Washington Health Insurance Consumer Guide

To be eligible to enroll in private health coverage through Washington Healthplanfinder, you must:⁷

• 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 has obtained federal permission to allow undocumented immigrants to enroll in health plans through Washington Healthplanfinder starting in 2024. Undocumented immigrants will not be eligible for federal subsidies, but Washington Healthplanfinder will be able to provide them with state-funded Cascade Care Savings subsidies if their income doesn’t exceed 250% of the poverty level.⁸

In addition to basic enrollment eligibility, there are additional parameters that must be met in order 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).

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 1.⁹

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.

Seventy percent of Washington Healthplanfinder’s enrollees were receiving APTC as of early 2023. These subsidies covered an average of $438/month, reducing the average enrollee’s net premium to about $160/month.¹⁰

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. Twenty-nine percent of Washington Healthplanfinder’s enrollees were receiving CSR benefits as of 2023.¹⁰

And Washington is among the states where additional state-funded subsidies are available. As of 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.¹¹ 

(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.

Source: CMS.gov¹²

Twelve insurers offer 2023 exchange plans in Washington:¹³

• 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 2024, Washington’s Marketplace insurers have proposed the following average rate changes:¹⁴

Source: Washington Office of the Insurance Commissioner¹⁴

In addition, there are two insurers in Washington’s individual/family market – Asuris Northwest Health and Providence Health Plan – that only offer plans outside the exchange. They have proposed a 3.4% average rate decrease and a 4.7% increase, respectively.¹⁴ 

Across all the carriers, the overall proposed average rate change is an increase of 9.1%.¹⁴

But 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 2023.¹⁰ These subsidies change each year to keep pace with the cost of the second-lowest-cost Silver plan in each area.

During the open enrollment period for 2023 coverage, 230,371 people selected private plans through Washington Healthplanfinder.¹⁰

Source: 2014,¹⁵ 2015,¹⁶ 2016,¹⁷ 2017,¹⁸ 2018,¹⁹ 2019,²⁰ 2020,²¹ 2021,²² 2022,²³ 2023,¹⁰ 2024²⁴

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.