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 an illness or prior health issue.
The Exchange plans offer more options for insurance coverage through the Washington Healthplanfinder. Beyond the nonstandard (traditional) plan selection, the Exchange has Cascade Care Plans. Cascade Care launches Washington State on the path to achievable universal care. By 2025, only Cascade Standard and Public Option plans will be offered on the Exchange. Saving opportunities are available (if you qualify) to reduce your premium cost and/or cost sharing (deductibles, copayment’s and coinsurance).
There are three types of Qualified Health Plans (QHPs) plans to choose on the Washington Exchange:
- Nonstandard Plans (traditional plans) offer the ten essential health benefits.
- Cascade 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.
- Cascade 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 2023 open enrollment sign up period has ended. During 2023, certain life changes or special circumstances may qualify you for a special enrollment period.
- If you have a qualifying life change, you have 60 days to either enroll in a qualified health plan for the first time or change the plan you are enrolled for more suitable coverage.
- Cascade Care Savings offers the opportunity to enroll if your income is 250% or less of the Federal Poverty Level, you select a Cascade Silver or Gold plan, and you do not qualify for Apple Health.
- If you do not qualify for a special enrollment period, 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.
- Important message for patients with Washington Apple Health Medicaid coverage: Verify your contact information is up to date with the Washington Healthplanfinder to prevent a gap in your health care coverage. Over the next 12 months, Medicaid Members will receive a renewal notice letter prior to the end of their renewal period. Follow the instructions on the letter and submit the application as soon as possible so that your coverage is not terminated. Here is more information about these changes, frequently asked questions, and what changes to report. Contact Washington Healthplanfinder’s Customer Support Center at 1.855.923.4633 (TTY 1.855.627.9604) for further assistance.
Health Benefits Exchange 2023 Insurers
Exchange plans are offered by the following companies (listed alphabetically, by county):
- BridgeSpan Health Company: Benton, Clark, Columbia, Franklin, King, Kitsap, Klickitat, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Yakima
- Community Health Plan of Washington: Benton, Chelan, Douglas, Ferry, Franklin, Grant, Jefferson, King, Kitsap, Kittitas, Lewis, Mason, Okanogan, Pierce, Snohomish, Spokane, Thurston, Walla Walla, Whitman, Yakima
- Coordinated Care (Ambetter): Adams, Asotin, Benton, Chelan, Columbia, Douglas, Ferry, Franklin, Garfield, Grant, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whitman, Yakima
- Kaiser Foundation Health Plan of the Northwest: Clark, Cowlitz
- Kaiser Foundation Health Plan of Washington: Benton, Columbia, Franklin, Island, King, Kitsap, 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, Douglas, Ferry, Garfield, Grant, Island, Jefferson, King, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima
- Molina HealthCare of Washington: Benton, Clark, Cowlitz, Ferry, Franklin, King, Kitsap, Klickitat, Lewis, 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
- Regence BlueCross BlueShield of Oregon: Clark
- Regence BlueShield of Washington: Clallam, Columbia, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, Walla Walla, Whatcom, Yakima
- United Healthcare of Oregon: 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
- BRONZE CARE ON DEMAND, BRONZE ESSENTIAL
- CASCADE CARE STANDARD
MOLINA HEALTHCARE OF WASHINGTON
- CONSTANT CARE
- CASCADE CARE STANDARD
PREMERA BLUE CROSS
- PREFERRED EPO
- PREFERRED HSA EPO
- CASCADE CARE STANDARD
REGENCE BLUESHIELD OF WASHINGTON
- INDIVIDUAL AND FAMILY NETWORK
- CASCADE CARE STANDARD INDIVIDUAL AND FAMILY NETWORK
UNITED HEALTHCARE OF OREGON, INC.
- UHC VALUE, UHC ADVANTAGE
- CASCADE CARE STANDARD
Managed Medicaid Plans
UW Medicine is contracted with these Managed Care Medicaid payers, with exception of their capitated plans and any members assigned to the Patient Review and Coordination (PRC) program.
AMERIGROUP (AMG) APPLE HEALTH
COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW) APPLE HEALTH
- SPECIALTY CARE ONLY
COORDINATED CARE APPLE HEALTH
MOLINA (MHC) APPLE HEALTH
UNITED HEALTHCARE COMMUNITY (UHC) APPLE HEALTH
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)
- 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 Medicine Primary Care: 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 1
- 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
UW Medicine - Financial Counseling
Tuesday – Friday
9:00 AM – 4:30 PM
8:30 AM – 4:30 PM
UW Medical Center - Northwest Financial Counseling
|Monday – Friday||8:30 AM – 4:30 PM|
Valley Medical Center
|Monday – Friday||8:00 AM – 5:30 PM|
Valley Medical Center
|Monday – Friday||
8:00 AM – 4:30 PM