My experience signing up my sister and my son's was worthy of sharing. I found the plans are affordable for people earning the national average or less. I also found the obstacles are not the government or President Obama, but the insurance companies. They sell you a plan and train their staff to act stupid when it's time to pay the discounted rate.

1. Affordable Health Care Plans – Washington (but these concepts apply to every state)
Updated December 16, 2013
I wrote this to help my sister and my three sons choose the best value healthcare plan possible. They are
all educated and hard-working American’s who desperately need healthcare coverage. I am simply a
good father and brother with a good education that has taken the time to understand all the options. If
you listen to mass media, you would think the world was ending. I am not an insurance broker or agent,
nor do I work for or endorse any insurance company or political position about the Affordable
Healthcare Act or Obamacare. So, if you find this helpful, please pass it along to anyone trying to figure
out what healthcare coverage to apply for.
In Washington, three insurance companies are competing for your business. It is wise to look at the
websites and review the doctors and hospitals in your area that are in their networks before making a
decision. The information and application are found at https://www.wahealthplanfinder.org/
WARNING: The online system offered to compare plans has errors. If you are misled by a typo, it can be
a disaster for you when you need medical service and find out the plan is different than what the
website suggested. ALWAYS go to the “more information on this plan” link and at the bottom of that
page there is another link “See More Details” and there you will find another link “Open Summary of
Benefits Coverage.” There you will get the true information that will hold up in court.
Community Health Plan of Washington – 3 plans
http://www.chpw.org/
PPO – means you can choose one of their doctors or providers for the lowest cost or go to any provider
you want for a higher cost.
Kaiser Permanente – 7 plans
https://healthy.kaiserpermanente.org/html/kaiser/index.shtml
The drawback with Kaiser is a HMO so you can only go to their facilities, doctors, and contracted
hospitals.
LifeWise Health Plan of Washington – 8 plans
https://www.LifeWisewa.com/
This is also a PPO like LifeWise.
They are contracted with PeaceHealth South West Medical Center and Providence and Vancouver Clinic
and many other providers in the Vancouver, Portland area.
So the first choice is to decide which company makes the most sense for you. In this case, after looking
at the provider list, Community Health Plan is more focused in the central, northern, and western parts
of our big state. Our choice is limited between Kaiser (HMO) and LifeWise (PPO). I very much prefer the
flexibility of having many providers to choose from, so I would suggest LifeWise.
For example, a person earning $28,000.00 a year, the government allows a $61.00 credit per month.
Your monthly premiums will range from $124.00 to $270.00 a month depending on the plan you select.

2. Obviously, if you earn less, you will pay less and if you earn more, you will pay more. The most these
plans will cost is $61.00 more than the premiums mentions below. There are eighteen plans to choose
from. Anyone who says these plans are not affordable is not reading and only parroting what they hear
on television. What is true is that the Affordable Healthcare Act forced insurance companies to meet
minimum coverage requirements and not be allowed to turn you down because you were sick in the
past. What is expensive is the prices charged by hospitals and doctors and living without healthcare
coverage is like driving a motorcycle on ice; when you crash you are either dead or financially dead
along with forcing those of us with insurance to pay for your lack of wisdom or worse, your disregard for
your fellow American’s.
Some basic terminology needs to be understood before selecting a plan.
Annual deductible: This is the amount you have to pay before the insurance company starts paying
anything at all (unless they clearly state the benefit is paid “before deductible”)
Allowed Amount: This “allowed amount” is a real stab in the heart of consumers as the provider can bill
whatever they want and the insurance company is only going to cover the “allowed amount” for the
service. Some providers will bill you for the difference so always ask what the charges will be and what is
covered before having any expensive procedures performed.
Copay: This is the amount you pay at the time of service, for example $25.00 each doctor visit.
Coinsurance: This is the percentage you must pay after your deductible is met and your copay is paid;
for example, you have an operation costing $25,000.00. You have not used any other medical service so
far in the year, so you pay (for example) $1,500.00 deductible plus 20% coinsurance which would be
20% of $25,000 or $5,000.00. The total would be $1,500.00 plus $5,000.00 or $6,500.00.
Out of Pocket Max: This is the maximum you will pay in any one year. If you are like me, by this point
your head is spinning. The out of pocket maximum might be $4,500.00, so in the case above, you would
not pay the full $6,500.00, but only $4,500.00 and everything else would be covered 100%. So after the
deductible is met, all your copays and coinsurance costs are “usually” applied to the out of pocket
maximum. This is another area where insurance companies can kick the consumer to the curb.
Not Covered: You won’t find the “complete” list of what is not covered in any of the marketing
literature as this is yet another dirty little secret of the insurance industry. Make sure you review the
“not covered” list before you buy a plan as you may think something is covered and find out when you
get the bill that the service was not covered.
The plans are divided into four groups. Selecting a plan essentially depends on how much you expect to
be visiting the doctor and taking expensive prescriptions combined with your ability to pay and you
concern about something major happening to you.
Catastrophic: $180.70 per month
This plan requires you to spend $6,350.00 out of your pocket before the benefits kick in. After you spend
this amount you won’t pay anything for “covered services” at their “allowed” amounts for the medical

3. services you need. The ideal situation for this coverage would be to setup a health savings account and
make regular deposits into it until you have $6,350.00 saved up. Then let it sit and should you have any
medical needs, you pay them from the HSA. If the bill goes over $6,350.00, you should be fully covered.
Bronze: $124.73 to $178.23 per month
Annual deductible choices are $4,500.00, $5,000.00, $5250.00, 5,550.00, and $6,350.00
Copay choices are $0.00, $15.00, $20.00, $45.00, and $50.00
The bronze plans are cheaper, but you pay a lot more out of pocket each year if or should I say when
you need medical services. A bronze plan will cover you when you have a major medical event costing,
but it won’t help you if you need to go to the emergency room, make regular doctor visits or buy a lot of
expensive prescriptions.
Silver: $171.32 to $213.01 per month
Annual deductible choices are $1,300.00, $1,500.00, $2,000.00 and $3,000.00
Copay choices are $0.00, $12.00, $15.00, and $30.00
Gold: $224.48 to $269.93
The key feature of gold plans is their lower annual deductibles, but of course you pay more each month.
Annual deductible choices are $500.00, $1,000.00, or $, 1500.00
Copay choices are $10.00, $20.00, or $30.00
So, you can choose to spend anywhere from $1496.76 to $3,239.16 per year for a policy.
The average of all these premiums is $197.32 per month. So let’s assume you can afford to pay the
average; what does this buy? The closest plan to this cost is as follows:
Kaiser’s 2,500/30 plan
Premium: $196.17
This is the cheapest Kaiser plan that allows you to go to the doctor or specialist before paying the
deductible and pay only the copay shown below.
Annual Deductible: $1,500.00
Out-of Pocket Max: $6,350.00 *The website has an error and it says $4,000.00*
This the maximum you have to spend in one year including all deductibles, copays, and co-insurance if
you use a lot of services or end up in the hospital.
Primary Doctor: $30.00 copay
This is before deductible, meaning you can go the doctor and only pay $30.00. You don’t have to first
spend the $1,500.00 to cover the deductible.
Specialist: $50.00 copay
This is before deductible, meaning you can go their specialist (if they decide you need one and the

4. primary doctor refers you) and only pay $30.00. You don’t have to first spend the $1,500.00 to cover the
deductible.
Prescription drugs: $15.00 generic and $45 brand name after you spend the deductible of $250.00
Emergency Room: $350.00 copay, 0% coinsurance which is nice
Out-patient X-ray: You pay 20% after deductible
Out-patient surgery: You pay 20% after deductible
Hospitalization: You pay 20% after deductible
Lifetime max coverage: unlimited
HSA eligible: Yes – this means you can setup a special bank account or investment account for the
purpose of paying your copays, deductibles, and uncovered medical expenses (because the out of
pocket is so high). Any gains you earn on these savings or investments are tax free as long as the money
is used for medical expenses.
Conclusion: In my opinion, this plan is acceptable but not optimal based on what I just spent hours of my
life explaining above. The annual deductible is fairly low but the out of pocket max is very high. A stay in
the hospital will cost you $6,350.00, which at least is manageable when you return to work. They cover
drugs with a $250.00 deductible for brand names. Doctor visits only require a copay and you don’t need
to spend the deductible first like all the lower cost Kaiser plans. The biggest benefit I see compared to
the LifeWise Silver 2,000/15 plan is that you can go to the emergency room with a total cost of $350.00.
The LifeWise plan is $250 copay plus 20% coinsurance, so you many have to pay $450.00 to $1,250.00
for a trip to save your life, but it’s a lot better than the lower cost plans which leave you paying the full
bill up to $4,500.00 or more.
Again the major downside to Kaiser is that it’s an HMO, so you can only go to their doctors and they
decide what services will be done, when they will be done, and by whom. In no way am I intending here
to shed a bad light on Kaiser. They run a quality and efficient operation and I have used them myself
long ago. I know people who have good things and bad things to say about Kaiser, but what in this world
doesn’t have good and bad? I just prefer to be able to shop around for other opinions and other prices
for services if I can.
So, again you are probably asking yourself, how do I choose the optimal plan for me?
If you are young and healthy, you are probably thinking you rarely if ever go to the doctor or take any
medications. So, why pay a lot more per month for services you never use? It is true that if you are in
excellent health, eat well, exercise or walk regularly, don’t participate in risky activities, and your family
has no serious genetic issues that are passed down, you probably can buy the $124.73 a month bronze
policy from LifeWise and save between $73.00 to $145.00 a month. However, this does not mean you
should forget about healthcare and spend that money on junk food and beer. The wise choice would be

5. to save $5,250.00 ($437.50 a month) on the side to cover the deductible/out of pocket max should the
unthinkable happen. If you can’t save that much, what can you save? Saving $100.00 a month will take
you over four years to cover the deductible. If anything happens along the way, you will have a big
medical debt later if you need medical attention.
The scariest part of our American life is having a sudden medical problem like cancer, heart attack,
stroke, or other serious condition that lands you in the hospital. This is when it’s easy to rack up
$100,000.00 to $1,000,000.00+ in bills which of course will force 99% of the population into bankruptcy.
Chances are this won’t happen to you until you are over 50 or 60, hopefully never, but there is no way to
know. The uncertainty and the fear of it happening is why insurance companies are billion dollar giants.
So how do you make a decision on which plan to choose? Let’s use the average Kaiser 2,500/30 plan I
described above as our baseline; the cost is $196.17 a month or $2,354.04 of your net pay every year.
All the possible eighteen plans will cost plus or minus approximately $72.00 a month compared to this
average policy. So you could save $7.00 to $72.00 in premiums by choosing less coverage or spend
another $7.00 to $72.00 for better coverage.
The insurance industry is banking that you won’t need to go to the doctor as much as your fears will
make you think. They want you to take the best Gold Plan and hardly use it. Conversely, they are also
very happy if you jump on the cheapest plan and never spend enough to cover the high deductible.
Essentially, they take your money every month and you get nothing but some peace of mind that should
something really bad happen, you will be covered. You can now see why it makes sense to start an
insurance company.
This game is like playing the lottery, we know the odds of winning are very low, but we play anyway in
hope of a big payoff. We pay for insurance knowing the probability of a serious problem is low, but
should it happen even one time it would wipe out our savings.
Take the top Gold plan, the cost is $269.93 a month or $3,239.16 a year. You will spend this amount
plus any deductible for services without a dime paid by the insurance company. For this you can go to
the doctor for a $30.00 copay or a specialist for $40.00 copay and have an out of pocket maximum of
$4,800.00 per year. What is interesting about this plan is that your emergency room coverage is
$250.00 copay and 0% coinsurance, so if you are the type to run to the ER every month, this would be a
good plan for you. However, this behavior will cause everyone’s premiums to skyrocket, so please don’t
do that unless you are in-fact having monthly life and death emergencies.
Let’s say you go to a specialist once a month and need a $200.00 prescription each month, along with
some lab tests. Without insurance this will easily cost you around $6,000.00. So with this Gold plan, you
would spend $3,739.16 plus $480.00 in copays and maybe $50.00 toward the lab for a total of
$4,269.00. Your savings $1,731.00, so it is worth it for you to go with the top Gold plan because you
have an ongoing chronic condition.

6. If you don’t have an on-going problem that needs regular attention, you would have wasted a lot of
money and made an insurance executive very happy. However, let’s say you get bit by a spider, fall off
of a ladder or ATV, get a serious infection or injury and you need to rush to the emergency room. The
cost will be anywhere from $1,000.00 to over $5,000.00.
If you choose a high deductible bronze plan, you probably will avoid going to the emergency room and
try to hang in there until an urgent care facility opens because you have to first cover the annual
deductible ($4,300.00 to $6,350.00). Of course this could end up costing your life or a limb. I know
people in excellent health that have suffered each of those scary events and believe me; you don’t want
to wait when those things happen.
It is sad that in America we have to pay our auto insurance first so we can drive to work, before we pay
for our own health insurance. Car insurance should be covering our cars and health insurance should be
covering our health.
Clearly, if you are scraping by week to week on $28,000.00 a year, you may struggle to just come up with
the $124.73 a month for the lowest cost plan. If this is the case, you need to get serious about your
budgeting and spending. Honestly, for an extra $64.76 a month, you can get a decent Silver plan which I
will explain in a moment.
Shut off your extra cable TV channels, cut back you cellular plan, use Skype instead of cell minutes, drop
the gym membership, stop going to fast food or the coffee shop, drive slower, buy your bulk items at
the warehouse store, stop smoking, drink more water and less booze at the bar, prepare your own
meals instead of eating out, I could go on and on. Then you can have peace of mind and keep your
savings in the bank when you need medical attention. If you don’t have any savings, then at least you
won’t have another five or six thousand dollars in debt and collection agencies driving you crazy.
So after all this, I have come to the conclusion that for a young man in good health who is earning
around the national average with the same odds of an accident or disease popping up as anyone else in
his situation; the best plan for him is the following:
LifeWise Silver 2000
Premium: $202.46
Annual Deductible: $2,000.00
Out-of Pocket Max: $5,200.00
This the maximum you have to spend in one year including all deductibles, copays, and co-insurance if
you use a lot of services or end up in the hospital.)
Primary Doctor: $15.00 copay
This is before deductible, meaning you can go the doctor and only pay $15.00 and you don’t have to first
spend the $2,000.00 to cover the deductible.

7. Specialist: $45.00 copay
This is before deductible, meaning you can go their specialist (if they decide you need one and the
primary doctor refers you) and only pay $45.00 and you don’t have to first spend the $2,000.00 to cover
the deductible.
Prescription drugs: $10.00 generic and $45.00 brand and non-preferred brand names, specialty drugs
are not covered until you pay the annual $2,000.00 deductible.
Emergency Room: $250.00 copay + 20% coinsurance
Out-patient X-ray: You pay 20% before deductible
Out-patient surgery: You pay 20% before deductible
Hospitalization: You pay 20% after deductible
Lifetime max coverage: unlimited
HSA eligible: No – this means you cannot setup a special bank account or investment account for the
purpose of paying your copays, deductibles, and uncovered medical expenses.
For my sister, who lives in NJ, is much older and pays higher rent for a tiny apartment, the scenario is
different, but the reasoning is totally the same. NJ uses Healthcare.gov to generate the tax credit, offer
plans, and enroll applicants. The site was up and down, but we were able to enroll, get the tax credit
applied, and select a plan to “complete” the process on December 6th.
I can’t say it was easy or the site was intuitive but I was able to get it all worked out. The aggravating
part of what is happening to my sister is the marketplace completes the enrollment, but it does not
accept the first month premium. The phone number on the plan’s summary of benefits to call for more
details is staffed by liars who clearly want to kill Affordable Health Care.
Checking this number on Google shows it is the customer service number for AmeriHealth, but the
people there say they don’t accept payment for plans sold on the Marketplace, they don’t accept any
tax credit and will only charge her the full price! The people at Healthcare.gov say this is nonsense as
they sold us the policy through healthcare.gov marketplace and they have to honor it and take the
payment so she is covered.
We are scrambling to give this company money before the deadline! If we don’t get in touch with
someone who cares at AmeriHealth, she won’t have any coverage for two three more months! Clearly
this is not President Obama’s fault; the insurance companies are blocking people from the discounted
coverage so it appears the government is NOT the problem and the true culprits are the insurance
companies.
December 16 update: NJ situation - On our third call back, AmeriHealth suddenly finds my sister’s
application and Member ID number, but they still can’t accept payment. We were told that a letter
should come in the US Mail in a couple of days.

8. Washington situation – the online system will accept the payment directly without having to wait for
letters or go through the insurance company. The payment options are e-check or credit card. This is a
far better process than the poor folks in NJ have to suffer through.
I hope you find this helpful and if I have made any errors let me know and I will correct them.
honestdon57@comcast.net