Washington health insurance marketplace guide 2023

Washington runs its own exchange, Washington Healthplanfinder. 

Washington was one of the first states to move ahead with a state-run health insurance marketplace as envisioned by the Affordable Care Act. Former Gov. Chris Gregoire signed legislation creating the state exchange in May 2011.

For the first two years it was in operation, Washington Healthplanfinder collected premiums from enrollees and sent them to insurers (enrollees had the option to send payments directly to the insurers, but about 80% opted to pay premiums to the exchange). But the exchange struggled with billing problems and ultimately decided to switch to the approach used in other states, in which enrollees pay their premiums directly to insurers, rather than the exchange. This change took effect in September 2015.

Washington Healthplanfinder charges a per member per month fee to fund the exchange. For 2016 through 2018, the fee was $7.46 per member per month. So a family of four was paying almost $30/month in fees to fund the exchange, as part of their health insurance premiums. But because enrollment grew so much in 2018, and because the exchange has been working to improve its financial efficiency, the fee was reduced by 55% for 2019, to just $3.36 per member per month. Although enrollment declined in 2019, the exchange kept the $3.36 per member per month fee in effect for 2020 as well (and reduced the fee on dental plans from $1.54 to $0.81 per member per month).

In March 2014, Washington legislators tried to pass a bill that would have created much more transparency in the state’s health insurance industry, providing consumers with data on how much insurers are paying for services in each region of the state. It had widespread support, but opposition from Premera Blue Cross — the state’s largest insurer — sank the bill and Washington did not join the 11 other states that had all-payer claims databases by 2014. But lawmakers persisted, and in 2015, SB5084 was signed into law, advancing the process of creating an all-payer claims database in Washington state. Subsequently, S.B.5741 was enacted in 2019, to improve the state’s all-payer claims database.

For 2023 coverage, there are twelve insurers that offer exchange plans in Washington, with coverage areas that vary from one insurer to another:

• BridgeSpan Health Company
• Community Health Plan of Washington (previously Community Health Network of Washington)
• Coordinated Care Corporation
• Kaiser Foundation Health Plan of the Northwest
• Kaiser Foundation Health Plan of Washington
• LifeWise Health Plan of Washington
• Molina Healthcare of Washington
• PacificSource Health Plans
• Premera Blue Cross
• Regence BlueCross BlueShield of Oregon
• Regence BlueShield
• UnitedHealthcare of Oregon

For 2023, Community Health Network of Washington clarified that their plan would be moving to their affiliate, Community Health Plan of Washington. Enrollees will be automatically enrolled into the corresponding new Community Health Plan of Washington plan during the open enrollment period for 2023 coverage (but will have the option to pick a different plan, as is always the case during open enrollment). Community Health Plan of Washington will also be available in two new counties — Ferry and Whitman.

PacificSource is expanding its coverage area significantly for 2023, adding 11 new counties. 

Insurer participation in Washington’s exchange has changed significantly over time (a detailed list of the counties where each carrier offered plans is available here). 

In 2019, there were 14 counties in Washington with only one insurer offering plans in the exchange, up from nine in 2018. And when rates were initially filed for 2018, there were two counties where no insurers had proposed plans. That was eventually remedied before the start of open enrollment, but lawmakers also wanted to address the issue in the 2018 legislative session.

H.B. 2408 (signed into law in March 2018) mandates that as of 2020, any insurer that offers coverage to school employees must also offer at least one silver and one gold plan in the individual market via Washington Healthplanfinder in any areas where the insurer offers coverage for school employees. In the meantime, if necessary, the legislation would have made coverage in the Washington state health insurance pool more affordable for people who live in counties where no insurers offer exchange plans. But all areas of the state have continued to have plans available in the exchange from at least one insurer.

Here’s a summary of insurer participation in Washington’s exchange has changed over time:

• 2014: Plans were available from eight insurers in 2014: BridgeSpan, Community Health Plan of Washington, Coordinated Care (Ambetter/Centene), Group Health Cooperative, Kaiser Foundation Health Plan of the Northwest, LifeWise, Molina, and Premera.
• 2015: Plans were available from 10 insurers in 2015, with Moda and Columbia United Providers joining the exchange, along with the eight insurers that had offered plans in 2014. But both insurers’ forays into the exchange were short-lived.
• 2016: On October 28, 2015, Moda Health announced they were exiting the Washington market in order to focus on Alaska and Oregon (Moda subsequently left Alaska’s market as well, but remains in Oregon). Effective immediately, they ceased sales and renewal of health plans in Washington, and 47,000 existing policy-holders had to select coverage from a different carrier for 2016.
  In November 2015, Columbia United Providers also announced that they would exit the individual market in Washington. Their plans were only available in Clark County, and they only had about 100 enrollees. But Regence BlueCross BlueShield, United Healthcare of Washington, and Health Alliance Northwest all joined the exchange for 2016, resulting in 11 insurers offering plans.
• 2017: For 2017, United Healthcare exited the exchanges in nearly every state where they participated in 2016, including Washington (United had 2,978 enrollees in the Washington exchange in 2016, or about two percent of the total exchange enrollments). And Health Alliance Northwest also exited the exchange, although the impact of that was minimal, as they only had nine on-exchange enrollees in 2016. There were no new entrants in 2017, so nine insurers offered plans in the exchange that year.
• 2018: For 2018, BridgeSpan and Regence BlueShield had both initially said they would discontinue their exchange participation and would only offer off-exchange plans after 2017. And Community Health Plan of Washington planned to exit the individual market altogether at the end of 2017. At that point, no individual market insurers had filed plans for 2018 in Klickitat County or Grays Harbor County.
  So Washington Insurance Commissioner Mike Kreidler began working with insurers to fill in the bare counties. Kreidler’s first success was in Grays Harbor County; he announced on June 19 that Premera had stepped up and agreed to offer coverage there. And on June 26, Kreidler announced that two insurance companies had agreed to offer exchange plans in Klickitat County, including BridgeSpan. This was particularly notable given that BridgeSpan had initially intended to exit the Washington exchange altogether at the end of 2017. But thanks to Kreidler’s negotiations, BridgeSpan and Molina both agreed to offer plans in the exchange in Klickitat County in 2018.
  Every area of the state had on-exchange options available in 2018, although nine counties (out of 39 in the state) had just one insurer offering plans: Chelan, Douglas, Ferry, Grays Harbor, Island, Pend Oreille, San Juan, Skagit, and Skamania. And there were seven counties in Washington where there were no bronze plans available in the exchange for 2018: Chelan, Douglas, Ferry, Lincoln, Pend Oreille, Skamania, and Stevens.
• 2019: Seven insurers offered plans in the Washington exchange; 14 counties had just one participating insurer.
• 2020: Providence and PacificSource joined the exchange for 2020, bringing the total number of participating insurers to nine. There were six counties with just one participating insurer.
• 2021: Thirteen insurers offer coverage in the exchange. Four insurers joined the exchange for 2021: UnitedHealthcare of Oregon, Community Health Network of Washington, Regence BlueShield, and Regence BlueCross BlueShield of Washington (the latter two were already part of Washington’s individual market, but only offered plans outside the exchange in 2020, after exiting a few years ago). Regence had previously participated in the Washington exchange, but had exited at the end of 2017. UnitedHealthcare of Oregon is new to the state’s individual market, but UnitedHealthcare of Washington had participated in the exchange in previous years, leaving at the end of 2016. Community Health Network of Washington is new to the state’s individual market, but Community Health Plan of Washington — an affiliated entity — exited the market at the end of 2017. All counties in Washington have at least two participating exchange insurers for 2021. This is a significant reversal from just a few years earlier, when insurers were exiting the market and reducing their coverage areas, leaving Kreidler scrambling to ensure that the state wouldn’t be left with areas that didn’t have any participating insurers at all. There are also bronze plans available statewide now, whereas that was not the case prior to 2020. Some counties had no available bronze options for a couple of years, making their lowest-cost options more expensive than the lowest-cost options for people in most of the state.
• 2022: Providence exited the exchange at the end of 2021, leaving twelve insurers offering plans in the exchange in Washington for 2022. Four of them expanded their coverage areas, while one (Premera) reduced its coverage area from seven counties to five.
• 2023: Community Health Network of Washington transitioned to its affiliate, Community Health Plan of Washington. Most insurers continue to have roughly the same coverage areas in 2023, but PacificSource grew from four counties to 15.

The open enrollment period in Washington runs from November 1 to January 15. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.

Native Americans can enroll at any time. And so can anyone who is eligible for Apple Health (Medicaid) in Washington. There is also a year-round special enrollment opportunity for applicants who are eligible for Cascade Care Savings and who enroll in a Cascade Care plan at the silver or gold level. 

In May 2022, the Washington Office of the Insurance Commissioner published a summary of the proposed individual/family market rate changes for 2023, along with a chart showing the counties where each insurer will offer plans in 2023. The average approved rate change ended up being slightly larger than the insurers had initially proposed, at 8.1%.

The dozen insurers that offer plans in Washington’s exchange have implemented the following average rate changes, which amount to an overall average increase of 8.1% (up the 7.2% average rate increase the insurers had proposed):

• BridgeSpan Health Company: 15.7% increase
• Community Health Plan of Washington (formerly Community Health Network of Washington): No official rate change, as these are technically new plans (details of the transition from CHNW to CHPW are in Washington SERFF tracking number CHNW-133261691)
• Coordinated Care Corporation: 3.5% decrease
• Kaiser Foundation Health Plan of the Northwest: 5.2% increase
• Kaiser Foundation Health Plan of Washington: 7% increase
• LifeWise Health Plan of Washington: 16.1% increase
• Molina Healthcare of Washington: 10% increase
• PacificSource Health Plans: 15.5% increase
• Premera Blue Cross: 10.1% increase
• Regence BlueCross BlueShield of Oregon: 0.4% increase
• Regence BlueShield: 12.8% increase
• UnitedHealthcare of Oregon: 15.3% increase

In addition, two insurers offer coverage only outside the exchange: Asuris Northwest, and Providence Health Plan (a third insurer, Health Alliance Northwest, offered plans outside the exchange as of 2022, but does not appear to be continuing those plans for 2023). 

For 2020 and 2021, average rates declined in Washington’s individual market, but they increased modestly for 2022, and increased again for 2023.

When the exchange began offering health plans for 2014, premiums were essentially an educated guess, as there was no ACA-compliant individual market claims experience on which to base rates. Here’s a summary of how full-price (ie, pre-subsidy) premiums have changed over the years in Washington’s exchange:

• 2015: Increase of 1.9%: Washington Healthplanfinder’s rates increase by an average of just 1.9% for 2015.
• 2016: Increase of 3.8%: The average rate increase for 2016 was 3.84%. A Kaiser Family Foundation analysis determined that the benchmark plan for a 40-year-old in Seattle was $254 in 2015, and dropped to just $227 in 2016 (the benchmark plan isn’t necessarily from the same carrier that offered it the year before — it’s just the second-lowest-cost silver plan in a given year). That’s more than a 10% decrease, which means that premium subsidies (which are based on the cost of the benchmark plan) were smaller in 2016.
• 2017: Increase of 13.6%: The average premium increase in the individual market in Washington was 13.6% for 2017 (nationwide, the average premium increase, before any subsidies were taken into consideration, was about 25%). Premera had the largest segment of Washington Healthplanfinder market share in 2016, at 22%. And their approved rate increase for 2017 was the highest of any of the state’s plans, at 18.9%.
• 2018: Increase of 36.4%: In September 2017, Washington Healthplanfinder announced that the exchange had finished certifying plans for 2018, with an average rate increase of 24% for plans sold in the exchange (final rate changes available here). At that point, the approved rates were still based on the assumption that CSR funding would continue, but the exchange noted that the premium increases were due to “cost trend and federal uncertainty, particularly enforcement of individual mandate” (the individual mandate penalty was eventually eliminated altogether, at the end of 2018). Regulators also approved a backup set of rates for silver plans sold in the exchange, which were high enough to make up for the loss of federal CSR funding. Ultimately, the Trump administration did cut off funding for CSR, and Washington regulators had to switch to the higher prices for silver plans, driving the overall average rate increase up to 36.4%.
• 2019: Increase of 13.8%: The average approved rate increase was 13.8% for 2019, which was a little lower than the insurers had proposed.
• 2020: Decrease of 3.3%: Overall average premiums in Washington’s exchange decreased by 3.3% for 2020. And two new insurers — Providence Health Plan and PacificSource Health Plans — began offering plans in the exchange for 2020.
• 2021: Decrease of 3.2%: There were 13 insurers offering plans through Washington Healthplanfinder for 2021, and average premiums decreased by 3.2%. Thirteen of the state’s 15 insurers offered plans in the exchange for 2021, and five of them offered the new “Cascade Care” public option plans. The participating exchange insurers for 2021 included two that were new to the state’s individual market (UnitedHealthcare of Oregon and Community Health Network of Washington, both of which only offered public option plans), as well as two that already offered coverage outside the exchange, but joined the exchange for 2021 (Regence BlueShield and Regence BlueCross BlueShield of Washington). So Washington’s exchange went from nine insurers in 2020 to 13 insurers in 2021. And three existing exchange insurers (BridgeSpan, Coordinated Care, and PacificSource) all expanded their coverage area in 2021. The 15 insurers that offered individual market plans in Washington in 2021 (including Asuris Northwest Health and Health Alliance Northwest Health Plan, both of which only offer plans outside the exchange) proposed an overall average rate decrease of 1.8%. Once the rate review process was complete, the overall average rate decrease was even more significant, with rates dropping by an average of 3.2% for 2021.
• 2022: Increase of 4.2%: The Washington Office of the Insurance Commissioner published average approved individual/family market rate changes for 2022, which amounted to an overall average rate increase of 4.2%

239,566 people enrolled in private plans through Washington Healthplanfinder during the open enrollment period for 2022 coverage. This was nearly a record high, but didn’t quite reach 2018’s enrollment, when more than 242,000 people signed up during open enrollment (nationwide, enrollment hit a record high in 2022).

For perspective, here’s a look back at enrollment in Washington Healthplanfinder since the exchange opened for business in 2014:

2014: As of April 2019, 163,207 people had enrolled in private health plans through Washington Healthplanfinder and paid their premiums to effectuate their coverage. In addition to the private plan enrollments, 909,752 people had enrolled in Medicaid through the Washington exchange by mid-April (nearly half of those people were already enrolled previously, but renewed their Medicaid coverage through the exchange).

2015: Total enrollment in qualified health plans through Washington Healthplanfinder amounted to 160,732 people by the end of open enrollment. On April 22, Washington Healthplanfinder announced that total private plan enrollment for 2015 had reached 170,101 people. This was the third-highest total (behind California and New York) of any of the state-run exchanges. All of these enrollees had paid for their coverage; Washington only reported enrollments in 2014 and 2015 if they were paid-up.

2016: HHS announced that Washington Healthplanfinder’s total enrollment for 2016 was 200,691 as of February 1 (this was the first year that Washington switched to reporting all enrollments — instead of only effectuated enrollments — bringing them into line with how most other states’ enrollments are reported). In June 2016, Washington Healthplanfinder reported that 169,182 people had effectuated their coverage for 2016.

2017: By the time 2017 open enrollment ended, more than 225,000 people had enrolled in private plans (QHPs) through the exchange. This was a 13% increase from the year before, which was notable given that total enrollment among states using HealthCare.gov was slightly lower in 2017 than it was in 2016 (the Trump Administration reduced advertising for HealthCare.gov in the final week of enrollment, while state-run exchanges like Washington Healthplanfinder were able to continue their advertising efforts as planned).

2018: Enrollment in Washington’s exchange reached a record high in 2018, with 242,850 people enrolled in private plans (CMS reported a slightly higher official enrollment total of 243,227). Although HealthCare.gov switched to a much shorter enrollment window (just over six weeks long) for 2018 coverage, Washington Healthplanfinder was one of ten state-run exchanges that opted for a longer enrollment window that year, allowing people to enroll until January 15, 2018.

2019: Enrollment dropped in 2019, with 220,765 people purchasing plans during open enrollment. Nationwide, there was an average decline in enrollment, although it was only about 2.4 percent. And among state-run exchanges, average enrollment increased slightly in 2019. Washington Healthplanfinder was one of just four state-run exchanges (out of 12 total) where enrollment declined in 2019.

2020: Enrollment dropped again, to 212,590.

2021: Enrollment grew to 222,731. And more than 57,000 people enrolled in plans through Washington’s exchange during the COVID/American Rescue Plan special enrollment period, which ran from February 15 to August 15, 2021.

2022: Enrollment grew to 239,566 people, nearly reaching the record high that had been set in 2018.