2020 Washington Individual and Family Plans

The information on this page is for plans beginning January 1, 2020.  

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At your service: plans and networks come with choice

Our Navigator health plan products are a unique combination of network and plan designs to fit the needs of you and your family. The county where you live determines which one of these you can enroll in.

Your product’s provider network determines which doctors, hospitals, and other healthcare providers are covered by in-network benefits for you. All of our Navigator products also offer out-of-network benefits, for more freedom and choice.

Navigator gives you exceptional coordinated care

In our effort to simplify health insurance, Navigator provides a more integrated approach to care—helping members get the right care, at the right time, in the right place. Navigator helps ensure a better member experience by promoting doctor-patient engagement and shared decision-making.

Navigator is available in the following counties:  

  • Clark
  • Pierce
  • Spokane
 

 

Review medical plans

Deductible and out-of-pocket limit amounts shown below are the costs for individuals. Amounts for families are twice the individual amounts. If members receive services from out-of-network providers, their deductible and out-of-pocket limit will be higher than the amounts listed in the table below. Most plans are available direct with PacificSource and through the Exchange at wahealthplanfinder.org.

Medical policy samples (PDFs):

Medical SBC and summary samples by plan (PDFs): 

Product

Deductible

Out-of-pocket Maximum

Preventive Services
No deductible, member pays:

Office Visits
After deductible, member pays:

SBCs (PDFs)
by Network
Summaries (PDFs)
by Network
Gold 1500 $1,500 $5,000 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*
Navigator Navigator
Gold 1500 (0)** $0 $0 Covered in Full Covered in Full Navigator Navigator
Gold 1500 (AI)*** $1,500 $5,000 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*
Navigator Navigator
Silver 3500† $3,500 $7,500 Covered in Full Primary/Urgent Care: $40*,
Specialist: 30%
Navigator Navigator
Silver 5000 $5,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: $70*
Navigator Navigator
Silver 5000 (0)** $0 $0 Covered in Full Covered in Full Navigator Navigator
Silver 5000 (AI)*** $5,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: $70*
Navigator Navigator
Silver 5000 (73)** $2,800 $6,300 Covered in Full Primary/Urgent Care: $35*,
Specialist: $70*
Navigator Navigator
Silver 5000 (87)** $700 $2,000 Covered in Full Primary/Urgent Care: $35*, 
Specialist: $70*
Navigator Navigator
Silver 5000 (94)** $500 $700 Covered in Full Primary/Urgent Care: $35*, 
Specialist: $70*

Navigator Navigator
Bronze 7000 $7,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: 40%
Navigator Navigator
Bronze 7000 (0)** $0 $0 Covered in Full Covered in Full Navigator Navigator
Bronze 7000 (AI)*** $7,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: 40%
Navigator  Navigator
Catastrophic^ $8,150 $8,150 Covered in Full Telemedicine and office combined visits 1-3 no deductible, covered in full. Visits 4+ covered in full after deductible. Urgent Care/ Specialist: Covered in Full. Navigator Navigator
Bronze HSA 6750 $6,750  $6,750  Covered in Full Covered in Full Navigator Navigator
Bronze 6750 (0)** $0 $0 Covered in Full Covered in Full Navigator Navigator
Bronze 6750 (AI)***  $6,750 $6,750 Covered in Full Covered in Full Navigator Navigator

*Not subject to deductible.

**This is a cost-sharing plan. Cost-sharing plans are only available to those who qualify financially and enroll through the Exchange at wahealthplanfinder.org.

***The Affordable Care Act (ACA) has special provisions for members of federally recognized American Indian tribes that purchase healthcare coverage through the Marketplace, including zero-cost health services for those whose income is at or below 300 percent of the Federal Poverty Level. Please note that even with a zero cost-sharing plan, out-of-network providers can bill for the amount over the network rate.

^ Only available for purchase through wahealthplanfinder.org by people under 30, or people of any age with a hardship exemption or affordability exemption. 

Available direct from PacificSource only.

 

Get more information

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2020 Washington Individual and Family Plan Rates (PDF)  

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Money 60 Remember: The only way to get help paying for your health insurance premiums is to purchase through the marketplace. You may also qualify for lower out-of-pocket costs. Click here for more information

 

 

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