Insurance and Cost of Care

Frequently Asked Questions

  • What are the options for purchasing health insurance for my child?
    • Get it through your employer.
    • Buy it on the Health Insurance Exchange:
    • Buy it from an insurance company, agent or broker.
    • Apple Health for Kids (Medicaid). Learn if you qualify. Contact one of our financial counselors for help applying.

    If you buy an insurance plan on the Washington Healthplanfinder or the Healthcare.gov exchange, you may qualify for tax credits or subsidies. If you buy outside the exchange, you do not. To learn more, visit the Washington State Office of the Insurance Commissioner’s website.

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  • What is a Health Insurance Exchange?

    Since all Americans are required to have health insurance, the Health Insurance Marketplace was designed to meet that requirement. The Marketplace (also called an Exchange) is a one-stop shop to find, compare and buy private health insurance options.

    Washington state’s exchange is called Washington Healthplanfinder.

    If you live outside of Washington, go to Healthcare.gov to learn how to enroll in a health plan.

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  • Which insurance plans include Seattle Children’s?
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  • What can I do if my insurance plan doesn’t cover Seattle Children’s?

    Talk with your child’s primary care provider. You may have other options. Your child may still receive care at Seattle Children’s but you may be responsible for the full cost. If you choose to receive care at Seattle Children’s, your insurance may cover services at a much lower rate which is called out-of-network. Financial assistance does not cover non-urgent or elective services that other in-network providers can provide.

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  • I have insurance, but how much will I have to pay?

    The amount you owe (out-of-pocket cost) depends on the insurance plan you have. Your cost is determined by your co-pay, co-insurance, individual and family deductible amounts, as well as the type of services your child receives. Contact your insurance to learn what is covered on your plan. If you’d like an estimate, we can help, but we need some additional information from you and your insurance company. Learn more.

    For more information about how insurance coverage works, see our resources page.

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  • What if I am unhappy with my insurance plan?

    You are the best advocate for your child. We encourage you to call the Office of the Insurance Commissioner (OIC) with concerns; the providers your insurance recommends; the timeframe for getting a response; or anything else about your health insurance. The OIC oversees the insurance industry and protects you as an insurance consumer.

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  • Why is Seattle Children’s not a provider on all plans?

    We are a provider with most plans. Despite our best efforts, a few companies have chosen not to contract with us. For more information, view our list of plans that include Seattle Children’s.

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  • What if my child is seen at Seattle Children’s and does not have insurance?

    Contact our financial counselors at 206-987-3333, and they will help you.

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  • What should I consider when comparing health insurance?

    When comparing, consider these things:

    • What is covered?
    • What is my monthly cost?
    • What is my deductible?
    • What is my coinsurance and copay?
    • Which providers can I see with this plan?
    • What is the annual out-of-pocket maximum for in-network services and annual out-of-pocket maximum for out-of-network services?
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  • What is an Accountable Care Network (ACN) or Accountable Care Organizations (ACO)?

    A group of healthcare providers who give coordinated care and chronic disease management with the goal of improving patient care. When you sign up for an ACN/ACO, you agree to receive all or most of your healthcare from the providers who are part of the ACN/ACO.

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  • How does a faith-based health cooperative compare to insurance?

    In faith-based health cooperatives, members make monthly payments, similar to an insurance premium. Then, when members get medical bills, they get money from the cooperative. It is not insurance, but is considered an alternative to insurance and can be used to avoid health insurance penalties. The two most common are Samaritan Ministries and Medi-Share.

    Faith-based health cooperatives may not cover pre-existing conditions. Also, there may be limits on how much is covered for each episode of care.

    If you belong to a faith-based cooperative, you can apply for Seattle Children’s Financial Assistance; however, we cannot approve financial assistance until we have determined you are not eligible for Apple Health (Medicaid).

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