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Washington HealthplanfinderCoverage Options
1
Webinar for UW Medical StudentsMarch 31, 2020
Agenda • Part I: Healthplanfinder 101 (20 minutes)
• ACA implementation in Washington• What is the difference between the Medicaid/Washington Apple Health
(WAH) plans and Qualified Health Plans (QHPs) offered through Washington Healthplanfinder?
• What carriers offer Medicaid Plans? What carriers offer QHPs?• Entering income
• Part II: Plan Shopping Demo (15 minutes) • How do we see available plan options in Healthplanfinder?• How do I know if a plan covers the care I need? • What tools/resources are available to help me select a plan?
• Part III: Q&A (25 minutes) • WAH: emergency care; urgent care; out of state coverage; telemedicine; rx
2
Webinar Experts • King County - Navigator Lead Organization
• Callista Kennedy, Program Manager, King County Public Health-Access & Outreach
• Health Care Authority (HCA)• Johnny Shults, Section Supervisor, Medicaid Program Operations and Integrit• Francesca Matias, Medicaid Eligibility Policy Manager
• Washington Health Benefit Exchange (HBE)• Mary McHale, Outreach Director • Chris Brown, Navigator Support Manager • James Manual, Policy Analyst • Joan Altman, Director of Government Affairs & Strategic Partnerships
3
Cross-agency desk aid: https://www.hca.wa.gov/assets/free-or-low-cost/customer_support_center_referrals.pdf
Outreach/Enrollment Events at UW • Illustrative King County outreach events with UW students:
• insurance webinar for grad students (Jan. 2020)• LEAH program UW presentation (Dec. 2019); • On-campus open-enrollment events - Hall Health, Ethnic Cultural
Center (November 2019) • Husky Fest (Sept. 2019)
• King County does quarterly enrollment events at the HUB• Within Reach does weekly outreach at UW Bothell• If you see an additional need for outreach and education, please
let us know
5
Upcoming: Student Task Force • Have been working hard to address student access barriers over
past several years (with Patricia and others) • Provided technical assistance to Spencer to help establish
student task force • Exchange included as member of new task force on improving
access to affordable healthcare for students at WA’s public institutions of higher education (also includes HCA and the Dept. of Health)
• Parallel efforts to expand coverage for undocumented
6
COVI
D-19
–N
ew S
pecia
l Enr
ollm
ent P
erio
d fo
r Un
insu
red
•In
resp
onse
to th
e on
goin
g Co
rona
viru
s (C
OVI
D-1
9) s
ituat
ion
in
Was
hing
ton
stat
e, th
e Ex
chan
ge e
stab
lishe
d a
spec
ial e
nrol
lmen
t per
iod
for
indi
vidu
als
who
are
uni
nsur
ed
•Un
insu
red
indi
vidu
als
can
com
e in
and
get
cov
erag
e th
roug
h M
ay 8
, 202
0•
Mus
t req
uest
the
spec
ial e
nrol
lmen
t and
sele
ct a
pla
n by
May
8 fo
r co
vera
ge st
art d
ate
begi
nnin
g M
ay 1
, 202
0. If
requ
est a
nd se
lect
a p
lan
by
April
8, g
et c
over
age
star
ting
April
1, 2
020
•To
requ
est a
spec
ial e
nrol
lmen
t, co
ntac
t Nav
igat
or, o
r Bro
ker o
r enr
ollm
ent
cent
er•
Or c
an c
all C
usto
mer
Sup
port
Cen
ter b
etw
een
7:30
a.m
. to
5:30
p.m
. M
onda
y-Fr
iday
at 1
-855
-923
-463
3; T
TY: 8
55-6
27-9
604.
Lan
guag
e as
sista
nce
and
disa
bilit
y ac
com
mod
atio
ns a
re p
rovi
ded
at n
o co
st.
•Ad
ditio
nal i
nfor
mat
ion
avai
labl
e at
: ht
tps:/
/ww
w.w
ahbe
xcha
nge.
org/
coro
navi
rus-
faqs
/
7
Part
I:
Hea
lthpl
anfin
der 1
01
8
ACA
Impl
emen
tatio
n in
Was
hing
ton
Stat
e•W
ashi
ngto
n St
ate
opte
d fo
r ful
l im
plem
enta
tion
of th
e Af
ford
able
Ca
re A
ct•A
dopt
ed th
e AC
A M
edica
id E
xpan
sion
(up
to 1
38%
FPL
) •E
stab
lishe
d th
e W
ashi
ngto
n H
ealth
Ben
efit
Exch
ange
(HBE
)•
Stat
e-ba
sed
exch
ange
, gov
erne
d by
11-
mem
ber b
ipar
tisan
boa
rd
•Ru
n W
ashi
ngto
n He
alth
plan
finde
r, w
hich
serv
es o
ne in
four
Was
hing
toni
ans
•Si
ngle
inte
grat
ed o
nlin
e po
rtal
for b
oth
MAG
I Med
icaid
(1.5
mill
ion)
and
co
mm
ercia
l ind
ivid
ual m
arke
t cov
erag
e (2
00,0
00)
•M
ust e
nrol
l thr
ough
Hea
lthpl
anfin
der t
o ge
t fed
eral
sub
sidie
s
•The
Hea
lth C
are
Auth
ority
(HCA
) adm
inist
ers W
ashi
ngto
n Ap
ple
Hea
lth p
rogr
ams
9
138%
317%
198%
215%
0
200
400
WAH
for
Adul
tsW
AH fo
rPr
egna
ntW
omen
WAH
for K
ids
WAH
with
Prem
ium
sH
IPTC
Avai
labl
e Pr
ogra
ms b
y Fe
dera
l Pov
erty
Lev
el% Federal Poverty Level
400%
138
Fede
ral
Pove
rty
Leve
l
11
Appl
e He
alth
Tax C
redi
ts w
ith co
st-s
harin
g re
duct
ions
Tax C
redi
ts
$100
0
$200
0
$300
0
$400
0
1 2
34
5
$500
0
Up to
$10,
057
Hous
ehol
d Si
ze
Income (monthly)
Up to
$8,5
83Up
to$7
,110
2020
Inco
me
Stan
dard
sW
ashi
ngto
n He
alth
plan
finde
r Tax
Cre
dit (
400%
FPL
); Co
st-S
harin
g Re
duct
ions
(250
% F
PL) a
nd A
pple
Hea
lth (1
38%
FPL
)
Plan
s offe
red
thro
ugh
Was
hing
ton
Hea
lthpl
anfin
der (
WAH
) •W
ashi
ngto
n Ap
ple
Hea
lth (M
edica
id) f
or a
dults
and
fam
ilies
•O
ffers
com
preh
ensiv
e m
edica
l cov
erag
e •
Gene
rally
no
prem
ium
and
no
or li
mite
d co
st-s
harin
g•
Prov
ider
ava
ilabi
lity
can
som
etim
es b
e lim
ited
•Ye
ar-r
ound
ope
n-en
rollm
ent –
can
join
at a
ny ti
me
•Au
tom
atica
lly e
nrol
led
if el
igib
le a
nd d
on’t
sele
ct p
lan
•Se
rvice
s prim
arily
offe
red
thro
ugh
five
man
aged
car
e or
gani
zatio
ns
(MCO
s) (*
indi
cate
s al
so o
ffer Q
HPs
)•
Amer
igro
up; C
oord
inat
ed C
are*
; CH
PW; M
olin
a*; U
nite
d
12
Plan
s offe
red
thro
ugh
Was
hing
ton
Hea
lthpl
anfin
der (
QH
P)
•Q
ualif
ied
Hea
lth P
lans
•
9 Ca
rrier
s of
fer 6
6 pl
ans
•Pl
ans o
ffere
d at
four
cov
erag
e le
vels
(mos
t to
leas
t)•
Gold
, Silv
er, B
ronz
e, C
atas
troph
ic •
Mus
t enr
oll d
urin
g op
en-e
nrol
lmen
t (st
arts
Nov
1 a
nnua
lly) o
r you
qua
lify
for a
spec
ial e
nrol
lmen
t per
iod
(qua
lifyi
ng e
vent
s inc
lude
loss
of i
ncom
e, lo
ss o
f hea
lth in
sura
nce
cove
rage
, mar
riage
, birt
h of
a c
hild
or a
m
ove
–m
ore
info
rmat
ion
at: h
ttps:/
/ww
w.w
ahea
lthpl
anfin
der.o
rg/_
cont
ent/
ther
e-ar
e-tw
o-w
ays-
get-
cove
rage
.htm
l)
•Ca
n dr
op c
over
age
at a
ny ti
me.
If st
art J
an 1
and
can
cel c
over
age
on F
eb 1
2, w
ould
end
effe
ctiv
e M
arch
1. I
f ca
ncel
cov
erag
e on
Fec
. 20
(bec
ause
it is
afte
r the
15t
hof
the
mon
th) c
over
age
wou
ld e
nd e
ffect
ive
April
1.
•M
ust s
elec
t a p
lan;
pre
miu
m p
aym
ents
go
dire
ctly
to c
arrie
rs
•Ca
n st
ay o
n pa
rent
s pla
n up
to a
ge 2
6 •
All p
lans
mus
t cov
er 1
0 es
sent
ial h
ealth
ben
efits
•
Mor
e ro
bust
cov
erag
e th
an sh
ort-
term
lim
ited
dura
tion
plan
s, as
socia
tion
heal
th p
lans
, hea
lth sh
arin
g m
inist
ries
•O
IC c
hart
com
parin
g he
alth
cov
erag
e op
tions
: http
s://w
ww.
insu
ranc
e.w
a.go
v/sit
es/d
efau
lt/fil
es/d
ocum
ents
/hea
lth-in
sura
nce-
com
pare
-cha
rt.p
df•
Mor
e ex
pens
ive
than
Was
hing
ton
Appl
e H
ealth
•
Fede
ral s
ubsid
ies a
vaila
ble
exclu
sivel
y th
roug
h W
ashi
ngto
n H
ealth
plan
finde
r to
help
low
er c
osts
•
APTC
: adv
ance
d pr
emiu
m ta
x cr
edits
up
to 4
00%
FPL
•CS
Rs: c
ost-
shar
ing
redu
ctio
ns u
p to
250
% F
PL (a
vaila
ble
in si
lver
pla
ns o
nly)
13
14
9 Q
HP Is
suer
s | 6
6 Q
HPs
2020
QHP
Pla
n of
ferin
gs b
y M
etal
Tie
r
Gol
d76
%-8
2% A
V
•9
Issu
ers
•15
Pla
ns
Silv
er66
%-7
2% A
V
CSR
s av
aila
ble
•9
Issu
ers
•21
Pla
ns
Bro
nze
56%
-65%
AV
•9
Issu
ers
•26
Pla
ns
Cata
stro
phic
Onl
y th
roug
h th
e Ex
chan
ge
Und
er a
ge 3
0 or
har
dshi
p
No
tax
cred
its
•4
Issu
ers
•4
Plan
s
Num
ber o
f Exc
hang
e Ca
rrie
rs in
Eac
h Co
unty
15
16
Scen
ario
: Age
28,
Kin
g Co
unty
, var
ious
inco
mes
with
Sec
ond
Low
est C
ost S
ilver
Pla
n
17
Inco
me
$1,3
00/m
onth
$1,6
00/m
onth
$2,7
00/m
onth
Prog
ram
Appl
e H
ealth
Tax
Cred
its &
Cos
t-Sh
arin
g Re
duct
ions
(Not
e: m
ust c
hoos
e sil
ver
plan
to g
et co
st-s
harin
g su
bsid
y)
Tax
Cred
its
You
pay
No
cost
$68.
74$2
28.6
8
Prem
ium
n/a
$317
.28
$317
.28
Tax
Cred
itn/
a$2
48.5
4$8
8.60
Scen
ario
: Age
28,
Kin
g Co
unty
, $1,
600/
mon
th in
com
e
18
You
pay:
$67.
64$6
8.74
$89.
59$1
01.6
8$1
24.4
3$1
81.8
2
Prem
ium
:$3
16.1
8$3
17.2
8$3
38.1
3$3
52.0
5$3
72.9
7$4
30.3
6
Tax C
redi
ts:
$248
.54
$248
.54
$248
.54
$248
.54
$248
.54
$248
.54
Plan
Nam
e:M
olin
a Ch
oice
Si
lver
Am
bette
r Bal
ance
d Ca
re 4
(202
0)Fl
ex S
ilver
-20
LifeW
iseEs
sent
ial
Silv
er Lo
w
Dedu
ctib
le
Silv
er H
DHP
3500
Ex
chan
ge E
PO U
W
Med
icine
Prem
era
Blue
Cro
ss
Pref
erre
d Si
lver
EPO
45
00
Met
al le
vel:
All p
lans
silv
er
New
Typ
e of
QH
Ps C
omin
g in
202
1
•The
Exc
hang
e w
ill b
e im
plem
entin
g Ca
scad
e Ca
re fo
r pla
n ye
ar 2
021
(ope
n en
rollm
ent s
tart
ing
Nov
embe
r 1, 2
020)
whi
ch in
clude
s st
anda
rd p
lans
. •S
tand
ard
plan
s will
offe
r con
sum
ers m
ore
serv
ices b
efor
e th
e de
duct
ible
at a
pre
dict
able
co-
pay,
inclu
ding
prim
ary
care
visi
ts,
men
tal h
ealth
serv
ices,
gene
ric d
rugs
, and
urg
ent c
are
visit
s. •A
ll ca
rrier
s will
be
requ
ired
to o
ffer s
tand
ard
plan
s to
cons
umer
s.•T
o le
arn
mor
e ab
out C
asca
de C
are
impl
emen
tatio
n, y
ou c
an v
isit
this
web
site-
http
s://w
ww.
wah
bexc
hang
e.or
g/ab
out-
the-
exch
ange
/cas
cade
-car
e-20
21-im
plem
enta
tion/
19
WAH
v. Q
HP
cove
rage
•
Wha
t is t
he m
ain
diffe
renc
e be
twee
n W
AH a
nd Q
HP?
(inc
ome
thre
shol
d an
d co
st)
•Ca
n I c
hoos
e to
not
app
ly fo
r WAH
? (y
es, b
ut th
en n
ot e
ligib
le fo
r fed
eral
subs
idie
s)
•H
ow si
gnifi
cant
are
the
subs
idie
s? (v
ery,
last
yea
r ave
rage
mon
thly
pre
miu
m fo
r sub
sidize
d co
nsum
er $
168/
mo
v. $5
36/m
ofo
r non
-sub
sidize
d)
•W
hy is
it im
port
ant f
or m
e to
repr
esen
t my
inco
me
accu
rate
ly in
my
appl
icatio
n? (s
ubm
it ap
p un
der p
enal
ty o
f per
jury
, and
misr
epre
sent
ed a
mou
nts
get r
econ
ciled
dur
ing
tax
seas
on)
•Do
I en
ter m
y fin
ancia
l aid
mon
ey a
s inc
ome?
(No,
stud
ent f
inan
cial a
id a
nd st
uden
t loa
ns a
re
not c
onsid
ered
inco
me
unde
r MAG
I).
20
Addi
tiona
l 101
Res
ourc
es
•M
edica
id m
ater
ials
•ht
tps:/
/ww
w.hc
a.w
a.go
v/he
alth
-car
e-se
rvice
s-su
ppor
ts/a
pple
-hea
lth-m
edica
id-
cove
rage
/sta
keho
lder
-tra
inin
g-an
d-ed
ucat
ion#
com
mun
ity-b
ased
-tra
inin
g•
Defin
ition
s of t
op h
ealth
insu
ranc
e te
rms
•ht
tps:/
/ww
w.w
ahbe
xcha
nge.
org/
wp-
cont
ent/
uplo
ads/
2015
/09/
HBE
_PT_
1605
23_U
sers
_Gui
de_K
ey_T
erm
s.pdf
•En
rollm
ent G
uide
•
http
s://w
ww.
wah
bexc
hang
e.or
g/w
p-co
nten
t/up
load
s/20
15/0
9/H
BE_P
T_15
1027
_Enr
ollm
ent_
Guid
e.pd
f•
Addi
tiona
l Exc
hang
e m
ater
ials
•ht
tps:/
/ww
w.w
ahbe
xcha
nge.
org/
part
ners
/par
tner
s-to
olki
t/
21
Part
II: S
hopp
ing
for
Cove
rage
22
Shop
ping
for C
over
age
•Mob
ile A
pp: W
APla
nfin
der–
Appl
e or
Goo
gle
App
Stor
e•W
ebsit
e: w
atch
out
for l
ook-
alik
e sit
es •www
.wah
ealth
plan
finde
r.org
•Key
web
site
feat
ures
•Cus
tom
er su
ppor
t •A
nony
mou
s bro
wsin
g •S
mar
t Pla
nfin
der(
sear
ch b
y do
ctor
, rx,
hosp
ital/c
linic)
23
Was
hing
ton
Appl
e H
ealth
El
igib
ility
and
Pla
n Se
lect
ion
Flow
Acc
ount
Cre
atio
nIn
divi
dual
crea
tes a
n ac
coun
t (o
r pro
ceed
s with
out a
n ac
coun
t)
App
licat
ion
Indi
vidu
al co
mpl
etes
all
appl
icatio
n sc
reen
s, an
d sy
stem
inte
rface
s with
Fe
dera
l Hub
to v
erify
in
form
atio
n pr
ovid
ed
Elig
ibili
tySy
stem
inte
rface
s with
the
Elig
ibili
ty Se
rvice
to d
eter
min
e an
d di
spla
y elig
ibili
ty re
sults
and
ta
x cre
dits
Fede
ral
Hub
ES
Prov
ider
One
Elig
ibili
ty re
sults
info
rmat
ion
flow
s to
Prov
ider
One
Plan
Sho
ppin
g &
Co
nfir
mBr
owse
s and
Sel
ects
a
man
aged
care
pla
n
Skip
Pla
n Se
lect
ion
Auto
mat
ically
Enr
olle
d in
a
man
aged
care
pla
n
Enro
llmen
tIn
divi
dual
Enr
olle
d in
m
anag
ed c
are
plan
Augu
st 8
, 201
924
Was
hing
ton
Hea
lth B
enef
it Ex
chan
ge
Tax
Cred
it El
igib
ility
and
Enr
ollm
ent F
low
Plan
Sho
ppin
g &
Co
nfir
mBr
owse
s and
Sel
ects
a
man
aged
care
pla
n
Fede
ral
Hub
ES
Paym
ent
to C
arri
erIn
divi
dual
wai
ts to
hea
r ba
ck fr
om ca
rrie
r bef
ore
mak
ing
a pa
ymen
t di
rect
ly to
the
carr
ier
Augu
st 8
, 201
925
Was
hing
ton
Hea
lth B
enef
it Ex
chan
ge
Acc
ount
Cre
atio
nIn
divi
dual
crea
tes a
n ac
coun
t (or
pro
ceed
s w
ithou
t an
acco
unt)
App
licat
ion
Indi
vidu
al co
mpl
etes
all
appl
icatio
n sc
reen
s, an
d sy
stem
inte
rface
s with
Fe
dera
l Hub
to v
erify
in
form
atio
n pr
ovid
ed
Elig
ibili
tySy
stem
inte
rface
s with
the
Elig
ibili
ty Se
rvice
to d
eter
min
e an
d di
spla
y elig
ibili
ty re
sults
and
ta
x cre
dits
▪Qu
alifi
ed h
ealth
pla
ns
▪Qu
alifi
ed h
ealth
pla
n w
ith ta
x cre
dits
▪Qu
alifi
ed h
ealth
pla
n w
ith C
ost S
harin
g Re
duct
ions
& ta
x cre
dits
▪W
ashi
ngto
n Ap
ple
Heal
th (f
or A
dults
, Fam
ilies
)
▪W
ashi
ngto
n Ap
ple
Heal
th fo
r Kid
s
▪W
ashi
ngto
n Ap
ple
Heal
th w
ith P
rem
ium
s (fo
r Kid
s)
▪W
ashi
ngto
n Ap
ple
Heal
th fo
r Pre
gnan
t Wom
en
▪W
ashi
ngto
n Ap
ple
Heal
th fo
r Fam
ilies
and
Hea
lth C
are
Exte
nsio
n
▪Al
ien
Emer
genc
y M
edica
l
▪In
elig
ible
Pote
ntia
l Elig
ibili
ty R
esul
ts in
Hea
lthpl
anfin
der
Smar
t Pla
nfin
der–
Decis
ion
Supp
ort
27
Smar
t Pla
nfin
ders
ugge
sts p
lans
that
ar
e a
Smar
t Cho
ice b
ased
on
your
pr
ovid
er a
nd p
resc
riptio
n ne
eds a
nd
estim
ated
cost
s und
er a
hea
lth p
lan.
Hea
lthpl
anfin
der D
emon
stra
tion
•Br
owsin
g av
aila
ble
plan
s (fa
st w
ay to
see
full
cost
pla
ns)
•Cl
ick
“Bro
wse
Pla
ns” l
ink
on h
omep
age.
Thi
s w
ill a
llow
the
cons
umer
to s
hop
curre
nt p
lans
(p
lan
year
202
0). W
e w
ill a
sk if
you
nee
d he
lp s
hopp
ing
for a
pla
n, c
licki
ng “Y
es” w
ill a
llow
a
cons
umer
to lo
ok u
p pr
ovid
er a
vaila
bilit
y an
d co
vera
ge o
f any
cur
rent
pre
scrip
tions
. En
terin
g in
com
e •
Usin
g Sm
art P
lanf
inde
rto
help
find
a p
lan
(sea
rchi
ng o
ut-o
f-st
ate
prov
ider
ne
twor
k an
d rx
cove
rage
) •
Our
con
sum
er sh
oppi
ng to
ol, S
mar
t Pla
nfin
der,
will
also
pro
vide
an
estim
ate
of e
xpec
ted
out-
of-p
ocke
t exp
ense
s with
eac
h pl
an.
•Fi
ndin
g de
taile
d pl
an c
over
age
info
rmat
ion
•Cl
ick
“Mor
e in
form
atio
n on
this
plan
” on
the
shop
ping
pag
e to
lear
n m
ore
abou
t eac
h pl
an’s
cove
rage
of c
erta
in b
enef
its a
nd a
ssoc
iate
d co
st sh
arin
g. C
onsu
mer
s ca
n al
so lo
ok
to th
e Su
mm
ary
of B
enef
its a
nd C
over
age
for f
ull d
etai
ls ab
out a
pla
n.
28
Questions?
•For contact help enrolling in a plan/understanding plans options •Callista Kennedy, Program Manager, King County Public Health-Access
& Outreach •General contact information for King County Public Health’s
Community Health Access Program (CHAP)•206-284-0331•800-756-5437•[email protected]
29
Part
III:
Q&
A
30
Heal
thpl
anfin
der–
Q &
A
31
Que
stio
n: W
hich
car
riers
offe
r out
of n
etw
ork
cove
rage
in W
ashi
ngto
n,
Wyo
min
g, A
lask
a, M
onta
na, a
nd Id
aho?
Ans
wer
: The
cha
rt b
elow
whi
ch g
ives
a g
ener
al id
ea o
f whi
ch c
arrie
rs
offe
r pla
ns w
ith n
etw
orks
, as i
llust
rate
d th
roug
h th
eir p
rovi
der r
oste
rs.
Deta
iled
info
rmat
ion
will
be
avai
labl
e fro
m e
ach
carri
er.
Was
hing
ton
Wyo
min
gA
lask
aM
onta
naId
aho
Am
erig
roup
(WA
H)
XX
XBr
idge
span
XCH
PW (W
AH
)X
XX
Coor
dina
ted
Care
XX
Coor
dina
ted
Care
(W
AH
)X
X
Del
ta D
enta
lX
Den
tegr
aX
Kais
er N
WX
XKa
iser
WA
XX
Life
Wis
eX
XX
Mol
ina
(WA
H)
XX
XX
Mol
ina
XX
XX
Paci
ficSo
urce
XX
XX
Prem
era
XX
XPr
ovid
ence
XX
Uni
ted
Hea
lthCa
re
(WA
H)
XX
X
Plan
Rec
omm
enda
tions
–Q
HP
32
Que
stio
n: W
hich
qua
lifie
d he
alth
pla
n m
akes
the
mos
t sen
se fo
r UW
SOM
st
uden
ts tr
avel
ing
thro
ugho
ut th
e W
WAM
I (W
ashi
ngto
n, W
yom
ing,
Ala
ska,
M
onta
na, I
daho
) reg
ion
ever
y fe
w m
onth
s for
per
iods
of 6
+ w
eeks
?
Ans
wer
: •
HBE
and
the
Call
Cent
er d
o no
t rec
omm
end
plan
s for
con
sum
ers.
Nav
igat
ors c
an h
elp
cons
umer
s lea
rn a
bout
the
optio
ns a
nd n
etw
orks
of
fere
d by
eac
h pl
an. B
roke
rs c
an re
com
men
d sp
ecifi
c pl
ans.
•N
avig
ator
s, Br
oker
s, an
d en
rollm
ent c
ente
rs a
re a
vaila
ble
by p
hone
to
answ
er q
uest
ions
and
get
con
sum
ers e
nrol
led
in th
e rig
ht h
ealth
pla
n.•
Cons
umer
s can
find
a lo
cal e
xper
t at
http
s://w
ww.
wah
ealth
plan
finde
r.org
/_co
nten
t/fin
d-ex
pert
-adv
ice.h
tml
Plan
Rec
omm
enda
tions
–W
AH
33
Que
stio
n: W
hich
WA
Med
icaid
pla
n m
akes
the
mos
t sen
se fo
r UW
SOM
st
uden
ts tr
avel
ing
thro
ugho
ut th
e W
WAM
I (W
ashi
ngto
n, W
yom
ing,
Ala
ska,
M
onta
na, I
daho
) reg
ion
ever
y fe
w m
onth
s for
per
iods
of 6
+ w
eeks
?
Ans
wer
: •
The
HCA
doe
s not
reco
mm
end
plan
s for
our
clie
nt.
All M
COs o
ffer t
he
sam
e re
quire
d co
vere
d se
rvice
s. W
e re
com
men
d vi
sitin
g th
eir w
ebsit
es to
le
arn
mor
e ab
out t
he o
ptio
ns a
nd n
etw
orks
offe
red
by e
ach
MCO
. •
Visit
the
HCA
web
site
at h
ttps:/
/ww
w.hc
a.w
a.go
v/he
alth
-car
e-se
rvice
s-su
ppor
ts/a
pple
-hea
lth-m
edica
id-c
over
age/
appl
e-he
alth
-man
aged
-car
eto
le
arn
mor
e ab
out o
ptio
ns in
you
r are
a. Y
ou c
an a
lso g
et th
e ph
one
num
ber a
nd w
eb si
te fo
r eac
h M
CO to
lear
n m
ore
abou
t wha
t is o
ffere
d.
Appl
e He
alth
–Q
& A
34
Que
stio
n: D
oes i
t mat
ter w
hich
hos
pita
l em
erge
ncy
room
I ge
t tre
atm
ent?
Or d
oes M
edica
id re
imbu
rse
for e
mer
genc
y ca
re
soug
ht a
t any
em
erge
ncy
room
any
whe
re?
Appl
e He
alth
–In
an
Emer
genc
y
35
Ans
wer
:•I
f you
hav
e a
sudd
en o
r sev
ere
heal
th p
robl
em th
at y
ou th
ink
is an
em
erge
ncy,
call
911
or g
o to
the
near
est e
mer
genc
y ro
om.
•As s
oon
as p
ossib
le a
fterw
ard,
cal
l you
r MCO
and
let t
hem
kno
w
that
you
had
an
emer
genc
y an
d w
here
you
rece
ived
car
e. Y
ou
do n
ot n
eed
pre-
auth
oriza
tion
to se
ek c
are
in th
e ev
ent o
f an
emer
genc
y. Y
ou m
ay u
se a
ny h
ospi
tal o
r em
erge
ncy
setti
ng if
yo
u ar
e ha
ving
an
emer
genc
y.•O
nly
go to
the
hosp
ital e
mer
genc
y ro
om if
it’s
an e
mer
genc
y. Do
no
t go
to th
e em
erge
ncy
room
for r
outin
e ca
re.
Appl
e He
alth
–If
you
need
urg
ent c
are
36
Ans
wer
(con
tinue
d):
•You
may
hav
e an
inju
ry o
r illn
ess t
hat i
s not
an
emer
genc
y bu
t ne
eds u
rgen
t car
e. C
onta
ct y
our M
CO to
find
urg
ent c
are
faci
litie
s in
thei
r net
wor
k or
visi
t the
ir w
ebsit
e. Y
ou c
an a
lso c
all
the
MCO
’s 24
hou
r nur
se li
ne fo
r adv
ice.
Ope
n se
ven
days
a
wee
k.
•You
r MCO
Enr
olle
e H
andb
ook
will
hav
e th
e ap
prop
riate
nu
mbe
rs to
cal
l.
Appl
e He
alth
–Q
& A
37
Que
stio
n: If
it is
a p
artia
l em
erge
ncy/
part
ial n
on-e
mer
genc
y, ar
e th
ere
dedu
ctib
les a
nd c
o-pa
ys?
Or i
s the
non
-em
erge
ncy
the
resp
onsib
ility
of t
he in
divi
dual
?
Appl
e He
alth
–Q
& A
38
Ans
wer
:•
As a
n Ap
ple
Hea
lth c
lient
, you
hav
e no
cop
ays f
or a
ny c
over
ed
serv
ices.
How
ever
, you
mig
ht h
ave
to p
ay fo
r you
r ser
vice
s if:
•Yo
u ge
t a se
rvice
that
is n
ot c
over
ed, s
uch
as c
hiro
prac
tic c
are
or c
osm
etic
surg
ery.
•Yo
u ge
t a se
rvice
that
is n
ot m
edic
ally
nec
essa
ry.
•Yo
u do
n’t k
now
the
nam
e of
you
r hea
lth p
lan,
and
a s
ervi
ce p
rovi
der y
ou se
e do
es n
ot k
now
who
to b
ill. T
his i
s why
you
mus
t tak
e yo
ur P
rovi
derO
neSe
rvice
s car
d an
d he
alth
pla
n ca
rd w
ith y
ou e
very
tim
e yo
u ne
ed se
rvice
s. •
You
get c
are
from
a s
ervi
ce p
rovi
der w
ho is
not
in y
our M
CO’s
netw
ork,
unl
ess
it’s
an e
mer
genc
y or
has
bee
n pr
e-ap
prov
ed b
y yo
ur h
ealth
pla
n.•
You
don’
t fol
low
the
MCO
rule
s for
get
ting
care
from
a s
peci
alist
.
Appl
e He
alth
–Q
& A
39
Que
stio
n: A
re th
ere
Med
icaid
pla
ns th
at p
rovi
de o
ut o
f sta
te
cove
rage
for:
•W
elln
ess v
isits
•Re
gula
r car
e fo
r chr
onic
cond
ition
s•
Beha
vior
al/m
enta
l hea
lth
Apple Health –Q
& A
40
Answ
er:•M
edicaid coverage is available in the state you were determ
ined eligible. If you are out of state, you are covered for em
ergency care. You should also contact your M
CO for urgent care
options. This include coverage benefits like Behavioral Health
Services. •H
owever, for non-urgent visits you m
ay need to wait until you
return home. Contact your M
CO for your options.
Apple Health –Q
& A
41
Question: Regarding telem
edicine coverage. Is this provider specific? Are there certain plans that can cover these kind of visits?
Answ
er: Telemedicine is an expanding service. You should
consult with your M
CO enrollee handbook or contact your M
CO
to discuss options.
Apple Health –Q
& A
42
Question: Are there M
edicaid plans that allow for M
edications to be sent across state lines?
Answ
er: All MCO
s including Apple Health w
ithout a Managed
Care Plan have some pharm
acies enrolled that offer mail order
services. There are also many specialty pharm
acies that only operate outside of W
A and ship products directly to mem
bers. It is dependent on the pharm
acy. Each MCO
may have a list.
Apple Health –Q
& A
43
Question: Do all M
edicaid plans offer 90-day “vacation” or “m
aintenance” supplies of some prescriptions?
Answ
er: Each MCO
will allow
up to a 90-day supply under some
circumstances. Each M
CO and FFS currently have independent
lists of “maintenance” m
edications that are allowed as 90 day
supplies. MCO
s have been instructed they must cover these
products as 90 days through mail order and retail pharm
acy.
Apple Health –Q
& A
44
Question: Are there lim
its to the type of medications that are
covered under this provision?
Answ
er: It is based on the MCO
medication lists. N
ot every m
edication is allowed for 90-day supplies and there is variation
between all M
COs. Contact your M
CO for additional details.
QH
P Prescription CoverageCarriers provide m
ail order Rx info on their websites
•Prem
era Mail O
rder Rx: Yes mail order
available via Express Scripts•
URL: https://w
ww.prem
era.com/w
a/visitor/pharm
acy/pharmacy-services/m
ail-order-prescriptions/
•Coordinated Care M
ail Order Rx: Yes via
Hom
escriptsand AcariaHealth
•URL: https://am
better.coordinatedcarehealth.com
/resources/pharmacy-resources.htm
l
•M
olina Mail O
rder Rx: Yes, mail order
form available on w
ebsite. •
URL: https://w
ww.m
olinahealthcare.com/m
embers/fl/en-us/m
em/m
edicaid/overvw/coverd/pages
/presdrugs.aspx
•Kaiser W
ashington Mail O
rder Rx: Yes, m
ail order form available on w
ebsite.•
URL: https://w
a.kaiserpermanente.org/htm
l/public/pharm
acy/mail-order
•Kaiser N
W (SW
Washington) M
ail Order
Rx: Yes, mail order available on w
ebsite.•
URL: https://healthy.kaiserperm
anente.org/oregon-w
ashington/get-care
•Regence M
ail Order Rx: Yes, m
ail order available via AllianceRx
Walgreens Prim
e•
URL: https://w
ww.regence.com
/provider/program
s/pharmacy
•PacificSource
Mail O
rder Rx: Yes, via CVS Carem
ark.•
URL: https://pacificsource.com
/mem
ber/pharm
acy-network/
•Providence M
ail Order Rx: Yes, m
ail order inform
ation available on website.
•URL: https://healthplans.providence.org/m
embers/m
ember-groups/phs-
caregivers/pharmacy-benefits/
•LifeW
iseM
ail Order Rx: Yes, m
ail order available via Express Scripts
•URL: https://w
ww.lifew
ise.com/about-
pharmacy
45
Additional Questions?
•Key contacts for help understanding Washington Apple H
ealth/Medicaid
policy•
Johnny Shults, Section Supervisor, Medicaid Program
Operations and Integrity:
a.gov•
Francesca Matias, M
edicaid Eligibility Policy Manager:
Francesca.Matias@
HCA.W
A.GOV
•Key contacts for help understanding QH
P policy•
James M
anual, Policy Analyst: james.m
anuel@w
ahbexchange.org•
Joan Altman, Director of Governm
ent Affairs & Strategic Partnerships:
joan.altman@
wahbexchange.org
46
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