Author Topic: Washington State Health Insurance  (Read 929 times)

nsmall

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Washington State Health Insurance
« on: January 10, 2021, 05:15:28 PM »
The big plan is to retire in eastern washington north of spokane about 50 miles in a small town named Chewelah in the summer of 2023.  We have kids but they were adopted from the foster care system in Cali so they will get health coverage until they are 18. 

I have done some research and the numbers are all over the place. Its really hard to find some numbers I can trust.

 Any guess what I would expect to pay for my wife and I?  My wife has type 1 diabetes but besides that we are both very fit and healthy.  I am very interested in knowing what the worst case costs would be.  I am a teacher and not sure if I would qualify for cobra or if that idea is trash.  Feel free to ask any questions or give me any advice as I am new to the Fire movement.  Thanks in advance.

shuffler

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Re: Washington State Health Insurance
« Reply #1 on: January 10, 2021, 05:50:20 PM »

Dusty Dog Ranch

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Re: Washington State Health Insurance
« Reply #2 on: January 10, 2021, 06:09:41 PM »
Not quite related, but be sure to factor in cost of travel to specialists. I'm a couple counties west of Chewelah and equally rural. The closest endocrinologist for the type 1 person in my home is 90 miles one way. I'm hoping the telemedicine set up will stick around post-pandemic.

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lhamo

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Re: Washington State Health Insurance
« Reply #3 on: January 10, 2021, 07:55:24 PM »
Highly recommend you try to identify a Healthcare Navigator once you do move-- here in Seattle they are often in community clinics that serve a lower-income population.   I made some significant errors when I first moved back to Washington state and tried to navigate signing up and paying for an ACA plan on my own.   I consulted a Navigator when my daughter moved back and ended up saving a LOT of money as a result. I have consulted with the same person whenever we have needed to make a change.   The Navigators have direct access to the state system and can save you a lot of time and frustration by entering info/troubleshooting on your behalf.


nsmall

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Re: Washington State Health Insurance
« Reply #4 on: January 10, 2021, 10:38:18 PM »
Thanks for your help.  @lhamo I know this may sound stupid, but how would I find a "healthcare navigator?"  Would I want one from the small town I am interested in moving to?

Thanks

nsmall

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Re: Washington State Health Insurance
« Reply #5 on: January 10, 2021, 10:46:40 PM »
Shuffler, I checked out that site that was a killer.  I didnt get to add my wife is type 1 diabetic, but I found a plan for 530 a month and 500 individual/1000 family deductible so that sounds good.

It says out of pocket max is $5,250 for an individual and $10,500 for a family.  Does anyone know what that means?  I just put my wife and I into the application and those are the numbers it said.  Thanks

shuffler

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Re: Washington State Health Insurance
« Reply #6 on: January 10, 2021, 11:25:18 PM »
Shuffler, I checked out that site that was a killer.  I didnt get to add my wife is type 1 diabetic, but I found a plan for 530 a month and 500 individual/1000 family deductible so that sounds good.

It says out of pocket max is $5,250 for an individual and $10,500 for a family.  Does anyone know what that means?  I just put my wife and I into the application and those are the numbers it said.  Thanks
Off the top of my head, so please double check, but ...

You need to know the ways in which you end up paying for health insurance.

Premiums - You pay this monthly, whether you receive any healthcare or not.  This is the $530/mo number you  found.

Deductible - You pay the full cost of all healthcare you receive until you reach your deductible.  Insurance won't help out until you've fully paid this amount.  This is the $500/$1000 number you found.

Co-Pay - After you reach your deductible, that's when the insurance company starts kicking in.  But how much do they pay?  In most plans (even plans with employers, and not on the ACA) this is a % of the cost of the healthcare.  In the case of the ACA, the "metal" type of the plan determines  the %.  In a bronze plan, the insurance will pay 70% of the cost.  Silver is 80%.  Gold is 90%.  So if you got a $1000 bill on a silver plan, you'd pay $200 and the insurance provider would pay $800.

Max OOP - This is when you've finally stopped paying.  When the amount you've paid in deductibles and co-pays reaches the Max-OOP, then the insurance provider pays the full cost of any further charges (until next year).

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So, let's suppose the plan you're referencing above is a silver plan.

You'd start by paying $530/mo, each month for the year.  So that'd be  $530 * 12 = $6360.

Now suppose you had a $800 medical bill, you'd pay the first $500 as deductible, and then (because it's a silver plan) 20% of the remaining $300.
$500 + (0.2 * $300) = $560

Now suppose your spouse had a surgery for $20,000.
You'd first pay her $500 deductible.
Then (because it's a silver plan) you'd pay 20% of the remaining $19,500 = $3,900.

Uh oh!  The surgery required a follow-up for another $10,000.
You would've paid 20% of $10,000 = $2,000 ... except that would make $3,900 + $2,000 = $5,900, which is greater than the $5,250 individual Max OOP.
So instead you just pay $1,350 to bring your full payments for the year up to the $5,250 individual max OOP.  ($3,900 + $1,350 = $5,250)

Even though your spouse has hit their individual max OOP, you still haven't.
So when you go see the doctor for $200, you're still paying 20% * $200 = $40.

lhamo

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Re: Washington State Health Insurance
« Reply #7 on: January 11, 2021, 10:14:21 AM »
Try this:

http://www.betterhealthtogether.org/navigators-about-us

They provide service over the phone.

FYI, you won't be able to start any plan through them until you have actually moved to Washington, but hopefully they will be willing/able to walk you through your options.

DaMa

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Re: Washington State Health Insurance
« Reply #8 on: January 11, 2021, 01:01:06 PM »
You will want to pay attention to the prescription drug coverage on the plans.  With diabetes, costs can go high very quickly.  Sometimes drugs are included with everything else in deductibles and out-of-pocket (OOP) max, but sometimes they are separate.

A friend has a teenage son with Type 1, and she hits her OOP max every year due to his drugs and supplies. 

(Her OOP max is $4000 or $6000 -- I can't remember which. She has a high deductible health plan.  Those count drugs toward the deductible and out-of-pocket max.)

lhamo

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Re: Washington State Health Insurance
« Reply #9 on: January 11, 2021, 04:11:03 PM »
Insulin copays are now capped at $100/month in washington state by order of the governor:

https://www.diabetes.org/newsroom/press-releases/2020/insulin-co-pays-washington


nsmall

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Re: Washington State Health Insurance
« Reply #10 on: January 13, 2021, 06:30:44 PM »
Original poster here.  Thank you so much for helping me out.  I really really appreciate your time and explanations as this is brand new to me.  What is exciting is this information is helping me see the math and the fact that we can retire soon.  I loved my job before covid hit, now I thinking about quitting every day.