give me a call!