Coverage Basics

What is a health plan?

A health plan helps pay for health care costs. You enroll in a health plan each year in case you or your family needs health care. Your insurance carrier pays a part of the cost of health care when you have a health plan.

Your health plan is an agreement between you and your insurance company.

A hand holding a green dollar sign icon.

You pay a monthly premium and some of the costs for your care.

A green shield with a cross in the center icon.

When you get sick or hurt, your insurance company helps pay those costs.

Why do I need a health plan?

A health plan for the future

You never know when you will need to go to the doctor. Having a health plan ensures that you can afford to get medical care when you need it.

Even if you are healthy, your health plan helps you stay healthy.

Invest in your health

Health care costs can be expensive without a health plan. Routine visits add up quickly. The cost of care for a surprise injury or major illness can deplete your savings.

You can save a lot in the future by spending a little on a health plan today.

Getting care with a health plan

With insurance, you pay a monthly premium, and most healthcare costs are shared between you and your insurance company. You benefit because the insurance company negotiates lower rates with doctors, and there is a yearly cap on how much you can pay for care.

Health insurance terms

Out-of-pocket costs

Out-of-pocket costs (deductibles, copays, and co-insurance) refer to the amount you pay when you go to the doctor.

Premium

Each member pays a monthly fee called a premium. The price of your premium depends on your health insurance plan.

Deductible

Your health insurance starts helping to pay your bills after you “meet your deductible” amount. All plans pay for certain things, like health checks, before the deductible has been met.

Copay and co-insurance

These are costs you pay when you go to the doctor. Your copay is a fixed amount ($1-$50). Your coinsurance is a percentage of the service cost. Your health insurance plan pays for the rest of your visit.

Learn more about health plan key terms.

How insurance works when you get sick or injured

With a health plan

$800 E R co-pay. $2,500 deductible. Envelope icon.

Example health plan

ER visit

Bill

ER co-pay: $800. Deductible: $2,500. Patient only pays: $3,300.

Without a health plan

Pay the full amount of $10,000. Bill icon.

Patient is responsible for total cost of visit.

*Copay and deductible based on 2025 Cascade Silver plan. Numbers shown may not reflect actual prices.

Applying for a health plan

Make an appointment with a navigator, broker or trusted resource in your community.

1-855-923-4633

TTY/TDD: 1-855-627-9604

Help is available in over 200 languages.

Create an account or sign in to begin your health insurance application.

When can I apply?

Open enrollment

Open enrollment happens every year. It begins November 1 and ends January 15. During this time, anyone can apply for health insurance through Washington Healthplanfinder™.

Special enrollment

Some life events let you sign up for a health plan outside of open enrollment. This is called a special enrollment period. Qualifying life events include job loss, birth, adoption, marriage and more. You have 60 days from the event to apply for a special enrollment period.

If you are a Tribal member, or eligible for Cascade Care Savings, you can apply at any time!

Learn more about qualifying life events.

What do I need to apply?

More documents may be required or requested, learn more about how to submit documents.

Savings options

There are three ways to get financial help to help pay for the cost of your plan:

Lower costs on monthly premium

Lower costs on monthly premiums: Premium tax credits help lower the costs of your plan premium each month. Tax credit amounts are based on your income and other factors, like whether you have access to other affordable insurance, and are set by the federal government.

Lower costs at the doctor's office

Cost-sharing reductions help reduce the amount you pay for healthcare, like when you visit the doctor. The amount you save depends on your income and family size. In most cases, you need to pick a Silver plan to get cost-sharing reductions.

Free coverage

Individuals with lower incomes qualify for free coverage, called Washington Apple Health (Medicaid).

Learn more about financial help available through Washington Healthplanfinder™.

Questions?

Our “Basics of Health Coverage” PDF covers everything you need to know about getting covered.

Local support is available in your community and virtually to help you answer questions and get enrolled. Find trusted resources in your community here.

You can also reach out to our Customer Support Center at 1-855-923-4633.

Keyboard with a finger clicking a key labeled "Know Your Plan" with a file icon on it.

Get to know your plan!

Once you enroll, it is time to use your coverage. You can use your coverage to:

Get prescriptions
Go to the doctor
Get emergency care
And more!

Learn more about how your plan works once you are covered.

Know Your Plan