Doctor Network Matters For Health Insurance

With the loss of the individual and family PPO health insurance networks coming in 2018, and those who are under the age of 65 and buying their own health insurance, making sure your doctors are in your health insurance plan network matters more than ever.  The plans in our area that are going to be offered are of the HMO, EPO, or other type of networks.  This means that you will not have the freedom to get your non-emergent care out of network, go anyplace you want, and many plans require you have a referral from your Primary Care Physician.

Here is what we recommend you do to prepare yourself for this change:

  • Make a list of the doctors, clinics, and hospitals that you are seeing or want to see if something were to happen to your health.
  • Make a list of the Rx you are currently being prescribed.
  • Talk to your doctors and ask them who they are contracted with, or dropping their contract with for 2018, or simply don’t like to deal with.

Advise your broker of this info and have them research what networks hopefully have everyone and everyplace in network.  Keep in mind that your broker will not be able to research this until Open Enrollment begins AND that the networks can change.  The change can occur for many reasons – the facility and health insurance carrier cannot come to an agreement or the facility purchases another clinic/facility and the network changes, etc.

We had a client who chose a plan that his doctor was in network with the carrier.  When the client went to visit the doctor, the doctor advised him that if he had a choice between the health insurance company he chose and the plague, he should have picked the plague.

The individual and family health insurance market open enrollment begins on November 1st, 2017.  This is the time for you to make your health insurance plan selection for 2018.



Is Your Short Term Medical Insurance ending?

At our agency we have seen a rise in the number of folks who are looking for health insurance right now since their short term medical insurance ended.  None of them realized that they did not have ACA compliant health insurance.  This means that they do not have a qualifying event to sign up for health insurance and cannot sign up for an ACA complaint health insurance plan.

ACA compliant health insurance is referred to as Obamacare and this health insurance covers the 10 essential health benefits and covers pre-existing conditions.

One of the folks told us that he thought he found a good deal when he signed up and didn’t really know it was even a short term medical plan.  This is particularly worrisome since the health issues he was diagnosed with while he was on the plan are not covered on a new short term medical plan (they are now a pre-existing condition).  Since he is responsible for his own health insurance, he will have to wait until Open Enrollment to sign up for an ACA compliant plan to help him.

Short term medical plans do have a place for the right situation.  For example, a healthy person needs coverage for 30 days while waiting for their work benefits to begin.  They are just not the deal some folks think they are.

Remember, there are no deals when it comes to health insurance premiums.






You may have recently been notified by your health insurance carrier that your current individual and family health insurance plan is going to be leaving the county you live in for 2018

There is nothing that you can do right now

• The health insurance plan you have now will provide your benefits until December 31, 2017
• The health insurance carriers that are offering plans in the individual and family market have submitted their 2018 plan designs and rates to our insurance commissioner. We are all waiting for the final decision.
• As a health insurance agency, the carriers will notify us with your options. We will then be prepared to review them all during Open Enrollment.
• Open Enrollment begins November 1st

 We are your health insurance partner and looking forward to assisting you with ALL your insurance options for 2018

BIG Insurance will help you with your strategy and keep you moving forward for 2018

Contact us:
Theresa Baker
Michelle Larson
BIG Agency 425-292-0004

Why can’t I buy Health Insurance anytime I want?

We received a call today from someone looking to buy health insurance right now.  They had individual health insurance and let it cancel for nonpayment several months ago.  Here is why they cannot sign up for health insurance now.

  • The Affordable Care Act established enrollment times when someone can sign up for health insurance.  (Annual Open Enrollment and Special Enrollment Periods)
  • Since we are not in Annual Open Enrollment, you must have a Special Enrollment Period qualifying event.  Letting existing insurance cancel for nonpayment is not a qualifying event for a Special Enrollment Period.

Unless they qualify for a Special Enrollment Period, they are unable to buy ACA compliant health insurance for the remainder of the year.



Premera Blue Cross recently announced a major change coming in its in-network providers. Will you be affected? Read about the change and what you can do.

Change is brewing, and it comes in the form of Premera Blue Cross.

As of January 1, 2017, Premera Blue Cross will no longer support Providence Health & Services as in-network providers. As the Northwest’s largest insurance provider, Premera’s move is significant: thousands will inevitably be affected. Providence comprises significant healthcare across the Northwest, including Providence Health and Services, Swedish Health Services, Pacific Medical Centers and Kadlec Regional Medical Center. In fact, since Providence took over Swedish in 2012, Providence has grown into the Northwest’s third-largest medical provider.

So, what’s next? Right now, nothing. While Providence is indeed large, it is only the third-largest healthcare provider in the region. Some of the many award-winning options, Evergreen, UW Medicine, and Virginia Mason, offer a robust range of services at in-network prices. Plus, Virginia Mason is the official healthcare provider of the Seahawks – what more do you need?

You have a few months to soak it in. Come November, you’ll be able to compare and review the updated Premera Blue Cross network; you can also take the opportunity to review competing health insurance providers and their networks. Most importantly, you have the entire Open Enrollment period (November 1, 2016 through January 31, 2017) to weigh your options and decide the best health insurance for you, your family or business.

Will it still be a happy new year? Absolutely. You’ll greet 2017 prepared with either a new health insurance plan or a new plan for in-network providers.

Prescriptions are Not for Medication Only

Prescriptions are no longer limited to medication – in today’s ever-changing insurance world, you may need a prescription for a service, too.

It’s a journey I just experienced myself: One round of Capture the Flag and my daughter now needs a physical therapist. The answer? Despite being on a PPO medical plan, the insurance carrier wants a “plan of care” in place, plus a prescription written for that plan. Thus, we need a prescription – not a referral.

No longer a simple PT appointment to soothe an ankle, we first had to set up a routine doctor appointment. The doctor prescribed PT, and we sought a PT provider in-plan. Was it a challenge? Maybe at first.

The majority of prescriptions you’ll continue to receive will of course be medication – pills, shots, injections and more. However, treatment and extended care plans are now being routed in the prescription process. The requirement and term may have changed, but the medical support you’ll find is as solid as ever.

Health Insurance Reform

Critical Illness – How are you prepared to live?

After having a conversation with a colleague this past week – where we dove in to the necessity of critical illness insurance – for most of us, we know this kind of insurance as cancer, accident, heart attack, hospital income, and even disability insurance – we debated how far the market has evolved – and then the poor joke of “heaven help us – we lived”.

Just how we are surviving/living is the issue.

I deal with many clients who are going on the thought that they have very generous friends and family to fall back on for money and time when they are struck with a critical illness – If you are one of these unprepared individuals, I invite you to have the conversation with your friends/family and let them know what you expect of them.  I think you will be surprised by the outcome.

Here is what I have to say:   Most of us do not have the financial/time resources to give you.  We will be your friend/family to love and emotionally support you – but please treat us with respect and be responsible and allow us this benefit and the opportunity to be the kind of friend/family you will emotionally need.  Take care of yourself, first.



Health Insurance for children open enrollment begins in WA State

March 15th to April 30th is open enrollment for children in the individual and family health insurance market.  During this time you can add children to your health plan, buy them their own health plan, or switch health plans.   Now is the time to make your changes.  For more info on this, please visit the WA State Insurance Commissioners website   or give a local agent an opportunity to help you.

How do I choose a health insurance policy?

When it comes to Health Insurance, I think we have all known someone who was confused and frustrated and decided to “just pick something” and hope it works out.  The world of health insurance lends itself to this, but it doesn’t have to.  Here are some basic rules to help you get started when choosing the right health insurance plan:

  • Make a list of your doctors
  • Make a list of your prescriptions
  • Make a list of the services you cannot live without (maternity, Rx, etc)
  • Does everyone that will be on your health plan need the same services (does one person need Rx, while another does not?)  Most of us do not realize that we do not need to insure everyone on the same health plan.
  • Check the health plan’s doctor network to make sure your doctors are in network/out of network.
  • Check the health plan’s pharmacy formulary to confirm if your Rx is listed for coverage and what pharmacies or mail order can you use.
  • Check the health plan’s deductible – keep in mind if it is an individual or family deductible.  Will the deductible be higher depending on where your receive the care (in network/out of network).
  • Check the health plan’s maximium co-insurance – keep in mind if it is an individual or family c0-insurance maximum.  Will the co-insurance amount be higher depending on where you receive the care (in network/out of network)
  • Check the health plan’s co-payments and how many doctor visits are covered before you have to satisfy the deductible.
  • Discuss with the health plan if you will have a pre-existing wait period applied to any health conditions you have when switching plans and/or health insurance carriers.
  • Read the health plan limitations and exclusions.

Remember health insurance is not designed to cover everything and this is a basic list to help you get started in the process of choosing a plan.  We recommend you call an agent – there are plenty of good ones out there waiting to help you.