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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.

Starting in CY2021, the Exchange plans offer more options for insurance coverage through the Washington Healthplanfinder.  Beyond the typical plan selection, the Exchange is introducing Cascade Care.  Cascade Care launches Washington State on the path to achievable universal care. Like the typical Exchange plans, the plans may allow you to receive federal subsidies for premiums through the exchange, with the subsidy level declining as income rises.

Cascade Care has two types of plans:

  • Standard Plans offer more benefits with just a copay instead of having to meet your deductible first.  These plans typically offer a lower deductible with more transparent, predictable cost-sharing.
  • Public Option Plans (also referred to as Standard Plans Plus or Select) takes the Cascade Care Standard Plans a step further.  These Public Option plans may cost less because they will cap aggregate statewide provider reimbursement rates at 160% of Medicare rates.  The Health Care Authority is partnering with the Exchange to establish public option plans.

Important Enrollment Information

  • The open enrollment period for insurance is November 1, 2020 through December 15, 2020 for health coverage to start January. 1, 2021. If you miss this enrollment period, you can still buy a plan in the Exchange December 16, 2020 though January 15, 2021 for coverage to start February 1, 2021.
  • In general, after open enrollment and special enrollment period for insurance, 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.  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.
  • 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.

Health Benefits Exchange 2021 Insurers

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

  • BridgeSpan Health Company: Benton, Clark, Columbia, Franklin, King, Kitsap, Kittitas, Klickitat, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Yakima
  • Community Health Plan of Washington: Chelan, Douglas, Grant, Kitsap, Kittitas, Okanogan, Pierce, Spokane, Yakima
  • Coordinated Care (Ambetter): Adams, Asotin, Benton, Chelan, Columbia, Douglas, Ferry, Franklin, Garfield, Grant, Jefferson, King, Kitsap, Kittitas, Lewis, Lincoln, Mason, Okanogan, Pend Oreille, Pierce, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whitman, 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, Thurston
  • Premera Blue Cross: Franklin, Grays Harbor, King, Kitsap, Pacific, Skamania, Wahkiakum
  • Providence Health Plan: Benton, Clark, Franklin, Spokane, Thurston, Walla Walla
  • Regence BlueCross BlueShield: Clark
  • Regence BlueShield of Washington: Clallam, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, Whatcom, Yakima
  • United Healthcare: Adams, Clallam, Jefferson, King, Kittitas, Lincoln, Mason, Pierce, Whitman, Yakima

"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:

BRIDGESPAN HEALTH COMPANY

  • REALVALUE EPO
  • CASCADE STANDARD REALVALUE

MOLINA HEALTHCARE OF WASHINGTON

  • MOLINA CHOICE, CONSTANT CARE & CORE CARE HMO
  • CASCADE CARE STANDARD

PREMERA BLUE CROSS

  • PREFERRED EPO
  • PREFERRED HSA EPO
  • CASCADE CARE STANDARD

REGENCE BLUESHIELD OF WASHINGTON

  • EPO
  • CASCADE CARE STANDARD

UNITED HEALTHCARE

  • CASCADE CARE SELECT (PUBLIC OPTION)

How to Sign Up

  • Online: visit Washington Healthplanfinder
    • 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.
      • 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!
  • 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-Montlake, UW Medical Center-Northwest 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 Harborview or UW Medical Centers 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:

  • Harborview Medical Center and UW Medical Center: 206-744-3084, option 2
  • Valley Medical Center: 425-656-5599 or 425-690-3578, option 5

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 Exchange (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  8:30 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 – 5:30 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