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Washington Health Benefit Exchange and Medicaid (Apple Health)

What You Need To Know

The Affordable Care Act (ACA) is a program that allows many Washington residents to access health insurance coverage at an affordable rate and, in some instances, at no cost. The ACA was created to ensure most can get the healthcare they need. You cannot be denied health insurance coverage due to a sickness or prior health issue.

To obtain Washington Health Benefit Exchange coverage for 2020, once enrollment ends on May 8, 2020 you can only enroll if you have a *qualifying event.*

Washington Exchange current enrollees can report income changes at any time during the plan year. Income changes may include:

  • a reduction in work hours during the COVID-19 state of emergency
  • a lost employment altogether

Based on the income change you may be eligible for increased subsidy assistance to pay for Washington Health Benefit Exchange premiums or Washington Apple Health Medicaid provides healthcare at no cost. More information is available at https://www.wahealthplanfinder.org/_content/report-change.html
 

Due to COVID-19, the CARES Act offers financial relief for individuals and families that are eligible.  The financial relief may include a Federal stimulus check and/or a State expanded unemployment. 

  • If you are applying for Medicaid *do not include* the Federal stimulus check and State expanded unemployment as income.   If applicable, only include your State standard unemployment as income.
  • If you are applying for Washington Health Exchange *do not include* the Federal stimulus check as income.  If applicable include your State expanded and standard unemployment as income. 

If you have any questions, please contact the UW Medicine location where you are seeking care.   

Individuals seeking to request a change can:

Apple Health Medicaid enrollments or renewals are continuous throughout the year. Based on your income and citizenship status, you may qualify for the Apple Health Medicaid program. The Apple Health for Adults coverage program provides healthcare at no cost.

To help you find a health insurance plan, Washington State has set up the Health Benefit Exchange website (wahealthplanfinder.org). This website can help you:

  • Find and sign up for the health insurance plan that is best for you or your family.
  • Figure out how much your qualified health plan might cost you.
  • Find out what is covered by a basic level of health insurance. This may include:
    • doctor and emergency room visits
    • care for children (including dental and eye care)
    • prescriptions
    • maternity and newborn care
    • preventive care like cancer screenings and immunizations
    • and much more!

Health Benefits Exchange

  • In general, after open enrollment and special enrollment period, you can only enroll if you have a qualifying life event. If you experience a qualifying life event (such as loss of income, loss of health insurance coverage, marriage, birth of a child or a move) it may offer an opportunity to shop for coverage or qualify for Medicaid through Washington Apple Health.
  • If you have such an event, you have 60 days to either enroll in a qualified health plan for the first time or change the plan you are enrolled into more suitable coverage.
  • If you do not qualify for a life event, you will need to wait for the next open enrollment period to sign up for health insurance through Washington Healthplanfinder.
  • When selecting a new insurance plan during open enrollment or a qualifying life event change, evaluate the benefits to ensure the services you typically receive are a covered benefit.

Health Benefit Exchange 2020 Insurers

Exchange plans are offered by the following companies (listed alphabetically, by county):

  • BridgeSpan Health Company: Clark, King, Klickitat, Pierce
  • Coordinated Care (Ambetter): Adams, Benton, Chelan, Columbia, Douglas, Franklin, Grant, Jefferson, King, Kitsap, Kittitas, Lewis, Lincoln, Pierce, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Yakima
  • Kaiser Foundation Health Plan of the Northwest: Clark, Cowlitz
  • Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative): Benton, Columbia, Franklin, Island, King, Kitsap, Kittitas, Lewis, Mason, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom, Whitman, Yakima
  • LifeWise Health Plan of Washington: Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Doulas, Ferry, Garfield, Grant, Island, Jefferson, King, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pend Oreille, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima
  • Molina HealthCare of Washington: Clark, Ferry, King, Klickitat, Lincoln, Mason, Pend Oreille, Pierce, Skamania, Snohomish, Spokane, Stevens, Thurston
  • PacificSource Health Plans: Clark, Pierce, Spokane
  • Premera Blue Cross: Franklin, Grays Harbor, King, Kitsap, Pacific, Skamania, , Wahkiakum,
  • Providence Health Plan: Benton, Clark, Franklin, Spokane, Thurston, Walla Walla

"In-Network" Access to UW Medicine

UW Medicine is considered "in-network" for several health insurance plans offered on the Exchange. Generally, patients pay less out-of-pocket for services when providers are in-network rather than out-of-network. Out-of-network services may require a higher co-payment or deductible than in-network services, or they may not be covered by insurance at all. IMPORTANT: When selecting an Exchange plan, please consider whether you will have access to your preferred providers at in-network rates.

UW Medicine is considered in-network for Exchange plans offered by the following companies:

UW MEDICINE IN-NETWORK PLANS

  • BRIDGESPAN HEALTH COMPANY
    • RealValue EPO
    • UW Medicine EPO
  • MOLINA HEALTHCARE OF WASHINGTON
    • MOLINA CHOICE & CORE CARE HMO
  • PREMERA BLUE CROSS
    • PREFERRED EPO
    • PREFERRED HSA EPO

Before enrolling in an Exchange plan, confirm with both the plan and your medical provider(s) that your providers are part of the plan's network. Since networks and provider affiliations change over time, you should also periodically confirm your provider's network status even after you've enrolled in the plan. Be aware that health plans sold inside the Washington Health Benefit Exchange (wahealthplanfinder.org) may offer different provider networks than those sold outside the Exchange.

How to Sign Up

  • Online: visit Washington Healthplanfinder
  • By Phone: Washington Healthplanfinder offers customer support to help you get the information you need to enroll in health coverage that best meets your needs and your budget. A trained representative will help educate you about your options and walk you through the enrollment process. The Washington Healthplanfinder Customer Support Center is open to enroll individuals, families and small businesses in quality health coverage and answer questions about financial help and the enrollment process. Toll-free support is available Monday through Friday. Call 1-855-WAFINDER (1-855-923-4633) or TTY/TDD 1-855-627-9604.
  • At UW Medicine Hospitals: Harborview Medical Center, UW Medical Center and Valley Medical Center have staff on-site to help you sign up. Call ahead to schedule your appointment if you plan to come to one of the enrollment sites.
  • At UW Neighborhood Clinics: You can utilize any UW Medicine Hospital for assistance with questions or enrollment.

Enrollment Assistance, Questions, and Appointment Scheduling

UW Medicine is here to help you understand your healthcare coverage options so you can make an informed selection regarding your healthcare. Please call to schedule an appointment for assistance with your application or if you have questions:

Before you begin, make sure you have information for all household members applying for coverage:

  • Legal names
  • Family relationships for each member of the family unit
  • Birth dates
  • Identification numbers (Social Security Number or immigration information)
  • Proof of immigration status if you're a legal permanent resident
  • Proof of tribal status if you're a registered American Indian/Alaska Native
  • Income before taxes
  • Proof of income if your income has changed since you last filed taxes
  • Tax filing status: this is what you report on your IRS tax form
  • Current health insurance information (coverage dates, group number and policy number)
  • Open Enrollment Renewal letter from the Washington HealthPlanFinder (if applicable)

UW Medicine Enrollment Sites

Location Days Times

UW Medicine - Financial Counseling
Harborview Medical Center and UW Medical Center
Appointment Location: Harborview Medical Center 8th Ave Ground West Lobby
Call for an appointment (206.744.3084, option 2)

Monday
 

Tuesday – Friday

9:00 AM – 4:30 PM

8:30 AM – 4:30 PM

UW Medical Center - Northwest Financial Counseling
Main Campus: First Floor Lobby
1550 N. 115th Street
Seattle WA, 98133
Call for an appointment (206.744.3084, option 2)

Monday – Friday  8:00 AM –  4:30 PM

Valley Medical Center
Main Campus: Financial Advocates
Main Admitting Department
400 S. 43rd Street
Renton, WA 98055

Monday – Friday  8:00 AM – 6:00 PM

Valley Medical Center
Emergency Department
400 S. 43rd Street
Renton, WA 98055

Monday – Friday  8:00 AM – 6:00 PM

Valley Medical Center
Patient Financial Services: Customer Service
3600 Lind Avenue, Suite 110
Renton, WA 98058

Monday – Friday 

8:00 AM –4:30 PM