TABLE OF CONTENTS
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.
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:
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:
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:
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.
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.
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|
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 is Washington’s Medicaid program. It covers low-income residents for services such as:
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.
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:
To apply for Medicaid coverage or the CHIP program, you can use the portal provided on Washington’s Health Insurance Marketplace.
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
Washington’s CHIP program offers comprehensive benefits to children under the age of 19 and pregnant mothers. You’re covered for: