If you live in Washington, there are a lot of ways for you to obtain health coverage. You can enroll in a health insurance plan through your employer, obtain coverage through the Healthcare Insurance Marketplace, shop for a plan with individual insurance companies, apply for Apple Health (Medicaid), or enroll in Medicare.

This guide explains all of these options so that you can make informed decisions about your health care.

What to know about insurance in Washington

  • Buy coverage: You can buy individual insurance coverage in Washington even if you’re enrolled in an employer-sponsored health plan. You may do this if you feel that your work coverage isn’t covering your needs.
  • Open Enrollment: Washington residents can enroll for health coverage every year during the open enrollment period that begins on November 1 and ends on December 15. If you don’t enroll during the annual open enrollment period, you might lose the ability to enroll until the next enrollment period.
  • Special Enrollment: Special enrollment periods allow you to apply for insurance outside of open enrollment. To qualify, you have to have moved, changed jobs, gotten married, or had a child.
  • Health Insurance Exchange: Washington uses its own health insurance exchange and uses the same exchange to allow residents to apply for financial assistance programs. The only way to qualify for the Advanced Premium Tax Credit is to use the state exchange.
  • Types of plans: In Washington, about 53% of people get health coverage through an employer. Another 5% have a non-group policy. Just under 14% are enrolled in Medicare, and 19.8% receive coverage through Medicaid. Around 6.6% of the state is uninsured.

How do I enroll in Washington’s Health Insurance Marketplace?

Washington runs its own Health Insurance Marketplace. You can access the exchange by visiting wahealthplanner.org and creating an account. You only need to follow the instructions, provide your contact information, and select a password and security questions.

Before you apply for coverage, gather all of the information you’re going to need. This includes the birth date, full name, and Social Security number for everyone you want to add to your plan. After you create your account, you can apply for insurance coverage. Your application asks several questions that help the website determine if you qualify for the Advanced Premium Tax Credit or other forms of financial assistance:

  • Are you interested in applying for financial assistance?
  • Are you single or married?
  • How many dependents do you claim on your income tax return?
  • What is your total household income?

The website automatically determines if you’re able to apply for Apple Health (Medicaid) or CascadeCare plans, which are cost-sharing plans that could save you money. Use the available comparison tool to shop for different insurance plans before you decide which one is right for you or your family. Once you’ve found the plan that you like, you can finish enrolling on the website.

The following insurance companies currently offer individual health insurance coverage in Washington:

  • BridgeSpan Health Company
  • Community Health Network of Washington
  • Coordinated Care Corporation
  • Kaiser Foundation Health Plan of the Northwest
  • Kaiser Foundation Health Plan of Washington
  • LifeWise Health Plan of Washington
  • Molina Healthcare of Washington
  • PacificSource Health Plans
  • Providence Health Plan
  • Premera Blue Cross
  • Regence BlueShield
  • Regence BlueCross BlueShield UnitedHealthcare

How do I enroll in Washington individual and family insurance?

Whether you’re looking for an individual plan or family coverage, your enrollment process is exactly the same. You should take some time to consider your needs before you shop for insurance.

The things you need to determine ahead of time include:

  • How much you can afford to pay for insurance
  • The deductible you’re required to meet each year
  • The type of plan you’d prefer
  • your family’s medical needs

Insurance for individuals in Washington 

You’ve got more options when you’re looking for insurance as an individual. You’re only looking for coverage suited to your needs, so if you’re healthy and unlikely to need regular medical care, you can save a bit of money. Purchasing lower-cost policies with high annual deductibles and coinsurance is a good strategy if you only want to cover yourself in the case of an emergency, but remember that you still need to meet the deductible and copayment.

You can save money or receive more comprehensive benefits depending on the type of plan you choose.

  • Health Maintenance Organization (HMO) plans are the cheapest and most restrictive plans. You’re required to only see doctors inside the plan’s network and have to get a referral any time you need to see a specialist.
  • Preferred Provider Organization (PPO) plans allow you to see whatever doctors you wish but are more expensive.
  • Point-of-Service (POS) plans provide you with a network and require you to get a referral for specialists like HMO plans do, but you’re allowed to see out-of-network doctors if you agree to a higher copayment.

Insurance for families in Washington 

Shopping for family coverage is more difficult because your own medical needs and history is only a part of the bigger picture. You might be healthy and don’t need to see doctors or specialists regularly, but your family members may suffer from chronic medical conditions. When this is the case, you need to balance the monthly cost of your plan, your family deductible, and the amount of coverage you receive so that your total cost of health care is lower.

How much does health insurance cost in Washington?

When you shop for health coverage on the Health Insurance Marketplace, you’re going to see four different tiers: bronze, silver, gold, and platinum. The tiers identify plans based on monthly premiums, annual deductibles, and copayment requirements. When you’re evaluating a plan’s premium, consider what you’re getting in return to determine whether a more expensive plan can actually save you money.

Average premiums in Washington 2018 2019 2020 2021
Most affordable bronze plan $281 $343 $305 $280
Most affordable silver plan $326 $394 $386 $380
Most affordable gold plan $400 $455 $435 $422

  • Bronze plans are the cheapest plans on the exchange, but they’re often the most restrictive. You’re required to meet a higher deductible and to cover 40% of your medical expenses after you pay the deductible. If you’re healthy and only shopping for yourself, a bronze plan can save you money, but it’s not recommended if you’re seeking family coverage. The cheapest bronze plan in Washington costs $280 per month in 2021.
  • Silver plans are slightly more expensive than bronze plans, but you’re only required to pay a 30% copayment and your deductible is lower. If you qualify for financial assistance, you’re able to purchase many silver plans at a lower premium than a bronze plan. Most families are able to save the most on the total cost of healthcare with a silver plan. The most affordable silver plan in Washington costs $380 per month in 2021.
  • Gold and platinum plans are the most expensive, but if your family has specific medical needs, a gold or platinum plan provides the most comprehensive coverage. Gold plans only require 20% coinsurance, and your coinsurance is reduced to 10% with a platinum plan. A gold or platinum plan is more expensive month-to-month, but the lower deductible and coinsurance requirement will reduce your total cost of care if you or a family member suffers from a serious medical condition that requires ongoing treatment. The most affordable gold plan in Washington costs $422 per month.

What kind of low-income health insurance is available in Washington?

Washington offers two primary programs to residents looking for low-cost coverage: Apple Health (Medicaid) and the Children’s Health Insurance Program (CHIP). Washington runs both programs with the assistance of federal subsidies.To qualify, your income must be considered low or very low.

Apple Health in Washington 

Apple Health is Washington’s Medicaid program. It covers low-income residents for services such as:

  • Cancer screenings
  • Hospital stays
  • Medical treatments that are considered medically necessary
  • Medications
  • Outpatient procedures
  • Routine care

You may qualify for Apple Health if you’re over the age of 65, disabled, taking care of a family member with a disability, or responsible for children under the age of 18.

To be able to qualify, your income must remain under a threshold that is determined by the size of your household. For example, you can qualify for Apple Health if your income is under $1,482 per month while a family of five still qualifies with a total monthly income of under $3,570 per month. If you’re unable to qualify for Apple Health, you can find cost-sharing plans meant for low-income families on the Health Insurance Marketplace.

Washington CHIP Program 

If you don’t qualify for the Apple Health program, you may still be able to enroll your children for health coverage through the CHIP program. Children and pregnant women can qualify with higher incomes than the regular Apple Health thresholds.

The CHIP program provides your children or pregnant family members with coverage for:

  • Approved outpatient care
  • Dental
  • Emergency care
  • Medication coverage
  • Mental health services
  • Prenatal care
  • Routine doctor visits
  • Vision

To apply for Medicaid coverage or the CHIP program, you can use the portal provided on Washington’s Health Insurance Marketplace.

What are Washington’s Medicare options for seniors and people with disabilities?

You have several options if you’re of retirement age or living with a disability when it comes to health care. You can enroll in traditional Medicare, enroll in an Advantage plan, and sign up for Medicare Part D and Medicare Supplement plans to cover the cost of your medications and out-of-pocket expenses.

  • Original Medicare consists of Parts A and B. Part A covers inpatient care, such as hospital stays, nursing care, and home health care while Part B covers outpatient procedures, preventative care, diagnostic testing, medical equipment, medical supplies, and medical transportation.
  • Medicare Advantage plans are required to cover everything offered under traditional Medicare but are run through insurance companies. You can add vision, dental, drug coverage, and more to these types of plans.
  • Medicare Part D offers multiple tiers of prescription drug coverage, and you can apply even if you have an Advantage plan.
  • Medicare Supplement plans are useful if you’re worried about your ability to cover your out-of-pocket expenses.

Eligibility

To be eligible for Medicare, you must be a U.S. citizen or permanent resident, over the age of 65, or have a qualifying disability. Your disability qualifies if you’ve received Social Security Disability Insurance for 24 months or you have ALS or end-stage renal disease.

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • Medicare Advantage open enrollment: You can enroll in Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can enroll, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources 

If you require assistance enrolling in Medicare, you can reach out to the Office of the Insurance Commissioner or the Statewide Health Insurance Benefits Advisors (SHIBA). To be put in touch with a counselor, you can call 800-562-6900.

Are there short-term health insurance plan options in Washington?

Washington lets you enroll in short-term health insurance plans if you need to cover a gap in your health care coverage. You may not enroll in a plan that offers coverage for more than 90 days, and you’re also not allowed to renew a short-term plan after its expiration. You may only seek a short-term insurance policy once a year. Short-term health insurance companies are allowed to deny you coverage for certain medical conditions, but they’re not able to deny you coverage for any pre-existing conditions you’ve been diagnosed with for the last two years.

Washington Insurance FAQs

Does Washington require health insurance? 

In Washington, you’re not required to enroll in a health insurance plan. The Affordable Care Act has a national mandate, but there is no tax penalty as of 2019.

Do I have to use the Health Insurance Marketplace in Washington? 

You don’t need to use the Health Insurance Marketplace to buy a plan, but it’s the only place where you may qualify for the Advanced Premium Tax Credit.

What types of alternative health insurance plans (like cost-sharing plans) are available in Washington? 

There are insurance plans available both on and off the Health Insurance Marketplace that can reduce your costs because they pool the resources from everyone enrolled in the group to be distributed when you need to file a claim.

What type of marketplace does Washington have? 

Washington created its own Health Insurance Marketplace to offer insurance through the ACA. It’s called Washington Healthplanfinder, and you can use it to apply for insurance and financial assistance programs.

Do I need health insurance if I have HSA/FSA? 

Flexible savings accounts like HSAs and FSAs help you plan ahead in case you’re responsible for a large medical bill. Unless you can save a lot of money, these resources are not an effective replacement for insurance. Health insurance covers the majority of your expenses while a savings account helps you cover your out-of-pocket expenses.

Do I need short-term disability coverage in Washington if I have health insurance? 

You don’t need to enroll in a short-term disability plan, but you might want to consider it. Health insurance can’t cover some costs when you’re injured or diagnosed with a condition that requires you to take time off of work. A short-term disability plan can replace your wages and help you pay the mortgage, utility, and grocery bills.

Do I need long-term disability coverage in Washington if I have health insurance? 

Long-term disability coverage works in the same manner as short-term disability coverage. In the event you become permanently disabled, you’re able to receive coverage for your day-to-day expenses. You need health coverage to handle your medical expenses as well.

What does CHIP cover? 

Washington’s CHIP program offers comprehensive benefits to children under the age of 19 and pregnant mothers. You’re covered for:

  • Dental treatment
  • Emergency care
  • Hearing problems
  • Immunizations
  • Medications
  • Mental health services
  • Preventative care
  • Routine physical examinations
  • Social care for learning disorders
  • Speech therapy
author-img
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies, as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and healthcare consultant, now helping people understand the medical system. Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

Sources