Washington State has simplified the process of searching for health insurance through both the state’s medicaid program and the state’s exchange program. Washington Health Plan Finder (https://www.wahealthplanfinder.org/) is easy to use and helps identify publicly available plans.
Apple Health is the Washington State Medicaid program. For those who qualify, Apple Health provides a wide range of benefits and services. The Washington State Health Care Authority website provides information about eligibility, coverage plans, benefits, and related links for assistance. The Washington HCA has developed a quick reference pamphlet which may be useful for determining your eligibility for Apple Health: https://www.hca.wa.gov/assets/free-or-low-cost/19-003.pdf
If you have any questions about Apple Health, Statewide Health Insurance Benefit Advisers (SHIBA; 1-800-562-6900) are free, unbiased, and confidential support resources provided through the Office of the Insurance Commissioner of Washington State.
If you’re interested in applying, you’ll need:
Once accepted, you'll receive a ProviderOne services card in roughly two weeks. The first day of the month in which the application was received will be the start date for coverage. You can choose a managed care plan online or be automatically enrolled in one.
The Washington State legislature passed a public plan option called Cascade Care which meets the requirements of the Affordable Care Act (ACA). Multiple Cascade Care plans are available with varying premiums, deductibles, co-insurance, and maximum out of pocket expense (About WA Health Plan Finder plans). The Washington Health Plan Finder website provides comprehensive information and frequently asked questions and has an easy to use tool to help you find a plan that meets your needs. If you would prefer to speak with a person, call 1-855-923-4633 or TTY/TTD 1-855-627-9604.
There are many private health insurance companies licensed to provide plans within Washington State. A licensed independent insurance agent will be able to assist you in locating a plan with many of these companies. The Office of the Insurance Commissioner for Washington State maintains an updated searchable list of all licensed agents and agencies https://fortress.wa.gov/oic/consumertoolkit/Search.aspx.
You may also contact private insurance companies directly. The follocawing private insurance companies offer both private plans and participate in the Cascade Care Plans:
Please note that listing in this section does not constitute Seattle University's endorsement of a particular company, plan, or service. The companies listed above have chosen to participate in Cascade Care, a program of Washington State.
Washington State offers specific health care programs for individuals with low incomes or those who need additional help with health care costs. The Office of the Insurance Commissioner for Washington State maintains a list of these program https://www.insurance.wa.gov/health-insurance-plans-and-health-care-programs.
In Seattle, Washington, Community Health Clinics serve low-income families without insurance with free, high-quality medical treatment. This website https://www.wahealthcareaccessalliance.org/free-clinics links many different clinics located in several counties. Washington 2-1-1 is a community resource with trained operators who have access to public and non-profit programs throughout the state. It is a one-stop helpline designed to assist with many different concerns from healthcare to housing insecurity.
Insurance law requires that insurance companies make available two documents:
A practical example:
While running, Sam Student injures their leg. They go to an in-network primary care who orders an MRI. Sam’s provider charges $180 for the visit which is reduced to $110 because of the contract between Sam’s provider and Sam’s insurance company. Sam’s insurance waives deductibles for primary care but does require a $20 copay to the provider. Sam then goes to the local in-network diagnostic imaging clinic for an MRI. The clinic charges $2000 for the MRI which is reduced to $600 because of the agreement between the clinic and the insurance company. For this service, Sam has a 20% coinsurance after deductible. This time, Sam must pay the $100 before their insurance starts paying, after which they owe another $100 for coinsurance on the remaining bill. This brings Sam’s total out-of-pocket expenses at this point to $220.
The MRI finds that Sam has torn multiple ligaments in his ankle and must have surgery. The total cost of the surgery is $32,000 between hospitals fees, surgeons fees, and anesthesiologists fees. This has all been negotiated by the insurance company and Sam owes for coinsurance of 20% which would normally be $6,400, but Sam’s maximum out of pocket expense is $2,500, so Sam only owes $2,280 which is the maximum less the other copays, coinsurances, and deductible. This was Sam’s only doctor’s visit during that plan year, but if Sam had been to the doctor earlier that plan year, the amount owed would have been reduced by any other amounts that Sam paid. If Sam has more follow up visits or new issue visit with their doctor during the plan year, then Sam cannot be charged any amount, because they have reached their out-of-pocket maximum.
This is provided as a general example for illustrative and educational purposes only. Your plan may vary. The best way to understand what your plan will cover is to call and speak with a representative from your insurance carrier. These calls are generally recorded, so it's a good idea to take careful notes and include the day and time of your call and the name of the person with whom you spoke in case there are discrepancies.