Insurance Companies in Washington State

Most people's health insurance depends on whichever company you work for. However, some people have the option to choose their own insurance. The main Washington state private healthcare insurance companies are Aetna, Cigna, First Choice, Group Health, Lifewise, Premera, Regence and United. There are some smaller companies not listed here that may have their own health insurance plan, or may be a overseen by the larger companies. Most companies listed, with the exception of Group Health, belong to what is known as a Preferred Provider Organization (PPO). These insurances allow you to choose any practitioner who belongs to their "network". Group Health is known as a Health Maintenance Organization (HMO) and generally only allows you to see providers practicing within the Group Health organization. For both PPOs and HMOs, any provider (doctor, naturopathic doctor, chiropractor, acupuncturist, massage therapist, etc.) that accepts your insurance is known as an "in-network" provider. Any provider that does not accept your insurance is known as an "out-of-network" provider. There are some state insurances such as 1) Washington Basic Health Plan, which is a program to help low-income individuals have basic health insurance and 2) Labor and Industries (L&I), which employees can apply for if they are injured on the job. Another insurance you may have used or will need to use is Personal Injury Protection (PIP), which is a short-term plan provided by your car insurance company should you get into an accident and need to seek medical care. Even if you have private insurance, any provider treating you for you injuries from your car accident can bill your PIP insurance, which does not affect your private insurance in any way.

Some Helpful Terms:

Premium

Your premium is the monthly amount you owe to your insurance company. You pay this amount whether you use you health insurance or not. If you work for a company that offers health insurance, the company often pays for part or all of your monthly premium. Your premium amount depends on a number of factors including 1) the amount of coverage you have including office visits with doctors, alternative treatments like chiropractic, massage, acupuncture, etc., 2) the amount of people that are on your health insurance—the more people in the family, the higher the premium, 3) the insurance company you use, and 4) your deductible (see the "Deductible" section).

Deductible

The deductible is the amount you pay out-of-pocket per year before your insurance company will start covering your medical visits. As mentioned in the "Premium" section, your deductible can determine whether your monthly premium is higher or lower. A higher deductible, sometimes called "catastrophic insurance," generally means you have lower monthly premiums. Conversely, a lower deductible generally means you pay more for your monthly premium. Depending on your insurance, you may not have to pay for what are called "preventative services" like annual visits to the doctor and Pap smears; you may only need to pay your coinsurance or copay for these visits (see descriptions for both "Copay" & "Coinsurance" below). Some insurances even cover some or all office visits with doctors without your deductible being affected. Insurances generally have different deductibles for in-network and out-of-network providers. This means that even if you have reached your in-network deductible, if you see an out-of-network provider there will be a separate deductible for those visits and treatments. Deductibles also vary depending on how many people are on the particular insurance plan. Many people are on what are known as "family plans" to include dependents like spouses and children. The benefits of a family plan may include a lower out-of-pocket deductible for the entire family. For example, a family with two parents and two children may each individually have a deductible of $250, but in their family plan they only owe a maximum deductible of $750. So if all family members have any kind of medical treatment throughout the year, then they will only end up paying for three of the four family members' deductibles.

Copay

Copay and coinsurance (see more in "Coinsurance" section below) are the amount you owe for each visit, no matter what. Insurance companies and plans within those insurances will differ on which type of copayment you owe. Copays are a set dollar amount you owe each time, like $20, and you pay at the time of the visit.

Coinsurance

Coinsurance is a percentage of the visit you owe each time, like 10% or 20%. Unlike copays, you generally pay them after your visit. The provider you see first has to bill your insurance company for the visit and/or treatments they have given, then the insurance company responds back with the amount they will pay the provider and the amount the patient owes.

These are just a few items involved in your healthcare coverage. Your insurance company can provide information on everything your health insurance covers. In understanding your healthcare benefits, you can keep you and your family as healthy as possible while being practical with your out-of-pocket expenses.