Washington Health Insurance

Health Insurance Overview

Washington residents have many options for health care coverage. There are numerous Washington insurance providers to choose from, along with a variety of Washington medical insurance plans designed to meet the specific needs of individuals, families and groups.

We can help you find the right information for your situation—whether you need independent self-employed health coverage, or your employer simply doesn’t offer group Washington health insurance benefits; whether you are looking to cover your spouse and children under the same low rate, or you are a small business that wants to provide your employees with affordable coverage. We are the one-stop resource for all your health care needs—including quality Washington medical insurance from the best Washington insurance providers around.

Even under the new Affordable Care Act, each state is unique in its individual laws and regulations, as well as the types of coverage it offers. Here you will find an array of resources and useful information to help you better understand Washington health insurance and the range of options available to you. This includes current facts and statistics about residents, important state legislation, financial assistance and public Washington health insurance programs, healthcare exchange information, and even details on some of the top Washington insurance providers.

To compare specific Washington medical insurance plans offered by the various Washington insurance providers, and get a free personalized quote for the options that are right for you, contact us now. We’ll connect you with a highly qualified insurance agent near you who will be happy to help with all of your Washington health insurance needs.

At Healthcare Solutions Team, we’re committed to making affordable health care accessible to everyone. Our group of elite Washington health insurance advisors is dedicated to helping find the right coverage to fit the needs of all families, individuals and groups. Not a resident of Washington? Find your state here.

Washington Health Insurance Facts & Statistics

Total Washington Residents – 6,794,000

Total Health Insurance Coverage In Washington:
Employer – 50%
Individual – 5%
Medicaid – 16%
Medicare – 13%
Other Public – 3%
Uninsured – 14%

Average Individual Monthly Premiums – $231

Average Annual Single Employee Contribution for Employer-Based Health Insurance Plan – 16%

Average Annual Single Employee Premium for Employer-Based Health Insurance Plan – $877

Average adjusted hospital cost per inpatient day – $2,875

Source data according to the Kaiser Family Foundation (http://www.kff.org/) (2009-2012 data) and http://www.statehealthfacts.org/

Washington Medical Insurance Laws, Regulations & Policies

Washington was one of the first states to move ahead with a state-run health insurance marketplace as envisioned by the Affordable Care Act (ACA). Under ACA, all Washington health insurance plans for individuals and families are guaranteed issue, as are group health insurance plans for small groups of two to 50. This means that individuals have a variety of options for healthcare coverage and a greater chance of being eligible for stable and affordable health insurance plans.

All residents of Washington are required to have health insurance coverage, whether it is purchased through the Washington State Healthcare Exchange or individually through an approved Washington insurance provider. Plan availability and premiums are based on many factors, including age, family status, income, and more. Depending on the health insurance company, Washington individual and family health insurance rates can vary widely, so it’s important to check all options.

If a policy is purchased through the exchange in Washington, enrollees pay their premiums directly to Washington Healthplanfinder and the exchange then sends the premiums out to each insurer. This is different from the standard billing method used in most other states, where premiums are paid directly to the policy carriers after enrolling through the exchange.

Under ACA, stronger emphasis is placed on the importance of preventative care. Washington medical insurance plans are required to cover cancer screening for prostate, breast and colorectal cancer. Washington insurance providers are also required to uphold mental health parity, which means that mental health conditions must have coverage limits and maximums set equal to those for physical conditions.

Policyholders in Washington group health plans have a right to health insurance coverage for time in between jobs. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows insured individuals to stay on their employer’s insurance for a temporary time period up to 18 months after losing a job. However, it can be quite expensive, and qualifying is mandatory. For example, Federal law makes employees eligible for COBRA only in companies with more than 20 workers. Learn more here.

To learn more about the Washington State health insurance online marketplace or healthcare exchange, visit www.wahealthplanfinder.org. You may be able to get help paying your premium—visit www.wahbexchange.org. For a handy guide to review your options by area, click here.
To learn more about buying a plan directly from a health insurance company, click here.

Washington Health Insurance Resources

Washington State Department of Social and Health Services

Explore Washington Public Health Department’s Guide to Health & Medical Services, with convenient links to many other key state programs.

Washington State Office of the Insurance Commissioner

Get all the details on the state’s health system and get answers to common questions.

The Affordable Care Act: Immediate Benefits for Washington

Learn how the ACA has impacted Washington State residents, and get updates on future changes and open enrollment opportunities.

Washington Health Insurance High Risk Pool

The ACA established temporary national high risk pools to provide health insurance to those who have been denied coverage due to their medical status. Under the new ACA guaranteed issue laws, insurance companies are no longer able to deny individual coverage due to pre-existing conditions. Washington State’s Health Insurance Pool (WSHIP) is one of the few state-run pools in the country that will remain operational—for existing members only—until the end 2017. WSHIP is continuing to enroll Medicare members as well as some non-Medicaid eligible applicants. For more information on the Washington health insurance high risk pool visit http://www.wship.org/

To stay up-to-date on the latest health care reform news, visit: http://healthreform.kff.org/

Washington Medical Insurance and Health Care Programs

The state of Washington offers residents quite a few public health insurance programs to assist low-income residents in getting access to affordable health care and insurance coverage. These programs include:

  • Washington Apple Health (Medicaid)
    In Washington, Medicaid is called Washington Apple Health and offers coverage for seniors who qualify. For more information and detailed eligibility requirements, click here.
  • Washington Apple Health for Kids Program
    Apple Health for Kids is an initiative aimed at streamlining applications for children’s health care coverage. The program covers preventative care like immunizations, physical exams and even dental check-ups for eligible children. To get more information on the Apple Health for Kids Washington medical insurance program, visit http://www.hca.wa.gov/applehealth/Pages/default.aspx.
  • Basic Health
    Individuals and families who income qualify can find healthcare coverage at a reduced rate. Learn more.
  • Healthcare for Workers with Disabilities (HWD) Program
    The HWD program allows people with disabilities who are working to purchase medical coverage by paying a monthly premium that is based on their income. Get details here.
  • Family Medical
    Learn more about medical coverage options and plans for families with children.
  • Washington Medicare Savings Programs
    If your income falls below the Federal poverty limit annually set by the government, then you may qualify for a Medicare savings program. These offer financial relief to help some Medicare recipients pay for all or part of their Medicare premiums.
  • Alien Emergency Medical Program
    This is an emergency medical program for persons who do not meet the citizenship requirements for other Washington State Department of Social Health Services medical programs. Learn more.
  • Pregnancy Medical Program
    The Pregnancy Medical Program allows pregnant women to receive care and medical benefits, based on specific income requirements and other eligibility.
  • Aged, Blind and Disabled Medical Program
    Persons who are age 65 and over, blind or disabled and who meet income and resource requirements can get medical coverage through this program.
  • Washington Wellness
    Washington Wellness (WW) works to make healthy choices easier for state employees, retirees, and their dependents; improve the productivity of state employees; and positively impact the medical cost trend of state health plans’ enrollees.
  • Prescription Drug Program
    The goal of the Prescription Drug Program is to develop an evidence-based prescription drug program to identify preferred drugs for use by the participating programs (UMP, L&I, and Medicaid); make prescription drugs more affordable to Washington residents and state health care programs; and increase public awareness regarding the safe and cost-effective use of prescription drugs.
  • TRICARE
    Past and present members of the military can consider TRICARE when it comes to keeping in good health, especially if they are active members of the military. Present members who are still in the service get completely free coverage from the government via TRICARE for themselves and their families. Retired members have to pay for coverage, but they’ve got a few good options to choose from.
  • VA CARE
    For those who aren’t eligible for TRICARE, VA CARE may be the right healthcare fit. Contact the Department of Veteran’s Affairs to learn more.
  • CHAMPVA
    Washington residents who do not qualify for care under TRICARE may qualify under CHAMPVA. The Civilian Health and Medical Program of the Department of Veterans Affairs has three ways to meet eligibility requirements: 1) spouse or child of a veteran who is now permanently disabled because of an incident related to their military service; 2 surviving spouse or child of a veteran who has died or because of a military-related disability; 3) surviving spouse of child of a veteran who died during their service.
  • Public Employees Benefits Board (PEBB)
    The Public Employees Benefits Board (PEBB) program provides insurance coverage for eligible employees of state agencies, higher education institutions, certain employer groups, and their families. The state of Washington, through the PEBB program, provides medical, dental, life, and long-term disability coverage (and offers optional insurances) through private health insurance plans to eligible state and higher-education employees as a benefit of employment. Find out more.
  • Uniform Medical Plan
    The Uniform Medical Plan (UMP) is a self-insured, preferred provider health insurance plan available to Public Employee Benefits Board (PEBB) enrollees worldwide.
  • Washington State Health Insurance Counseling and Assistance Program (SHIP): Statewide Health Insurance Benefits Advisors (SHIBA) provides free, unbiased health care coverage counseling to Washington residents to help understand health care options and Medicare rights.
  • HealthPlan Washington
    The state of Washington has created a new program to help integrate the benefits of those who take part in both Medicare and Medicaid. Each plan is designed to suit the individual who is enrolled, and can provide medical, mental health, pharmacy benefits, and long-term services for individuals who are enrolled.

Washington Insurance Providers, Plans and Rates

If your employer doesn’t provide health insurance, you’ll need to buy your own individual health plan to comply with ACA. Health reform provides two ways to buy an individual health plan during the annual open enrollment period:

  • Washington Healthplanfinder – An online marketplace, also called the exchange, where you can compare health plans and get help paying your premium (www.wahbexchange.org), depending on your income. For a handy guide to help, click here.
  • Buy a plan directly from a health insurance company – Additional health plans are available outside of the exchange, but if you buy a health plan outside the exchange, you won’t get help paying your premium. To see what plans or programs are available in your area, please click here.

In 2014, eight insurers are selling individual policies through the Washington Healthplanfinder online marketplace:

  • Bridgespan
  • Community Health Plan of Washington
  • Group Health Cooperative
  • Coordinated Care
  • Kaiser Foundation Health Plan of the Northwest
  • LifeWise Health Plan of Washington
  • Molina Healthcare of Washington
  • Premera Blue Cross

The carriers are offering a total of 46 individual policy options, but not all options are available in all counties. Pediatric dental-only coverage is being offered by Delta Dental of Washington, Kaiser Foundation Health Plan of the Northwest, LifeWise Health Plan of Washington, and Premera Blue Cross in all 39 counties.

Four more carriers have submitted plans to join Washington Healthplanfinder for 2015:

  • Moda Health Plan Inc.
  • Columbia United Providers
  • Health Alliance Northwest Health Plan
  • United Healthcare of Washington

The addition of more carriers and plans demonstrates how successful Washington’s exchange has been in its first year, and the new plans should be beneficial in terms of competition, consumer choice, and rate stabilization.

Individual and Family Health Insurance Companies for Private Policies in Washington

Short Term Insurance Providers in Washington

Important Contacts and Links

Washington State Health Care and Insurance

Find contact Information for Washington health insurance and public health departments at:

Washington State Office of the Insurance Commissioner
P.O. Box 40256
Olympia, WA 98504
(800) 562-6900
www.insurance.wa.gov

Washington State Health Care Authority
Executive Office
626 8th Avenue SE
P.O. Box 45502
Olympia, WA 98504-5502

Street Address (please do not mail or ship to this address)
626 8th Avenue SE
Olympia, WA 98501

1-800-562-3022
http://www.hca.wa.gov/Pages/contact.aspx

Public Records Requests
Ramona Roberts
PO Box 42700
Olympia, WA 98504-2700
360-725-1911 or Fax 360-586-9080
Email: PublicDisclosure@hca.wa.gov