Overview of Washington’s Health Insurance Exchange
When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. The Washington Health Benefit Exchange, created in 2011, is responsible for the creation of Washington Healthplanfinder. The Healthplanfinder is an easily accessible online marketplace for individuals, families, and small businesses to find, compare, and enroll in qualified health insurance plans.
Since October 1, 2013, Washington Healthplanfinder offers Washington State residents the opportunity to compare qualified health plans side by side. It also allow residents to apply for financial help in the form of tax credits or assistance with covering premiums and copays. Online, phone, and in-person support are also available for the search and enrollment process.
The key health insurance providers in Washington state are: BridgeSpan, Community Health Plan of Washington, Coordinated Care, Group Health Cooperative, LifeWise Health Plan of Washington, Molina Health Care of Washington, Premera Blue Cross, Kaiser Foundation Health Plan of the Northwest, and Delta Dental of Washington.
A full list of available providers by county is available at Washington Health Benefit Exchange.
People can start shopping on October 1, 2013. Shoppers can browse for health plans anonymously or enter basic information to get more accurate pricing in their area (by zip code). Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
With Washington Healthplanfinder, you shop anonymously at the beginning and find a plan you like. You can place different plans side by side to compare, and you can also sort and filter plans based on key factors.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Read this helpful FAQ put together by the Washington Health Benefit Exchange for more basic information about plans for individuals and small businesses.
There are three basic plans available in Washington, with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), and Gold (80 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan with a high deductible is available for folks under the age of 30.
Adults living at or below 133 percent of the federal poverty level (also known as the FPL, which is $11,490/year in wages for one person and $23,550/year in wages for a family of four), or pregnant women living at or below 196 percent of the FPL, can qualify for Medicaid in Washington State, based on eligibility standards that take effect January 1, 2014.
Additional federal financial protection provisions will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to the Silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the health care rates may be where they live.
Costs are determined by the plan you choose, your rating area, your age, whether or not you are a tobacco user, and the amount of financial assistance you may be eligible for.
The 39 counties of Washington state are divided into five “Rating Areas” by the Washington Healthplanfinder:
- Rating Area 1 includes King County, and the average cost of a Silver Plan for a 40-year-old non-smoker is $298.99 per month.
- Rating Area 2 includes Clallam, Cowlitz, Grays Harbor, Island, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston, Wahkiakum, and Whatcom counties, and the average cost of a Silver Plan for a 40-year-old non-smoker is $319.36 per month.
- Rating Area 3 includes Clark, Klickitat, and Skamania counties, and the average cost of a Silver Plan for a 40-year-old non-smoker is $317.71 per month.
- Rating Area 4 includes Ferry, Lincoln, Pend Oreille, Spokane, and Stevens counties, and the average cost of a Silver Plan for a 40-year-old non-smoker is $286.25 per month.
- Rating Area 5 includes Adams, Asotin, Benton, Chelan, Columbia, Douglas, Franklin, Garfield, Grant, Kittitas, Okanogan, Walla Walla, Whitman, and Yakima counties, and the average cost of a Silver Plan for a 40-year-old non-smoker is $303.94.
This PDF brochure entitled “Health Insurance Companies and Plan Rates for 2014” includes the full 2014 rates for every plan in each geographical area of Washington.
Individuals and families with incomes under 400 percent of the federal poverty level and who are covered by an exchange plan are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much the subsidy is, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the cost of Bronze, Silver, Gold, or Platinum, and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
Information on Subsidies
General information about financial assistance and subsidies in Washington is available at the Washington Health Benefit Exchange. For more specifics and a calculator to determine your eligibility, visit Washington Healthplanfinder.
Customer support is available via email firstname.lastname@example.org and by phone at 1-855-WAFINDER (1-855-923-4633).
QUESTION(s): I signed up on the Washington health exchange and was told I was enrolled in a health plan and that I qualified for health coverage with no premiums. I am now hearing about bronze, silver and gold options. I am assuming that I was automatically enrolled in the bronze level option. Is it possible for me to get some information about my other options and perhaps choose another option?
It’s not wise to assume you enrolled in the bronze level option. You need to reach out to the Washington Health Benefit Exchange to see what your options are for changing your plan. You can call them at 1-855-WAFINDER, or visit their website (http://www.wahbexchange.org/).
QUESTION(s): I'm checking for my single daughter, age 43, two children 7 and 10--need services at Children's Hospital in Seattle--which carrier in the Exchange includes care at Children's? Annual income $48,000; also, subsidy only available if coverage with a carrier in The Exchange? Thank you.
Your daughter may qualify for the Advanced Premium Tax Credit. This subsidy will lower the monthly premiums she pays to cover herself and her children. When she applies for insurance, she will need her latest tax returns to find out exactly what assistance she’s eligible for. These subsidies are only available if you purchase health insurance through the Exchange.
Each health insurance plan has an agreement with a wide array of doctors, hospitals, and healthcare facilities. Before you purchase health insurance, check the list of in-network providers to see if your doctor or preferred healthcare facility is listed.