Think about the following things when choosing a health plan. If you have questions or need specific information, call the health plan directly.
Whether you choose Health 75 or Health 100, Washington Health offers the same basic benefits, but monthly premiums, providers, and some details of coverage vary.
Doctors or other Providers
Be sure to consider your choice of providers (doctors, clinics, hospitals, pharmacies, and other health care professionals), as well as monthly premiums when making your selection. Your current provider, or the providers nearest you, may not contract with Community Health Plan of Washington. You will also have the option of seeing a provider out-of-network, but it will cost you more out of pocket.
If you have a specific provider you would like to see, ask if he or she plans to participate with Washington Health and the health plan you've chosen. You should also confirm this with Community Health Plan.
Some health plans may contract with provider groups, called subnetworks; this may limit your choice of providers. You may be required to see specialists or use facilities, such as hospitals, which are in the same subnetwork as your Primary Care Provider (PCP). This means that even if a provider is listed with your health plan, the provider's services may not be available to you unless the provider is also affiliated with your PCP. Call the health plan or your PCP to find out if your PCP can refer you to anyone listed as a provider with that health plan, or if your PCP can refer you to only a selected group of providers within Community Health Plan. You may see a specialist or use a facility that is out-of-network, but you will pay more for these services.
If you take medications regularly, ask Community Health Plan if it covers them. Be sure to ask the health plan about the cost of the specific drugs you are taking. Health plans do not all cover the same drugs.