When the Affordable Care Act (ACA) was passed in 2010, states began to build health insurance marketplaces called exchanges. The Washington Health Benefit Exchange was created in 2011. It’s responsible for creating the Washington Healthplanfinder. This is a website designed to help residents and businesses find, compare, and enroll in qualified plans.
You can also apply for financial assistance, such as tax credits and reduced costs. Learn more about the Washington Health Benefit Exchange and how you can enroll.
The key Washington health insurance providers are:
- Columbia United Providers
- Community Health Plan of Washington
- Coordinated Care
- Group Health Cooperative
- Kaiser Foundation Health Plan of the NW
- LifeWise Health Plan of Washington
- Moda Health Plan
- Molina Health Care of Washington
- Premera Blue Cross
Moda and Kaiser provide coverage for small businesses.
Dental coverage is available through:
- Delta Dental
- Dental Health Services
- Kaiser Permanente
- Premera Blue Cross
Each provider offers three basic plans. These include:
- bronze (60 percent of costs paid by plan)
- silver (70 percent of costs paid by plan)
- gold (80 percent of costs paid by plan)
Lower plans have lower premiums, which are the base amounts you pay for coverage. These also have the highest out-of-pocket costs, which include deductibles, copays, and coinsurance. A deductible is the amount you must pay before insurance covers costs. A catastrophic plan with a high deductible is available. You must be under the age of 30 and have a low income to qualify.
All plans must cover:
- visits to the doctor’s office
- chronic disease management
- emergency medical care
- inpatient hospital services
- maternity care
- newborn and pediatric care
- mental health services
- prescription drugs
- rehabilitative and habilitative services
- diagnostic laboratory services
- preventive and wellness services
- substance abuse treatment
Each 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. Check to see if your doctor or preferred facility is on the list.
Costs are determined by:
- the plan you choose
- your rating area
- tobacco use
- the amount of financial assistance you may be eligible for
Assistance is partially determined by the federal poverty level (FPL), which was $24,250 for a family of four in 2015. Medicaid is available for qualifying adults and pregnant women.
In 2015, the government placed maximum annual out-of-pocket costs at $6,350 for individuals. It is $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.
If your income is less than 400 percent of the federal poverty level and you don’t qualify for Medicaid, you may qualify for a premium tax credit. This is a subsidy that would help pay for part of your insurance. On average, individuals who earn about $45,960 a year or less qualify. For a family of four, the eligible income level increases to about $94,200 or less.
The percentage of your costs that this subsidy would cover depends on income level and the cost of a second-tier silver plan where you live. For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for a second-tier silver plan is nine percent of your income. This averages to about $2,926 a year, or $244 a month. You can choose a plan other than the second-tier silver plan and use your tax credit, but the subsidy amount will stay the same. This means a gold plan would cost you more, even if you use a subsidy to cover some of the cost.
Some people may also be eligible for a cost-sharing subsidy. This subsidy is for silver plans only and reduces the total out-of-pocket cost of a plan. People who have household incomes between 100 and 250 percent of the poverty level can qualify for this subsidy.
The Kaiser Family Foundation has a free calculator that can also help you determine subsidies.
The Washington Healthplanfinder divides the 39 counties of Washington into five “Rating Areas”.
Area 1 includes King County. The average cost of a silver plan for a 40-year-old non-smoker in Area 1 is $298.99 per month.
Area 2 includes the following counties:
- Grays Harbor
- San Juan
The average cost of a silver plan for a 40-year-old non-smoker in Area 2 is $319.36 per month.
Area 3 includes Clark, Klickitat, and Skamania counties. The average cost of a silver plan for a 40-year-old non-smoker in Area 3 is $317.71 per month.
Area 4 includes the counties of:
- Pend Oreille
Here, the average cost of a silver plan for a 40-year-old non-smoker in Area 4 is $286.25 per month.
Area 5 includes:
- Walla Walla
The average cost of a silver plan for a 40-year-old non-smoker in Area 5 is $303.94.
This PDF brochure includes the full rates for every plan in each area of the state.
General information about financial assistance and subsidies is available at the Washington Health Benefit Exchange.
You can email customer support at firstname.lastname@example.org. You can also call 1-855-WAFINDER (1-855-923-4633).
Open enrollment runs from November 1 to January 31. Make plans early on so that you will have coverage by January 1.