Washington Health Insurance Consumer Guide

To be eligible to enroll in private health coverage through Washington Healthplanfinder, you must:⁵

• Live in Washington
• Not be incarcerated
• Not be enrolled in Medicare

Under the ACA, a person must also be lawfully present in the U.S. in order to use the exchange/Marketplace in any state. But Washington obtained federal permission to allow undocumented immigrants to enroll in health plans through Washington Healthplanfinder starting with the 2024 plan year. The approval is effective through 2028,⁶ but could be extended in the future. Undocumented immigrants are not eligible for federal subsidies, but Washington Healthplanfinder can provide them with state-funded Cascade Care Savings subsidies if their income doesn’t exceed 250% of the poverty level.⁶

Starting in July 2024, a limited number of adults in Washington who are undocumented immigrants were able to enroll in Medicaid (Apple Health) if their income wasn’t more than 138% of the federal poverty level.⁷ This coverage is free, whereas the Marketplace coverage for undocumented immigrants averages about $210/month after the state-funded subsidies are applied.⁸

But the state only had enough funding to provide Apple Health coverage to 13,000 undocumented immigrants, and that enrollment cap was reached within just a couple of days. At this point, undocumented residents can still apply and be put on a waiting list in case spots open up.⁹

In addition to basic enrollment eligibility, there are additional parameters that must be met to qualify for financial assistance. To be eligible for income-based federal Advance Premium Tax Credits (APTC), state-funded Cascade Care Savings, or federal cost -sharing reductions (CSR), you must:

• Not have access to an affordable plan offered by an employer. If you are eligible to sign up for an employer’s plan and aren’t sure whether it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies for a plan obtained through Washington Healthplanfinder. 
• Not be eligible for Apple Health (Medicaid/CHIP).
• Not be eligible for premium-free Medicare Part A.¹⁰
• File a joint tax return with your spouse, if you’re married.¹¹ (with very limited exceptions)¹²
• Not be able to be claimed by someone else as a tax dependent.¹³

Beyond those basic requirements, premium subsidy eligibility depends on your household’s income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. 

In Washington, the open enrollment period begins November 1 and continues through January 15. Enrollments completed by December 15 will have coverage effective January 1, whereas enrollments completed between December 16 and January 15 will have coverage effective February 1.¹⁴

After the open enrollment period ends, you may still be able to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying life event. 

Enrollment in Washington’s Apple Health (Medicaid) is available year-round for eligible applicants.

To enroll in an ACA Marketplace/exchange plan in Washington, you can: 

• Visit Washington Healthplanfinder – the state’s health insurance exchange – to compare the health plans that are available in your area, determine whether you’re eligible for financial assistance (including federal subsidies and Washington’s Cascade Care Savings), and enroll in coverage during open enrollment or during a special enrollment period. 
• Enroll in coverage through Washington Healthplanfinder with the help of an insurance agent or broker, or an exchange-certified Navigator.
  

You can reach Washington Healthplanfinder’s customer service team at 855-923-4633 (TTY/TDD: 855-627-9604). They are available Monday through Friday, 7:30 am to 5:30 pm.

When you enroll in a health plan through Washington Healthplanfinder, you may find that you’re eligible for financial assistance. And for those with income up to 250% of the federal poverty level, the assistance may be more robust than it is in many other states, as both federal and state subsidy programs are available in Washington.

As a result of the Affordable Care Act (ACA), federal premium subsidies (advance premium tax credits, or APTC) are available depending on your income. If you’re eligible for APTC, it will reduce the amount you pay for your health coverage each month, as long as you select a metal-level plan through Washington Healthplanfinder.

More than seven out of ten Washington Healthplanfinder enrollees qualified for APTC during the open enrollment period for 2024 coverage. These subsidies covered an average of $453/month, reducing the average APTC-eligible enrollee’s net premium to about $160/month.¹⁵

Source: CMS.gov¹⁶

Applicants with household income up to 250% of the federal poverty level are also eligible for federal cost-sharing reductions (CSR), which will reduce the deductible and other out-of-pocket expenses for Silver-level plans. One-third of Washington Healthplanfinder’s enrollees were receiving CSR benefits as of 2024.¹⁵

And Washington is among the states where additional state-funded subsidies are available. Starting in 2023, Washington began offering state-funded premium subsidies for applicants with income up to 250% of the poverty level, as long as they select a Cascade Care silver or gold plan. The Cascade Care Savings are available in addition to the federal premium subsidies and cost-sharing reductions.¹⁷ 

(Note that federal APTC can be used with any metal-level plan, federal CSR is available with any silver-level plan, and Cascade Care Savings are available with silver or gold Cascade Care plans. To receive all three benefits at once, an enrollee would need to have income up to 250% of the poverty level and select a silver Cascade Care plan.)

Depending on your income and circumstances, you may be able to enroll in free or low-cost health coverage through Apple Health (Washington Medicaid). Learn more about whether you might be eligible for Medicaid in Washington. As noted above, Apple Health became available as of July 2024 to a limited number of undocumented immigrants who met the income requirements.⁷ But once 13,000 people had enrolled, additional applicants were put on a waiting list, as the state only had enough funding to provide Apple Health to 13,000 undocumented immigrants.⁹

Twelve insurers offer Marketplace plans in Washington as of 2024.¹⁸

Eleven of them will continue to offer coverage in 2025.¹ 

But PacificSource (which offered Marketplace plans in four counties in 2024¹⁹) is exiting the Washington market at the end of 2024.²⁰ People who are enrolled in PacificSource plans in 2024 will need to select a new plan during open enrollment, which begins November 1, 2024.

For 2025, the following average rate increases have been approved for individual/family coverage offered through Washington Healthplanfinder, amounting to an overall average rate increase of 10.7% (before subsidies are applied):¹

Source: Washington Office of the Insurance Commissioner¹

It’s important to note that average rate changes apply to full-price premiums, and most enrollees do not pay full price. Seven out of ten Washington Healthplanfinder enrollees were receiving premium subsidies in 2024.¹⁵ These subsidies change each year to keep pace with the cost of the second-lowest-cost Silver plan in each area.

In addition to the exchange insurers, there are two insurers in Washington’s individual/family market – Asuris Northwest Health and Providence Health Plan – that only offer plans outside the exchange. Their proposed average rate increases for 2024 are 15.8% and 9.3%, respectively.²¹ These proposals were still under review when the approved rates for Marketplace plans were announced.

For perspective, here’s an overview of how average full-price premiums have changed in Washington’s individual/family market over the years:

• 2015: Average increase of 1.9%²²
• 2016: Average increase of 3.84%²³
• 2017: Average increase of 13.6%²⁴
• 2018: Average increase of 36.4%²⁵
• 2019: Average increase of 13.6%²⁶
• 2020: Average decrease of 3.3%²⁷
• 2021: Average decrease of 3.2%²⁸
• 2022: Average increase of 4.17%²⁹
• 2023: Average increase of 8.18%³⁰
• 2024: Average increase of 8.9%³¹

During the open enrollment period for 2024 coverage, Washington Healthplanfinder enrollment reached a record high, with 272,494 people selecting plans through the Marketplace.³² (See below for a chart of enrollment in previous years.)

The record-high enrollment in 2024 (which mirrored national trends) was due to the continued enhancement of premium subsidies under the American Rescue Plan and Inflation Reduction Act, as well as the “unwinding” of the pandemic-era Medicaid continuous coverage rule. By February 2024, CMS reported that 68,594 Washington residents had transitioned from Medicaid (Apple Health) to Marketplace coverage during the “unwinding” process.³³

Source: 2014,³⁴ 2015,³⁵ 2016,³⁶ 2017,³⁷ 2018,³⁸ 2019,³⁹ 2020,⁴⁰ 2021,⁴¹ 2022,⁴² 2023,⁴³ 2024⁴⁴

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

Washington State Office of the Insurance Commissioner
Licenses and regulates the state’s health insurance companies, brokers, and agents. Provide assistance and information to consumers who have questions or complaints about regulated entities.

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