Frequently asked questions about health insurance
coverage options in Washington
Washington State operates its own health insurance marketplace, known as Washington Healthplanfinder. A dozen private insurers offer plans 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. Washington’s public option, dubbed Cascade Care, was the first in the nation, debuting in 2021.
Washington Healthplanfinder gives residents access to the ACA’s premium subsidies and cost-sharing reductions. And as of 2023, Washington Healthplanfinder also offers state-funded premium subsidies to people with household income up to 250% of the poverty level.
The open enrollment period for individual/family coverage runs from November 1 through January 15 in Washington. Learn more about open enrollment in our comprehensive guide.
Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage. But there are some exceptions: Native Americans can enroll year-round, as can anyone eligible for Medicaid (Apple Health). And as of 2023, 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.
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; available in two new counties for 2023)
- 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 (expanded to 11 new counties for 2023)
- Premera Blue Cross
- Regence BlueCross BlueShield of Oregon
- Regence BlueShield
- UnitedHealthcare of Oregon
For 2023, the average approved rate change ended up being slightly larger than the insurers had initially proposed, at 8.1%.
For 2020 and 2021, average rates declined in Washington’s individual market, but they increased modestly for 2022, and increased again for 2023.
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 the peak enrollment that Washington saw in 2018, when more than 242,000 people signed up during open enrollment (nationwide, enrollment hit a record high in 2022).
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% of Washington residents were uninsured in 2013, and that had dropped to 6% by 2016. For perspective, the national uninsured rate was 14.5% in 2013, and had fallen to 8.6% by 2016. By 2019, the uninsured rate in Washington had inched up a little, to 6.6% (nationwide, the uninsured rate also increased slightly by 2019 — under the Trump administration — to 9.2%).
As a result of Washington’s decision to expand Medicaid (Apple Health), enrollment in Washington Medicaid and CHIP grew by 89% between the fall of 2013 and mid-2022. That growth was due to a combination of Medicaid expansion as well as the COVID pandemic. Under the Families First Coronavirus Response Act, states have not been disenrolling anyone from Medicaid, but routine eligibility redeterminations will once again resume after the COVID public health emergency ends.
As of early 2022, there were nearly 211,000 Washington residents enrolled in private plans through Washington Healthplanfinder, all of whom had coverage for the ACA’s essential health benefits.
And 70% of enrollees were receiving premium subsidies in 2022 to offset the monthly cost of their health insurance premiums, making coverage more accessible and affordable than it would otherwise be (this is an increase from 62% of enrollees at the start of 2021, before the ARP was implemented; the ARP has made subsidies larger and more widely available than they have been in prior 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% of the uninsured population in Washington would be eligible for expanded Medicaid or CHIP.
As a result of Medicaid expansion and the COVID pandemic (and resulting pause on Medicaid eligibility redeterminations), total enrollment in Washington Medicaid plans and CHIP grew by roughly one million people between the fall of 2013 and mid-2022. That was an enrollment growth of 89%, versus nationwide enrollment growth of 57%.
Read more about Medicaid expansion in Washington State.
As of 2022, there are no insurers offering short-term health plans 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. Short-term plans cannot be sold in Washington during the open enrollment period for ACA-compliant plans, which runs from November 1 to January 15.
Washington had just one insurer, LifeMap, offering short-term plans in the state. As of late 2020, LifeMap indefinitely suspended sales of new plans, in order to bring their plans into compliance with Washington’s new rules. The insurer resumed sales in June 2021, but then suspended them again in mid-2022, with no plans to resume sales in the future.
(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 mid-2022, there were 1,454,964 Washington residents with Medicare coverage. Most Washington Medicare beneficiaries are eligible for Medicare due to age, but nearly 11% 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 the 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 could 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.