Washington has its own health insurance exchange, with nine carriers offering individual and family plans for 2020.
Washington Health Insurance Overview
If you’re looking for information about health insurance in the State of Washington (not Washington, D.C.), then you’re in the right place. Washington sets itself apart as one of the first states to have a state-based health insurance exchange since 2011.1 Residents can use the exchange to enroll in private health insurance under the Affordable Care Act (called Obamacare) as well as public health coverage through Medicaid.
Those who qualify can get health insurance through Medicare. The Evergreen State also offers short-term health insurance plans that provide temporary coverage.
Washington and the Affordable Care Act
The first change in the uninsured rate happened in 2014 when the state adopted Medicaid expansion under the ACA. The rate dropped from 14% to 9%.4
Due to the expansion, 622,300 more adults have Medicaid benefits in Washington. In total, about 1.5 million adults and children (21% of the total population) are enrolled in Washington’s Medicaid program.
Washington’s Health Insurance Exchange and Enrollments
Most states use the federal exchange via Healthcare.gov for Obamacare enrollment. But Washington created its own state-run exchange called Healthplanfinder.7
You can use Healthplanfinder to shop for individual and family coverage, see if you qualify for financial assistance with health insurance costs, or apply for Medicaid.
Nearly 221,000 Washington residents enrolled in Obamacare plans for the 2020 open enrollment.8 Sign ups were extended to December 30, 2019, instead of the usual December 15 deadline.9 After the deadline, you can only buy a plan if you have a qualifying life event, such as getting married. Otherwise, you’ll have to wait until the next enrollment period starting on November 1, 2020.
Health Insurance Companies in Washington State
You can choose from 13 Washington health insurance companies for 2020 individual and family plans. But only nine offer plans on the exchange.
Washington Health Insurance Carriers for 2020
|Company Name||On the Exchange||Off the Exchange|
|Asuris Northwest Health||✔️|
|Health Alliance North West||✔️|
|Kaiser Foundation Health Plan of the Northwest||✔️||✔️|
|Kaiser Foundation Health Plan of Washington||✔️||✔️|
|LifeWise Health Plan||✔️||✔️|
|Molina Healthcare of Washington||✔️|
|PacificSource Health Plans||✔️||✔️|
|Premera Blue Cross||✔️|
|Providence Health Plan||✔️|
|Regence BlueCross BlueShield of Oregon||✔️|
How Much Does Health Insurance Cost in Washington?
Washington residents paid less for a Marketplace health plan in 2019 than the year before. These are plans with an effective date of January 1, 2020.
The average lowest cost for a 2020 metal plan sold on Washington’s health benefits exchange is as follows:
- Average Lowest-Cost Bronze Premium: $305
- Average Lowest-Cost Silver Premium: $386
- Average Lowest-Cost Gold Premium: $435
Washington Health Insurance Costs After Subsidies
Subsides (or premium tax credits) can help lower your monthly premiums on any metal plan sold through the Marketplace. The federal government offers them based on your income and household size. You typically qualify if you make between 100% and 400% of the federal poverty level (FPL), or $12,760 and $51,040 for an individual in 2020.
Sixty-four percent of Washington’s Marketplace enrollees received subsidies on 2020 coverage.10
Here are some examples of Washington health insurance costs after subsidies:
A 30 year old in Seattle, Wash. earning $28,000 a year could get a 2020 silver plan for $172 per month after subsidies ($331 per month without subsidies).
A family of four in Spokane, Wash. earning $40,000 a year could get a silver plan for $326 per month after subsidies ($990 per month without subsidies).
Washington’s Medicaid Program for Low-Income Adults and Children
Medicaid is called Apple Health in the State of Washington. It includes a children’s health insurance program called Apple Health for Kids. If you qualify, you can enroll any time throughout the year.
About 1.5 million low-income Washingtonians enrolled in Medicaid as of October 2019.11 This includes children under 19 and their caretakers/parents, foster care youths up to age 21, pregnant women, people with disabilities, the elderly, and childless adults under 65 who qualify due to Medicaid expansion.
The income requirements to qualify for Medicaid in Washington vary. For instance, seniors and people with disabilities can earn up to 74% of the federal poverty level (FPL). This amount comes to roughly $9,442 a year for an individual in 2020. Parents and childless adults can earn up to 138% of the FPL, which is at or below $17,609 for an individual in 2020.12
Medicare for Seniors and People With Disabilities in Washington
Medicare is a health insurance program usually for people 65 and older. Close to 9 out of 10 Washingtonians on Medicare qualify based on age. The other beneficiaries are younger adults with disabilities.13
Among Washington’s roughly 1.3 million Medicare enrollees, nearly 7 out of 10 receive coverage through Original Medicare provided by the federal government.14 It includes coverage for inpatient hospital (Part A) and outpatient medical (Part B) care. Other beneficiaries get Part A and B through Medicare Advantage, an alternative plan sold by private insurance companies.
Medicare Advantage plans typically include Part D prescription drug coverage. But individual drug plans are also available. These plans are often paired with Original Medicare because it doesn’t cover most prescription drugs. Close to half a million Washingtonians have a separate Part D drug plan.15
Washington insurers also offer plans that help pay your Original Medicare out-of-pocket costs, including copayments, coinsurance, and deductibles. These plans are known as Medicare Supplement or Medigap.
Buying Short-Term Health Insurance in Washington
Short-term health insurance is designed to fill a temporary coverage gap, such as when you’re waiting for benefits to start at a new job. These plans are not the same as qualified health insurance under the Affordable Care Act (ACA). So they’re not required to cover pre-existing conditions.
Federal law allows states to offer short-term coverage up to 12 months with renewals up to three years. But Washington limits short-term health insurance to three months with no option to renew. Once the three months passes, you cannot buy another plan for another 12 months. Currently, you can only get short-term coverage from one insurer in the state.
Washington has several restrictions on the sale of short-term health plans, such as:
- Insurers must clearly state plan limitations on a specific disclosure form
- Insurers can only look back at a maximum of 24 months for pre-existing conditions
- Insurers cannot sell short-term plans during open enrollment with an effective date of January 1. This is to avoid confusion with ACA plans that have the same effective date16
Washington is a unique state with a robust private and public health insurance market. You should have no trouble finding coverage to meet your needs.