Health insurance in Washington
Washington State operates its own health insurance exchange: Washington Healthplanfinder.
Washington is working to create standardized health insurance plans for the individual market and a “public option” that will involve the state contracting with a private insurer to offer Washington health insurance plans starting in 2021.
The open enrollment period in Washington for 2021 health plans is November 1 – December 15, 2020. Outside that window, residents who have qualifying events can enroll in health coverage.
Short-term health insurance plans are limited to three-month terms in Washington and cannot be sold during the ACA open enrollment period with a January effective date.
About 212,000 residents enrolled in medical insurance in 2020 through the Washington health insurance marketplace.
Washington adopted the ACA’s Medicaid expansion in 2014, offering Medicaid coverage to adults with incomes up to 138% of the Federal Poverty Level ($1,468 per month for an individual; $3,013/month for a family of four).
Washington enacted several important pieces of healthcare reform legislation in 2019.
This page is dedicated to helping consumers quickly find health insurance resources in the state of Washington. Here, you’ll find information about the many types of health insurance coverage available for individuals and families. You can find the basics of the Washington health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Washington; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of Washington health insurance resources for residents.
Washington State operates its own health insurance marketplace/exchange: 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.)
The marketplace is used by people who need to buy their own health insurance, including self-employed people, early retirees, and people employed by a small business that doesn’t offer health benefits to employees.
Carrier participation in the Washington health insurance marketplace is robust, with 13 insurers planning to offer coverage for 2021 through Washington Healthplanfinder (up from nine insurers in 2020).
Enrollment in plans for 2020 ended up at 212,000 people, which was the second straight year of declining enrollment.
Read our overview of the Washington health insurance marketplace – including news updates and exchange history.
Washington open enrollment period and dates
Open enrollment in Washington for 2021 coverage is scheduled to run from November 1, 2020 through December 15, 2020. Last year, Washington Healthplanfinder added a last minute extension through the end of December, and it’s possible they could offer another extension this year. But for now, consumers in Washington should assume that open enrollment will end on December 15, 2020.
A public option: Washington is a state to watch
In 2019, Washington enacted legislation (S.B.5526; the House version was H.B.1523) that calls for the creation of a “public option” health insurance plan in Washington, starting in 2021. The term “public option” has often been used to describe Medicaid buy-in programs and new coverage options that are administered by the government (at the state or federal level), but Washington’s approach is different, and the details are clarified in the final version of the legislation, which was signed into law by Governor Jay Inslee in May 2019.
Under the terms of S.B.5526, Washington will contract with one or more private health insurance companies to offer qualified health plans at the bronze, silver, and gold levels in the Washington exchange starting in 2021. The plans, dubbed “Cascade Care,” will offer standardized benefits, and at least initially, they will also cap provider reimbursements at 160 percent of the Medicare reimbursement amounts (with the exception of rural hospitals, which will be guaranteed reimbursements of at least 101 percent of Medicare-approved costs, primary care providers, whose reimbursements will be at least 135 percent of Medicare rates, and instances in which the plan can’t develop an adequate network under the prescribed reimbursement constraints.) Several earlier versions of the legislation called for rates equal to Medicare reimbursement, but lawmakers eventually settled on 160 percent of Medicare rates in an effort to ensure adequate provider participation and placate powerful healthcare lobbies.
Washington’s public option is expected to be the first in the nation. Nevada lawmakers passed a Medicaid buy-in public option in 2019, but the governor vetoed it. Colorado enacted legislation in 2019 that directed the state to explore a public option that would leverage current infrastructure, but without directing exactly how the program would work — that’s up to the legislature to sort out in 2020, although state regulators have provided substantial guidance and the program is expected to be available by 2022. Some have argued that the design of the Washington public option will be different from what people tend to think of as a “public option.” This side-by-side analysis shows a high-level comparison of what Washington and Colorado are doing with their programs.
The idea behind S.B.5526 is to make additional healthcare plan options available to individual market enrollees, and the state hopes that the cap on reimbursement rates will result in premiums that are 5-10 percent lower than other plans in the market. But the legislation does not require the Cascade Care plans to be available statewide. The hope is that they will be, but the legislation states that an insurer’s contract with the state would be to offer the plans “in a single county or in multiple counties.”
S.B.5526 also directs the state to “develop a plan to implement and fund” premium subsidies for people with modified adjusted gross income up to 500 percent of the poverty level. Under the ACA, the federal government provides premium subsidies to people with MAGI up to 400 percent of the poverty level, but people with income between 400 and 500 percent of the poverty level are often impacted by the subsidy cliff, which can be particularly onerous for older enrollees and people in areas where premiums are particularly high.
Another provision of S.B.5526 directs the state to create up to three standardized plan designs at the bronze, silver, and gold metal levels (several states already have standardized plans, but Washington is not among them). Insurers that offer plans in the Washington health insurance marketplace would have to offer at least one standardized plan at the silver and gold level starting in 2021 (and at the bronze level, assuming the insurer offers any plans at the bronze level — which is not always the case in Washington).
The legislation allows insurers to continue to also offer non-standardized plans, but it directs the state to analyze what the impact would be if all plans were required to be standardized starting in 2025. A report on this will be delivered to the legislature by 2023 so they can take action to require all plans to be standardized by 2025 or not, depending on what the analysis determines. California is currently the only state that requires all plans to be standardized.
Read more about Washington State’s health insurance marketplace.
Medicaid expansion in Washington State
When the ACA was implemented in 2014, Washington accepted federal funding to expand Medicaid coverage to those earning up to 138 percent 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 more than 622,000 people between the fall of 2013 and August 2018. That was an enrollment growth of 56 percent, the eighth-highest percentage increase in the nation.
Read more about Medicaid expansion in Washington State.
Short-term health insurance 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.
Read more about short-term health insurance in Washington State.
How has Obamacare helped Washington residents?
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 2018, the uninsured rate in Washington had inched up a little, to 6.4 percent (nationwide, the uninsured rate also increased slightly by 2018 — under the Trump administration — to 8.9 percent).
Washington’s elected officials and the ACA
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.
Does Washington have a high-risk pool?
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.
Medicare coverage and enrollment in Washington
As of August 2020, there were 1,398,832 Washington residents with Medicare coverage, amounting to about 18 percent of the state’s population. Most Washington Medicare beneficiaries are eligible for Medicare due to age, but 14 percent 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.
Washington State health insurance resources
Washington healthcare reform legislation
The Washington legislature has been very active in the area of healthcare, addressing numerous issues that impact public health. In 2019, 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.
Scroll to the bottom of this page for a summary of other recent Washington bills related to healthcare reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.