2015 Health Insurance FAQ

OPEN ENROLLMENT: Nov 15th – April 17th

After Feb 15th you’re locked into the same plan until 1/1/2016. You can’t switch an individual plan for ANY reason!

FAQ for 2015 Health Insurance. Call 425-802-2783 for answers to your questions!

FAQ for 2015 Health Insurance call 425-802-2783

Open Enrollment is officially here and all 2015 plans are out! BOOKMARK this page (forward to friends if they have questions). Last updated 3/31/2015.

The 2015 Health Insurance plans are out and the changes are not as dramatic as 2014. However, there are many things to think about before picking a NEW plan. We will walk you through things you might not have thought of until it is too late to switch.

Top Health Insurance things to think about:

1. Doctor Network (all networks change slightly from year to year). Ensure your doctor’s are still covered by your plan.

2. Hospital Network (more hospitals are covered in 2015).

3. Prescription Drugs (the coverage list varies from carrier to carrier).

4. How to Avoid Exclusions (tips on how to ensure your procedures are covered and how to reduce out-of-network charges).

Washington Health Exchange or Direct to Carrier Plan? What’s the Difference?

While the plans are the same IN & OUT of the Exchange, the pricing can be dramatically different. For those with income BELOW the 400% Full Cost Level amount you get immediate tax subsidies up front (see chart below to see if you qualify for Tax Credits).

For those that have 2015 income ABOVE the 400% Full Cost Level limit for size of family you will report on your 2015 tax return (can be an issue for blended families). Yes, you will need to estimate your income for 2015 before you sign up.

Call 425-802-2783 for more info

Call 425-802-2783 for more info

Health Insurance Carriers for Washington State Plans

EXCHANGE PLANS: Moda, Premera/LifeWise, Group Health Cooperative, Molina, BridgeSpan, Community Health Plan of WA, and Coordinated Care.

DIRECT TO CARRIER PLANS: Assurant Health, Moda, Premera/LifeWise, Group Health Cooperative, and Regence.

NOTE: Most Exchange plans have a SMALLER Network of doctors…the one’s with the SAME Larger Network are: Moda and Premera/LifeWise. These are generally the two best companies to sign up for with the widest network (Premera & LifeWise are technically the same company).


I get this question every single day. Here is a general overview of when and why you want to purchase one plan over another.

1. If you intend on having MASSIVE medical expenses, you want the Assurant Health Platinum Plan. It has a $0 Deductible, then you pay 25% until you hit a $2,000 MAX out of Pocket per year. See that was easy!

2. If you have more expensive PRESCRIPTIONS, the plan you want is the Assurant Platinum plan ($10/$30/$50 for Rx) and a close second choice would be Premera Silver or Gold ($10/$50/20%).

3. Premera is the best for those that see Psychologists, Psychiatrists, Councilors, or any other type of mental health provider since they cover visits before the deductible!

4. Premera pays 80% up front for those that need more bloodwork, x-rays, and diagnostic work (before the Deductible…truly amazing plan).

5. For Doctors that do NOT take Insurance, there is actually a plan that covers your doctor now! The Group Health Cooperative “Connect3 Gold” plan covers IN & OUT of Network Doctors with a COMBINED Deductible. In the GHC network you pay 20% and OUT of the Network you pay 40% of the visit cost with a MAX out of pocket of $6,350 per year (for approved medical expenses).

What’s your medical need? Above are the most common medical FAQ’s, yet if you have a specific question feel free to call to go over plan details. Often times picking the right plan can save thousands of dollars per year for simply digging into the fine print of coverages.


1. This year we have two Platinum Plans (there were zero in 2014), one with Assurant Health $2,000 Max out of pocket) (this plan has been discontinued since they literally lost money on it…good deal for my clients that signed up in time) and one with Regence ($2,500 Max out of pocket). The Assurant Plan is better and lower cost…so it’s a very simple choice.

2. Premera & LifeWise plans that will now cover Swedish Hospitals, UW Medical, Harborview and Childrens Hospital for 2015.

3. Assurant Heath has a significantly improved network of hospitals outside Washington State.

Below are my areas of expertise:

Gary Franke, MBA
Independent Broker
Achieve Alpha Insurance, LLC          
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783

Achieve Alpha