Are you confused about your health insurance options in Washington state? You’re not alone. And now that you found this website, you have help on your side. We’ve gathered insurance experts from across the industry together to help sort through the confusion and explain what your options are. Right now in Washington, you have the option to choose between major medical coverage through your state exchange, short-term health insurance, a health share plan, and various supplements that can help reduce your out-of-pocket costs. But choosing the right plan or the right combination of plans can be tricky if you aren’t familiar with the pros and cons of each option.
Major Medical Insurance in Washington
As a part of the Patient Protection and Affordable Care act of 2010, states were given the choice to either create their own state Health Insurance Marketplace exchanges or to rely upon the federal one at HealthCare.gov so that people could register for coverage. Washington has been running its own state exchange for quite a while. The Washington HealthPlanFinder website starts Open Enrollment every year on November 1st just like the federal Exchange; however, this most recent year extended the deadline to apply through December 30th for residents.
For residents of Washington state who missed Open Enrollment, you might have a qualifying life event that would allow you to apply for coverage during a special enrollment period as opposed to Open Enrollment. Events like a loss or a switching of jobs, a new child, or simply moving to a new zip code could qualify you. It never hurts to check with someone at the Washington HealthPlanFinder website if you are currently looking for coverage.
One of the reasons why you might want to check there first is because major medical coverage through the Exchange, even the state Exchange in Washington, is usually much more comprehensive and potentially more affordable than coverage outside of the exchange. This is partly due to the fact that all of these insurance policies are guaranteed issue, meaning that any pre-existing conditions you may have are not allowed to influence your monthly premium. You also cannot be rejected for coverage for any reason. But you may still face an altered monthly premium rate depending on any of the four factors below:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Another reason to look at the state exchange first is because of how comprehensive the policies are. Each one comes with the following 10 guaranteed Essential Health Benefits to give you the best possible care that you can get in the United States right now:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Unfortunately, extra benefits and guaranteed issue coverage don’t exactly come cheap. But they could actually be affordable if you happen to qualify for a subsidy. For most people, the threshold for premium tax credits and other financial aid to make your health insurance more affordable is around 138% of the federal poverty limit. You can take a look at the chart below to see whether or not you fall above or below this threshold.
|Household Size||Annual Income (138% of FPL)|
Because Washington was an early adopter of the Medicaid expansion program, falling below the threshold doesn’t mean that you can’t qualify for some sort of financial aid. You can apply for Medicaid in Washington instead if you make too little to qualify for a subsidy. But there are some extra requirements in addition to being low income that you might have to meet before you are eligible. For more information, visit the Apple Health Medicaid page on the Washington State Health Care Authority website.
Short Term Health Insurance in Washington
Short-term health insurance in Washington is a little tricky right now. Technically, it’s still legal, and insurance companies can still offer it to you if they want to. The problem is that most short-term health insurance providers have been scared away due to recent changes in the law. Unlike the federal rules, the state regulations for short-term health insurance in Washington limit plan duration to only 3 months.
Although it may be difficult to find short-term health insurance in Washington right now, that doesn’t mean you shouldn’t be aware of its benefits and limitations in case a good plan crosses your path. With short-term health insurance, you have better consumer protections which allow you to take your provider to court if you ever have a legitimate legal dispute over a claim. And your plan could end up costing as much as 33% less than an unsubsidized ACA plan through your state Exchange. Plus it works just the way insurance normally does, so you’re likely already familiar with how co-pays, deductibles, coinsurance, and monthly premiums work.
The two biggest pitfalls of short-term health insurance, however, are the lack of guaranteed issue status and the lack of completely comprehensive coverage. Since these policies aren’t guaranteed issue, you would be subjected to medical underwriting which could see rejected for coverage or paying substantially higher monthly premiums. And most short-term health insurance companies, although you may be able to negotiate for some benefits, won’t offer you all of the 10 Guaranteed Essential Health Benefits that the ACA does. There are also lifetime and annual caps on your benefits and these plans typically come with high deductibles, which means a greater share of your medical costs will be paid out-of-pocket by you.
Christian Health Plans/Health Share Plans in Washington
Here’s some news that might excite you as a Washington resident: in case you didn’t know, the federal individual mandate was no more as of 2019, and Washington has not decided to implement its own statewide individual mandate yet. This means that you technically don’t need to purchase health insurance. But healthcare is more expensive than ever these days, and being caught without coverage during a medical emergency can be catastrophic. That’s why you might want to look at a Christian health plan (also known as a health share plan) if you can’t get insured through the state Exchange or find a short-term health insurance policy.
To get a better understanding of how these plans work, it’s helpful to know that they have the most in common with short-term health insurance compared to most of your other options. Their commonalities include:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
- Their monthly payments can be up to 33% less expensive than unsubsidized ACA health insurance premiums
But despite all of their commonalities, these plans aren’t identical. These plans are administered by religious organizations, and therefore the government can’t regulate them – so you can’t expect the same consumer protections you would from a short-term health insurance company. But you can expect to follow participation guidelines that are imposed on every member. Usually, these guidelines involve declaring a specific (and usually Christian) faith, attending church regularly, or attending a specific church. You might also have to quit using tobacco products or make other health and wellness changes to lower your health care costs. Lastly, you can expect the language to be a little different. With major medical, you pay a monthly premium for your health insurance; with a health share plan, it’s referred to as a monthly share amount. Also, with major medical, you pay co-pays, deductibles, and coinsurance in addition to your monthly premiums; but with a health share plan, those charges are referred to as “unshared amounts” or “personal responsibility amounts”, even though they basically serve the same purpose.
Fixed Indemnity Plans in Washington
Fixed indemnity plans in Washington State work just about the same way they do anywhere else. But they work better as a healthcare supplement than they do as a replacement for major medical coverage. This is because major medical coverage will pay out a fixed percentage of your total medical costs, whereas an indemnity plan will only pay a fixed amount. This amount gets paid out per day, per week, per month, per incident, or per visit depending on your plan. Your indemnity plan could be limited to just hospital benefits, or could include doctor benefits or even dental benefits if you find a provider who will sell you that much coverage.
Fixed indemnity plans will likely subject you to medical underwriting, which means you could be refused coverage or charged more for pre-existing conditions. Unlike major medical coverage, indemnity plans don’t restrict you to any specific medical network. You can see basically any doctor or visit any hospital you like and still get care – albeit for a larger out-of-pocket cost to you. You’ll also have to deal with lifetime and annual benefit caps the way you would with other types of health insurance. But if your current health plan has a high deductible or a very restrictive medical network, adding an indemnity plan to your total health care coverage portfolio could benefit you in the long run.
Discount Cards in Washington
Another good way to supplement your out-of-pocket medical costs is with a medical discount card. But you have to be a little careful when you’re shopping around for one. Since there aren’t very many laws or regulations governing how these companies can operate, it’s easy to accidentally fall into a scam. Just be on the lookout for companies who try to advertise their discount cards as health insurance or an adequate health insurance replacement – because they are unfortunately not. Also, if it’s a medical discount card that charges a membership fee, be sure to do a little background check to make sure that the discounts they promised and the providers they say you’ll get discounts from are all genuine. If everything checks out, then it might be a good deal for you. But if not, you might want to stay away.
Here’s how medical discount cards basically work: you find a reputable company offering decent discounts at providers near you and pay their requested membership fee, if they have one. They send you a discount card in the mail, and you present it whenever you buy prescription drugs, get medical care, or make other healthcare-related purchases. With any luck, the money you save on your discounts will be substantially more than what you pay for your membership fee. But we strongly advise against anyone trying to use a medical discount card as a replacement for comprehensive, major medical coverage.