Washington Health Insurance

Health insurance in Washington

● Washington State operates its own health insurance exchange: Washington Healthplanfinder.

● Washington has created standardized health insurance plans for the individual market and a "public option" that will be available in more than half of the state's counties for 2021 coverage.

● The open enrollment period in Washington for 2021 health plans is November 1 to December 15, 2020. Outside of that window, residents who have qualifying events can sign up for health coverage.

● Short-term health insurance plans are limited to three-month terms in Washington and cannot be sold during the open ACA enrollment period with a January release date.

● About 212,000 residents enrolled in medical insurance in 2020 through the Washington health insurance marketplace.

● Washington adopted the ACA's Medicaid expansion in 2014, offering Medicaid coverage to adults with incomes up to 138% of the federal poverty level ($1,468 per month for an individual; $3,013/month for a family of four).

● Washington enacted several important pieces of legislation on health reform in 2019.

This page is dedicated to helping consumers quickly find health insurance resources in Washington state. Here you will find information about the many types of health insurance coverage available to individuals and families. You can find the basics of the Washington health insurance marketplace and the next open enrollment period; a brief overview of Medicaid expansion in Washington; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of Washington health insurance resources for residents.

Washington Health Insurance Marketplace

Washington State operates its own health insurance marketplace/exchange: Washington Healthplanfinder. The state also has a strong off-exchange market where ACA-compliant health insurance plans are available (though subsidies are only available through Washington Healthplanfinder).

The market is used by people who need to buy their own health insurance, including the self-employed, pre-home pensioners and people employed in a small business that does not offer health benefits to employees.

The carrier's participation in the Washington health insurance marketplace is solid, with 13 insurers planning to offer coverage for 2021 through Washington Healthplanfinder (compared to nine insurers in 2020). Washington's new standardized plans will be available for 2021 coverage, and the state's new public option plans will be available in more than half of Washington counties.

Enrollment in plans for 2020 ended at 212,000 people, which was the second consecutive year of declining enrollment. The number of people enrolling in the plans through the exchange peaked in 2018, at about 243,000.

Open enrollment period and dates in Washington

Registration open in Washington for 2021 coverage is scheduled from November 1, 2020 to December 15, 2020. Last year, Washington Healthplanfinder added a last-minute extension until the end of December, and it's possible they could offer another extension this year. But for now, consumers in Washington should assume that open enrollment will end on December 15, 2020.

The open enrollment period is an opportunity for individuals and families to sign up for new coverage (via Washington Healthplanfinder or directly through an insurance company) or change policies for next year. It is also an opportunity to renew existing coverage and update household financial information through exchange, to ensure that eligibility for financial assistance for next year is based on accurate information.

First public option in the country

In 2019, Washington enacted legislation (S.B.5526; the House version was H.B.1523) calling for the creation of a "public option" health insurance plan in Washington, starting in 2021. The term "public option" has often been used to describe Medicaid buy-in programs and new coverage options that are administered by the government (state or federal), but Washington's approach is different and details are clarified in the final version of the legislation, which was signed into law by Governor Jay Inslee in May 2019.

Under the terms of S.B.5526, Washington is awarded a contract with private health insurance companies to offer bronze, silver, and gold-grade qualified health plans on the Washington stock exchange starting in 2021 (with plans available for purchase starting November 1, 2020). The plans, nicknamed "Cascade

Care will offer standardized benefits and, at least initially, will also limit supplier reimbursements to 160% of Medicare reimbursement amounts, in an effort to keep premiums affordable (with the exception of rural hospitals, which will be guaranteed reimbursements of at least 101% of medicare-approved costs, primary care providers, whose reimbursements will be at least 135% of Medicare rates and instances where the plan is unable to develop an adequate network based on the constraints of reimbursement prescribed.) Several earlier versions of the legislation called for Medicare reimbursement rates, but lawmakers eventually settled on 160 percent of Medicare rates in an effort to ensure adequate supplier participation and placate powerful health lobbies.

Washington's public option is the first in the nation. Nevada lawmakers approved a public Medicaid buy-in option in 2019, but the governor vetoed it. Colorado enacted legislation in 2019 that directed the state to explore a public option that would leverage current infrastructure, but progress on the program was postponed amid the COVID pandemic in spring 2020.  This side-by-side analysis shows a high-level comparison of what Washington and Colorado are doing with their programs (though Colorado is paused for now). Some have argued that the design of Washington's public option will be different from what people tend to think of as a "public option."

Cascading plans should not be offered across the state, and by 2021 they will only be available in 20 of the state's 39 counties.

S.B.5526 also directs the state to "develop a plan to implement and fund" premium subsidies for people with adjusted gross income up to 500% of the poverty level. The state is working on plans for this, and will report to the legislator in more detail by the end of 2020 (grants should be available for the 2022 plan year). According to the ACA, the federal government provides premium subsidies to people with MAGI up to 400% of the poverty level, but people with incomes between 400 and 500% of the poverty level are often affected by the prescient of subsidies, which can be particularly onerous for older enrollees and people in areas where premiums are particularly high.

Another provision of S.B.5526 directed the state to create up to three designs of standardized planes at the bronze, silver, and gold metal level (many other states already had standardized plans). Insurers offering plans in the Washington health insurance marketplace must offer at least one standardized silver-and-gold plan starting in 2021 (and at the bronze level, assuming the insurer offers bronze-level plans; there are bronze plans across the state in 2020, but there have been previous years when bronze plan options were not available in some parts of the state).

The legislation allows insurers to continue offering non-standardized plans as well, but directs the state to analyze what the impact would be if all plans were needed to be standardized starting in 2025. A report on this will be delivered to the legislator by 2023 so that they can act to require all plans to be standardized by 2025 or not, depending on what determines the analysis. California is currently the only state that requires all plans to be standardized.

Medicaid expansion in Washington State

When the ACA was implemented in 2014, Washington accepted federal funding to expand Medicaid coverage to those earning up to 138% of poverty. In early 2014, the Kaiser Family Foundation estimated that about 47% of the uninsured population in Washington would be eligible for Medicaid or EXPANDED CHIP.

As a result of the Medicaid expansion, total enrollment in the Washington Medicaid and CHIP plans grew by nearly 642,000 people between fall 2013 and May 2020. That was a 57% increase in enrollment, the tenth highest percentage increase in the nation.

Short-term health insurance in Washington State

D.C. insurance regulators have implemented new rules for short-term health insurance plans, which are 2000 in effect in January 2019, limiting the plans to no more than three months in duration and banning renewals.

The new state regulations also include a list of other provisions designed to help consumers avoid confusion during open enrollment and protect shoppers with pre-existing conditions.

How did Obamacare help D.C. residents?

Since the Affordable Care Act was 2013, Washington has seen one of the nation's largest reductions in the percentage of uninsured residents.

According to U.S. Census data, 14% of Washington residents were uninsured in 2013, and this had fallen to 6% in 2016. From a perspective, the uninsured national rate was 14.5% in 2013 and had fallen to 8.6% in 2016. In 2018, the uninsured rate in Washington had risen slightly, to 6.4 percent (nationally, the uninsured rate also rose slightly by 2018 - under the Trump administration - to 8.9 percent).

As a result of Washington's decision to expand Medicaid (Apple Health), enrollment in Washington Medicaid and CHIP grew by 57% between the 2013 decline and mid-2020.

As of December 2020, there were more than 202,000 Washington residents enrolled in private plans through Washington Healthplanfinder, all with coverage for the ACA's essential health benefits. 61% of enrollees also receive premium subsidies that offset the monthly cost of health insurance premiums, making coverage more affordable and affordable than it would otherwise be.

Washington elected officials and the ACA

In 2010, both U.S. senators from Washington - Maria Cantwell and Patty Murray - supported the health care reform law. Both are still in the Senate and have continued to defend Obamacare by calling for improvements to the law.

The U.S. House delegation in Washington includes ten representatives, by a margin of seven to three for Democrats in 2020. The seven Democrats support the ACA or further health care reforms (such as moving toward a single-payer system), while the three Republicans support full repeal or significant changes to the law.

Governor Jay Inslee, a Democrat, is very supportive of the ACA and has worked enthusiastically with his state officials to implement Obamacare in Washington. The state is running the Washington Health Benefit Exchange and has also chosen to expand Medicaid.

Does Washington have a high-risk pool?

Before the ACA brought guaranteed issuance health insurance to the individual market, the plans were signed in almost every state. Pre-existing conditions could prevent an applicant from obtaining a policy or result in significantly higher premiums or policy exclusions. The Washington State Health Insurance Pool (WSHIP) was created in 1987 to provide people with an alternative if they were unable to obtain private health insurance because of their medical history.

Now that the ACA has been implemented, all health insurance plans are guaranteed issuance, largely eliminating the need for risk pools. But WSHIP is one of the few state-run pools that is still operational and will be for the next few years -- and indefinitely for some Medicare enrollees.

The pool was closed to most new non-Medicare enrollees at the end of 2013, but existing members can remain on the floor until the end of 2017. Under some conditions, WSHIP continues to enroll Medicare members and some eligible non-Medicaid candidates.

Medicare coverage and enrollment in Washington

As of August 2020, there were 1,398,832 Washington residents with Medicare coverage, or about 18% of the state's population. Most Washington Medicare beneficiaries are eligible for Medicare because of age, but 14% are under 65 and are eligible for Medicare because of a disability.

Resources for Washington State Health Insurance

● Health Care for All - Washington

● Washington Healthplanfinder - The state-run health insurance exchange, in which individuals and families can enroll in health plans and receive benefits based on household income. Washington Healthplanfinder is also the registration portal for enrollment in Apple Health (Medicaid) and INCOME-based CHIP.

● Washington Statewide Health Insurance Benefits Advisors (SHIBA) - A local service that can answer questions and provide information, advice, and assistance related to Medicare in Washington.

Washington Health Care Reform legislation

The Washington Legislature was very active in the health care industry in 2019, addressing numerous issues that have an impact on public health. Several legislative acts of health care reform have been implemented, including:

H.B.1065, which provides strong consumer protections against surprise billing for emergency services received at off-network facilities and also for services performed by an off-network healthcare provider in a networked facility. Washington Insurance Commissioner Mike Kreidler has long supported legislation to protect consumers from surprise balance billing and has been a driving force behind the 2019 successful effort (see his summary of the 2019 legislation here). Similar legislation did not pass in 2017 (H.B.2114) and 2018 (HB 2114), but lawmakers successfully reviewed the issue and it was signed into law in May 2019 and takes effect in January 2020:

The new law applies to plans regulated by the D.C. Insurance Commissioner. This does not include self-insured group plans — which account for most of the very large group plans — which are regulated by the federal government under ERISA. Self-insured group plans can choose to adhere to the status balance billing protection rules.

It requires insurers to maintain adequate networks.

Out-of-network healthcare professionals cannot balance patients in emergency situations or situations where off-network services have been received in a facility that was networked with patient insurance.

In these situations, insurers must pay off-network providers "a commercially reasonable amount, based on payments for equal or similar services provided in a similar geographical area."

If the supplier and insurer do not agree on the amount of the payment, it is sent to binding arbitration. The patient is no longer caught in the middle.

H.B.1870, codifying ACA consumer protections in state law.

S.B.5526, which creates standardized Washington health insurance plans, a public option, and additional premium subsidies.

S.B.5741, which improves the claims database for all payers in the state.

In 2020, Lawmakers in Washington approved S.B.6128, which would extend Medicaid coverage for new mothers for a year after a baby was born, but Governor Inslee vetoed it in April 2020, due to budget constraints caused by the COVID pandemic.