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Washington Health Insurance

Learn more about your health insurance options.

Overview

If you live in Washington and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

• Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)

From now until November 1, 2016, the start of the next open enrollment, you cannot get new yearly insurance unless you have a qualifying life event. See below for those options for coverage and how to avoid the penalty.

Frequently Asked Questions about Obamacare

Do I have to buy health insurance?

Yes. The Obamacare penalty, also known as the Individual Mandate, requires U.S. citizens under the age of 65 to enroll in a health insurance plan or pay a fine. For 2016, not carrying insurance will cost $695 per adult plus $347.50 per child (up to $2085 per family) or 2.5 percent of your family’s income, whichever is more. The fee will increase each year with inflation.

What are my options for buying an Obamacare health plan?

Most states offer health plans from multiple health insurance carriers in 5 coverage levels, commonly called metal tiers. Platinum is the most expensive plan type, but offers the best cost-sharing benefits, covering 90 percent of health expenses incurred. On the other hand, Bronze is the least expensive plan type, but only covers 60 percent of incurred health expenses. Some states also offer Catastrophic plans, which did not cover any percentage of costs, and serve as the most limited form of health insurance coverage available in the Obamacare market. Only persons ages 30 and younger may opt to purchase these plans. Based on 2014 enrollment figures, Silver plans are the most popular choice amongst Americans who purchased Obamacare plans.

Am I eligible for insurance?

You are eligible under Obamacare if you are under the age of 65 and also a U.S. citizen, a U.S. national or a lawfully present immigrant living in the U.S. Illegal immigrants and incarcerated individuals are not eligible to purchase coverage. You cannot be eligible for federal coverage programs such as Medicare, Medicaid, or CHIP. You may purchase insurance through the exchanges, even if you are eligible for employer-sponsored coverage, however, you will not be eligible for subsidies (tax credits to help you pay for insurance) unless your employer’s coverage amounts to more than 9.5 percent of your annual income.

Who is exempt from insurance?

You may qualify for an exemption from the Obamacare penalty if you are:

• Uninsured for less than 3 months

• Unable to find a plan that would cost less than 8.13% of your household income

• A member of a recognized health care sharing ministry, a recognized religious sect with religious objections to insurance or a federally recognized tribe

• Incarcerated

• Qualify for a hardship exemption

Can I buy Obamacare coverage for my children and not for myself?

Yes. You can choose to insure your children through the marketplace without including yourself in the coverage. However, you and your spouse will be subject to the tax penalty for remaining uncovered.

I hardly ever get sick. Can I opt for a Catastrophic plan to save money?

It depends on your age and your financial situation. Catastrophic plans are only available to adults under the age of 30 and for adults who cannot find a plan that costs less than 8 percent of their annual income.

If I am a smoker, are my rates higher?

It depends on where you live. In most states, an insurer can charge an individual as much as 50 percent more per person who uses tobacco. Some states have prohibited tobacco penalties (including California, Massachusetts, the District of Columbia and Rhode Island). Visit your state Marketplace to learn more about how tobacco surcharges work in your state.

I quit smoking, can my premium be readjusted?

Not necessarily. Your insurer is not required to lower your premium until the following year when you renew your policy.

I had a stroke last year, can I still get covered?

Under Obamacare, insurers are no longer allowed to deny coverage based on pre-existing medical conditions.

I’m unemployed. Where do I get coverage?

If you are unemployed, you might qualify for Medicaid or a subsidy to help cover the expense of a private health insurance plan. Which plans you are eligible for depend on your household size and income, not your employment status. If you are receiving unemployment compensation, you will need to report this expected amount when applying for coverage.

Do I have to be on the same plan as my spouse?

No. The Affordable Care Act does not require that spouses be on the same plan. However, if you are looking to qualify for a subsidy (tax credits to help you pay for your insurance), your total household income will be considered. That will include your spouse’s income, whether or not you are on the same plan.

I don’t like a decision made by health insurance carrier. Can I appeal it?

Yes. You may appeal by writing a letter to your Health Insurance Marketplace, or by mailing your state’s appeal request form. Navigators can also assist you in the process or you can appoint an authorized representative to help you.

If you need help choosing a health insurance plan or filling out your application, Washington has trained nongovernment groups to guide you through the process. Sometimes called Navigators, these groups can answer technical questions on insurance, Medicaid, and tax credits (subsidies on monthly premiums). Navigators also specialize in assisting non-English speaking populations. For more information, contact the Washington Healthplanfinder call center at 855-923-4633 or email customersupport@wahbexchange.org. The center is open Monday through Friday from 7:30 a.m. to 8:00 p.m.

The Washington State Office of the Insurance Commissioner exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 800-562-6900 or emailed through an online contact form. Residents can file an insurance complaint online.

Do I Have to Buy Health Insurance?

It’s important to sign-up for health insurance. You may have heard that everyone in Washington must have health insurance in 2016 or pay a penalty. With a few exceptions, this is true.

For 2016, not carrying insurance will cost $695 per adult plus $347.50 per child (up to $2085 per family) or 2.5 percent of your family’s income, whichever is more. 

To avoid the Obamacare tax penalty, U.S. News generally recommends getting health insurance of some kind, even if it is only Catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

The number and types of plans may have changed since last year.  Call your insurer to verify whether your plan is still available.

Where Do I Buy Health Insurance?

Washington Healthplanfinder is Washington's official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Washington Healthplanfinder, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

• Social security numbers for everyone in your household
• Your employer’s name and address
• Your most-recent pay stub or recent records of your wages
• Information about other types of income you receive, such as alimony, unemployment benefits or a pension

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether through the federal Washington Healthplanfinder, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

Do I Qualify for a Tax Break on Health Insurance?

If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Washington. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes. For example, insurers can no longer deny coverage to people with pre-existing medical conditions. 

Note: You have from November 1, 2016 until January 31, 2017 to enroll for coverage for 2017. If you miss this date, with few exceptions, you will pay a penalty. If you missed the deadline to enroll, read about your options for coverage and how to avoid the Obamacare tax penalty.

What If I Don’t Qualify for a Tax Break?

If you don’t qualify for a subsidy (a tax credit), you can still enroll in an Exchange Plan, or consider one of the many private health insurance plans available in Washington’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage. 

What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.