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Washington Health Insurance

Washington Medical Insurance Overview

There are quite a few options for health insurance benefits for people living in the state of Washington.  These programs are through group, individual and state-sponsored means.  Eligibility for each of these plan types are dependent on your income, age, health status, employment status and location of residency.  There are moderate amounts of people living in the state of Washington who do not have health insurance coverage, but the Affordable Care Act was enacted to increase the amount of insured residents statewide.  This legislation makes it easier for Washington state residents to check out their insurance options and obtain coverage.

The summary provided offers an in-depth view of the current state of health care and insurance in the state of Washington.

Washington’s Health Care Issues
Washington is ranked by the United Health Foundation in 9th place when compared to other states in the nation.  The study shows the state’s strong points as well as challenges:

Small disparity in health status by education level
Low incidence of infectious disease
Low rate of cardiovascular deaths

Low rate of high school graduation
Low immunization coverage among children
High prevalence of excessive drinking

Understanding Washington’s Uninsured Population
In the state of Washington, 9 percent of the population is without insurance coverage as of the year 2014.  In a report provided by the Kaiser Family Foundation, we are given the following statistics regarding the non-elderly uninsured portion of Washington’s residents:

  • 20% earn at or under 100% of the Federal Poverty Level
  • 15% earn between 100-199% of the FPL
  • 11% earn between 200-399% of the FPL
  • 4% earn over 400% of the FPL, but still have no insurance coverage whatsoever

In Washington, 34 percent of residents have coverage under public assistance programs like Medicaid and Medicare.  Residents receiving benefits under individual plans make up 7 percent of the state’s population and those receiving group health insurance benefits comprise 48 percent of the population.

Group Health Plans
In the state of Washington, your employer does not have to offer insurance benefits to you.  When there are benefits available, however, the plan options must be made available to all eligible employees.  When the employer covers a certain portion of the premiums under the group plan, the remainder is left under the responsibility of the employee.  In a lot of situations, the workplace is free to make the determination on premium costs.

Under a group plan, you nor your dependents can be denied coverage because you have a pre-existing medical condition.  However, you can be subject to waiting out an exclusion period for six months, but this does not apply to dependents under the age of 19.  Small business insurers cannot look at pregnancy as a pre-existing condition.

It can prove to be hard for smaller companies in Washington to offer group health plans to their workers due to the associated costs of coverage.  Due to new legislation, it is hoped that small businesses will receive a tax credit for offering insurance coverage to their employees.

Continuation Coverage
Through the Consolidated Omnibus Budget Reconciliation Act (COBRA), former employees and their covered dependents under group plans can receive continuation insurance coverage.  This becomes active when your benefits end because of a job loss or divorce from a covered spouse.  You can be eligible to receive COBRA benefits if the original company where the policy was issued has over 50 workers.

COBRA can be an expensive option for insurance coverage because there is no employer to offer payments on the premiums.  As such, it is still a much cheaper option that going through a private insurance company for individual coverage.

For smaller companies, Washington has yet to enact a state law that is similar to the benefits realized under COBRA.  If you work for a smaller company that has under 20 employees and lose your insurance coverage, you can shop for a temporary insurance plan.

Individual Health Plans
In order to get coverage under an individual policy in the state of Washington, you must begin by filling out a standard health questionnaire.  Your premiums will depend on a number of factors, including: smoking status, age of applicant and family members, location, size of your family, services covered and the deductible amount.

You can be turned down for insurance coverage under this plan type if you have a pre-existing condition or fail the questionnaire.  In that event, you may qualify for benefits under the WSHIP program.

Dependents under the age of 19 are not required to fill out the questionnaire and cannot be denied coverage because of a pre-existing condition.  However, the insurance company can create open enrollment periods specifically for the purposes of enrolling children.

In the state of Washington, the regulations involving individual health plans are taken care of by the Insurance Commissioner.

Washington Health Benefit Exchange
In Washington, residents can use the Washington health benefits exchange in order to obtain information on plan options, compare selections and select coverage.

Using this exchange, residents are able to meet with a Navigator in order to learn their benefits options or make changes to their health insurance plans.

Washington State Insurance Programs
The state of Washington has a variety of programs that are available to low income earners and eligibility is based on income, sex, health status and location.

Apple Health for Kids
Under this umbrella are all of the health insurance options for kids in Washington.  Coverage is based on the size of your family and the income guidelines provided.  When applying, you will be informed if there is a premium associated with your level of coverage and is based on your income.  Covered under this program are immunizations, dental checkups, physical exams and more.

Washington Basic Health
This program is offered as a low-cost means of obtaining coverage through private health insurance plans.  In order to be eligible, you must be a resident of Washington and a United States citizen, be between 19 and 64 years of age, earn a gross family income of 200% of the Federal Poverty Level, must not be eligible for Medicaid or Medicare, must not be enrolled in the state’s Health Program and not living in an institution.

Family Medical
Coverage under this program is offered to children who are 19 and under along with the adults who care for them.  In order to be eligible, you must meet certain income requirements as determined by the Temporary Assistance for Needy Families.  Under this program, there is no maximum amount of time that families can receive coverage.

Healthcare for Workers with Disabilities Program (HWD)
This program allows working residents with disabilities the ability to purchase medical insurance by paying premiums in accordance with their earnings.  To be eligible, you must be between the ages of 16 and 64, must meet disability requirements as set by the SSA, must be employed either full or part-time, and must have a net income of under 220% of the Federal Poverty Level.

Included in these benefits are Medicaid benefits along with personal care services.  A sliding scale is used to determine the premiums charged and is based on income levels.

Medicare Savings Programs
Under this program, Medicare recipients can receive help to pay their premiums as long as they meet guidelines regarding their income level and assets.  Available programs include QMB, SLMB, and QI-1.

Alien Emergency Medical Program
If you don’t meet the requirements for citizenship as set forth by the DSHS, then you can utilize this program to receive emergency medical services.  This covers emergencies that would put your life at risk if you were not otherwise able to receive treatment.

Pregnancy Medical Program
Pregnant women in Washington can use this program to receive health insurance benefits.  Along with living in the state of Washington and being pregnant, those who apply must meet specific income requirements to enjoy coverage under this program.

Aged, Blind, and Disabled Medical Program

This program is aims to help the elderly, blind, and disabled residents of the state of Washington. In order to be eligible, applicants will need to be either over the age of 65, disabled, or blind while meeting income guidelines.

Washington State Health Insurance Pool (WSHIP)
This plan was created to offer insurance coverage to residents who have previously been turned down for insurance benefits because of medical reasons.  In order to be eligible, you must prove your residency along with your rejection for coverage based on your health questionnaire.  Pre-existing exclusionary periods apply and can last six months.

Under WSHIP, you have six options for coverage:

  • Preferred Provider: There are 4 deductible options under this plan.  You have to pay an amount of 20% as coinsurance for services that are eligible.  Co-payments are required for prescription medications.
  • Limited Preferred Provider “A”: This plan option has a $1,500 deductible and will cover up to $3,000 worth of prescription medications annually.
  • Limited Preferred Provider “B”: This is similar to Plan “A,” but only offers $2,000 toward the costs of prescription drugs every year and doesn’t have maternity coverage available.
  • HAS Qualified Preferred Provider: This plan option has a high deductible amount and can be used alongside a Health Savings Account.
  • Standard Plan: There are 3 deductible options under this plan and there are co-payments required for prescription drugs.  You are required to pay a 20% coinsurance for services provided.
  • Medicare Basic Plan: This is a plan that supplements Medicare costs for Parts A and B, but it does not offer prescription drug coverage or supplements for Medicare Part D.

This program is not funded on a state level and health insurance carriers are responsible for paying the remainders of the costs associated with coverage under these plans.  In order to apply, you must reach out to the insurance provider and ask for an application along with information on enrollment.  To get coverage, you should apply within 90 days of receiving a letter denying coverage based on a medical condition.

Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) offers protections to citizens of the United States regarding their personal medical information.  Under HIPAA, there are limits to the length of time that people will have to wait for exclusion periods in the presence of a pre-existing condition.  It also provides the ability for people to get health care coverage if they lose their insurance benefits or need to make changes to their policy due to a qualifying life event.  It also provides creditable coverage from waiting periods for prior insurance policies.  It guarantees that small employers can provide health insurance to workers and prevents insurance companies from discriminating against you because of a medical condition.