Working with us as your health insurance broker is essentially like having a personal shopper and a legal advocate rolled into one—and the best part, it’s completely free.
Here is why it is a better move to work with us rather than doing it alone:
1. It Costs You Nothing Extra
Brokers are paid commissions directly by insurance companies. By law, insurance premiums are the same whether you buy through a broker or directly from the carrier. If you don’t use a broker, the insurance company simply keeps that commission for themselves, and you lose out on the professional guidance.
2. Access to "Off-Exchange" Plans
When you shop on the public marketplace (WA Health Plan Finder), you only see plans that are part of the government exchange. We have access to "off-exchange" plans—potentially lower premiums but aren't listed on the public portal.
3. We Cut Through the "Insurance Speak"
Insurance is designed to be confusing, so we do the heavy lifting for you by:
Checking your doctors: We verify which plans your specific physicians actually accept (networks change frequently).
Checking your meds: We run your prescriptions through "formularies" to see which plan covers your drugs at the lowest tier.
Explaining the details: We can explain the difference between a $0 deductible and a $0 premium, or why a plan with a high deductible might actually save you money.
4. Ongoing Support
Our relationship doesn't end when you sign up. If you have a problem, you call us, not a 1-800 number.
Claims Disputes: If a claim is denied, we can talk to the carrier on your behalf.
Annual Reviews: Every year, insurance rates and benefits change. We will proactively tell you if you should stay put or jump to a better plan during Open Enrollment.
What is it?
The ACA, short for the Affordable Care Act (and often called "Obamacare"), is a comprehensive U.S. health care reform law enacted in 2010. Its primary goal is to make health insurance more accessible and affordable while protecting consumers from common insurance company practices.
How to enroll?
In Washington state, you do not use the federal website (Healthcare.gov). Instead, you use the state’s own dedicated marketplace, Washington Healthplanfinder. https://www.wahealthplanfinder.org/
When to enroll?
November 1: Open Enrollment begins to obtain coverage on January 1.
December 15: The deadline to enroll if you want your coverage to start on January 1.
January 15: The final deadline to enroll with coverage starting February 1.
What is the Special Enrollment Period?
If you missed the deadline, you can only enroll if you have a Qualifying Life Event. This opens a 60-day window for you to sign up. Common events include:
Loss of Health Coverage: Losing a job, "aging out" of a parent's plan at 26, or losing Medicaid/CHIP eligibility.
Household Changes: Getting married, having a baby, adopting a child, or a death in the family that affects coverage.
Residence Changes: Moving to a different ZIP code or county.
Other: Becoming a U.S. citizen or leaving incarceration.
What does it cover?
Pre-existing Conditions: Insurers cannot deny you coverage or charge you more because of a health condition you already have (like asthma, diabetes, or cancer).
Essential Health Benefits: All ACA-compliant plans must cover 10 basic categories, including emergency services, maternity care, mental health, and prescription drugs. https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
Preventive Care: Services like flu shots, screenings, and annual wellness visits are covered at no cost to you. https://www.healthcare.gov/coverage/preventive-care-benefits/
What is a Deductible, Co-pay, Co-Insurance, and Out-of-Pocket-Max?
1. Deductible (The "Buy-In")
The deductible is the amount you must pay out-of-pocket for covered medical services before your insurance company starts to pay anything.
Example: If your deductible is $2,000, you pay the first $2,000 of your medical bills (like an MRI or a hospital stay) yourself.
2. Copay (The "Flat Fee")
A copay is a fixed, set dollar amount you pay for a specific service, usually at the time you receive it.
Example: You might have a $30 copay every time you see a primary care doctor or a $15 copay for a generic prescription.
When it happens: Often, you pay copays even if you haven't met your deductible yet (depending on your specific plan).
3. Coinsurance (The "Splitting the Bill")
Once you have fully paid your deductible, you enter the coinsurance phase. This is where you and the insurance company share the costs by a percentage.
Example: A common split is 20% coinsurance. If a post-deductible hospital bill is $1,000, you pay $200 (20%) and the insurance company pays $800 (80%).
4. Out-of-Pocket Max (The "Safety Net")
The out-of-pocket maximum is the most you will have to pay for covered services in a plan year. This is the absolute "ceiling" on your spending.
How it works: Everything you spend on your deductible, copays, and coinsurance counts toward this limit.
The Reward: Once you hit this limit, the insurance company pays 100% of all covered medical costs for the rest of the year.
Note: Your monthly premiums do not count toward this limit.
What does In & Out of Network mean?
In-Network
In health insurance, an "in-network" facility is simply a group of doctors, specialists, and hospitals that have signed a contract with your insurance company to provide services at a pre-negotiated, discounted rate. For HMO & EPO policies, you have to see ‘in-network’ facilities in order to have the visit, procedure, or medication covered.
Out-of-Network
What it is: These providers have no contract with your insurance. They can charge whatever they want.
The Cost: You pay much more—sometimes the full 100%. Many plans (like HMOs and EPOs) won't pay a single cent for out-of-network care unless it's a life-threatening emergency.
Emergency Exception: The "No Surprises Act"
The biggest rule to remember is that in a true emergency, networks don't matter. If you are rushed to the nearest ER and it happens to be out-of-network, federal law (the No Surprises Act) prevents that hospital from charging you more than your in-network rate. You are protected from "surprise" bills in emergency rooms and from out-of-network air ambulances.