Frequently asked questions about health insurance
coverage options in Washington
Washington State operates its own health insurance marketplace: Washington Healthplanfinder. The state also has a strong off-exchange market in which ACA-compliant health insurance plans are available (though subsidies are only available through Washington Healthplanfinder.)
In 2019, Washington enacted legislation (S.B.5526; the House version was H.B.1523) that called for the creation of a “public option” health insurance plan in Washington, starting in 2021. Washington’s public option, dubbed Cascade Care, is the first in the nation, with plans available through Washington Healthplanfinder in about half of Washington’s 39 counties.
Some have argued that the design of the Washington public option is different from what people tend to think of as a “public option,” since it’s administered by private insurers. Enrollment in the public option plans was fairly low for 2021. Additional legislation related to the public option has been enacted in 2021; lawmakers had initially intended to strengthen it, but ultimately backed off from several of their key goals.
Open enrollment in Washington for 2021 coverage ended on Jan. 15, 2021. But due to the COVID pandemic and the resulting widespread job losses, and in line with the Biden administration’s decision to open a special enrollment period on HealthCare.gov, Washington Healthplanfinder opened a special enrollment period from February 15 to August 15, 2021, for anyone who isn’t already enrolled in a plan through the exchange. A qualifying event is not necessary in order to use this enrollment window.
This enrollment period applies to uninsured Washington residents as well as current marketplace enrollees who would like to make a plan change. This is important, given that the American Rescue Plan has increased the size of premium tax credits and made them available to more people. So the COVID-related enrollment window is an opportunity to sign up for coverage as well as an opportunity for current enrollees to better take advantage of the enhanced subsidies.
By late February, 1,700 people had enrolled in coverage during the COVID-related enrollment period.
Carrier participation in the Washington health insurance marketplace is robust, with 13 insurers offering coverage for 2021 through Washington Healthplanfinder (up from nine insurers in 2020). Two new insurers — Providence Health Plan and PacificSource Health Plans — began offering plans in the exchange for 2020.
Washington’s new standardized plans are available for 2021 coverage, and the state’s new public option plans are available in more than half of the counties in Washington.
Overall average premiums in Washington’s exchange decreased by 3.2% for 2021. A similar reduction in premiums applied in 2020.
Since the Affordable Care Act took effect in 2013, Washington has seen one of the nation’s greatest reductions in the percentage of uninsured residents.
According to U.S. Census data, 14 percent of Washington residents were uninsured in 2013, and that had dropped to 6 percent by 2016. For perspective, the national uninsured rate was 14.5 percent in 2013, and had fallen to 8.6 percent by 2016. By 2019, the uninsured rate in Washington had inched up a little, to 6.6 percent (nationwide, the uninsured rate also increased slightly by 2019 — under the Trump administration — to 9.2 percent).
As of 2020, there were more than 202,000 Washington residents enrolled in private plans through Washington Healthplanfinder, all of whom have coverage for the ACA’s essential health benefits. Sixty-one percent of those enrollees also received premium subsidies that offset the monthly cost of their health insurance premiums, making coverage more accessible and affordable than it would otherwise be. And as a result of the American Rescue Plan, subsidies are larger and more widely available in 2021 than they have been in past years.
In 2010, both of Washington’s U.S. Senators – Maria Cantwell and Patty Murray – were supportive of the healthcare reform law. Both are still in the Senate and have continued to defend Obamacare while calling for improvements to the law.
Washington’s U.S. House delegation includes ten representatives, with a seven-three margin for Democrats in 2020. The seven Democrats are supportive of the ACA or additional health care reforms (such as a shift towards a single-payer system), while the three Republicans support either full repeal or significant modification of the law.
Gov. Jay Inslee, a Democrat, is very supportive of the ACA and has enthusiastically worked with his state officials to implement Obamacare in Washington. The state is running the Washington Health Benefit Exchange and also opted to expand Medicaid.
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 percent of the uninsured population in Washington would be eligible for expanded Medicaid or CHIP.
As a result of Medicaid expansion, total enrollment in Washington Medicaid plans and CHIP grew by nearly 764,000 people between the fall of 2013 and November 2020. That was an enrollment growth of 68%, the tenth-highest percentage increase in the nation.
Read more about Medicaid expansion in Washington State.
Washington insurance regulators implemented new rules for short-term health insurance plans, which took effect in January 2019, limiting the plans to no more than three months in duration and prohibiting renewals.
The new state regulations also include a list of other provisions designed to help consumers avoid confusion during open enrollment and protect buyers with pre-existing conditions.
Washington had just one insurer, LifeMap, offering short-term plans in the state. But as of late 2020, LifeMap indefinitely suspended sales of new plans, until if and when they can bring their plans into compliance with Washington’s new rules (LifeMap had a similar suspension of new plan sales in late 2018, after the state’s new rules first took effect; they resumed sales in April 2019, but then suspended them again in late 2020).
Read more about short-term health insurance in Washington State.
As of November 2020, there were 1,410,949 Washington residents with Medicare coverage, amounting to about 18% of the state’s population. Most Washington Medicare beneficiaries are eligible for Medicare due to age, but 14% are under the age of 65 and eligible for Medicare because of a disability.
You can read about Medicare in Washington, including the state’s robust consumer protections for Medigap enrollees, as well as details about Medicare Advantage and Medicare Part D plans in Washington.
You can also read more about Medicare’s open enrollment period (October 15 – December 7), during which Medicare beneficiaries have an opportunity to compare available plan options and change their Part D or Medicare Advantage policies for the coming year. And from January 1 to March 31 each year, Medicare Advantage enrollees have an option to switch to a different Medicare Advantage plan or switch to Original Medicare.
- Health Care for All – Washington
- 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 Statewide Health Insurance Benefits Advisors (SHIBA) — A local service that can answer questions and provide information, counseling, and assistance related to Medicare in Washington.
The Washington legislature was very active in the area of healthcare in 2019, addressing numerous issues that impact public health. Several pieces of health care reform legislation were implemented including:
H.B.1065, which provides strong consumer protections against surprise balance billing for emergency services received at out-of-network facilities and also for services performed by an out-of-network healthcare provider at an in-network facility. Washington’s Insurance Commissioner, Mike Kreidler, has long championed legislation to protect consumers from surprise balance billing, and was a driving force behind 2019’s successful effort (see his summary of the 2019 legislation here). Similar legislation failed to pass in 2017 (H.B.2114) and 2018 (HB 2114) but lawmakers successfully revisited the issue and it was signed into law in May 2019, and takes effect in January 2020:
- The new law applies to plans that are regulated by the Washington Insurance Commissioner. This does not include self-insured group plans — which account for the majority of very large group plans — which are regulated by the federal government instead, under ERISA. Self-insured group plans can choose to opt into the state’s balance billing protection rules.
- It requires insurers to maintain adequate networks.
- Out-of-network healthcare providers cannot balance bill patients in emergency situations or in situations in which the out-of-network services were received at a facility that was in-network with the patient’s insurance.
- In these situations, insurers must pay out-of-network providers “a commercially reasonable amount, based on payments for the same or similar services provided in a similar geographic area.”
- If the provider and insurer don’t agree on the payment amount, it is sent to binding arbitration. The patient is no longer caught in the middle.
H.B.1870, which codifies ACA consumer protections into 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 state’s all-payer claims database.
In 2020, lawmakers in Washington passed S.B.6128, which would have extended Medicaid coverage for new mothers for a year after the birth of a child, but Gov. Inslee vetoed it in April 2020, due to budget constraints caused by the COVID pandemic.
Before the ACA brought guaranteed issue health insurance to the individual market, plans were underwritten in nearly every state. Pre-existing conditions could prevent an applicant from getting a policy at all, or could 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 weren’t able to get private health insurance because of their medical history.
Now that the ACA has been implemented, all health insurance plans are guaranteed issue, largely eliminating the need for risk pools. But WSHIP is one of a few state-run pools that is still operational and will be for the next few years – and indefinitely for some Medicare enrollees.
The pool closed to most new non-Medicare enrollees at the end of 2013, but existing members can stay on the plan until the end of 2017. Under some conditions, WSHIP is continuing to enroll Medicare members as well as some non-Medicaid eligible applicants.