Health insurance in Washington State

If you’re seeking information about health insurance in Washington state (not Washington, D.C.), then you’re in the right place.

Washington stands out as one of the first states to have a state-based health insurance program since the year 2011.

Residents can use the exchange to enroll in private health insurance under the Affordable Care Act (known as Obamacare) as well as public health coverage via Medicaid.

Choosing an insurance plan that meets your needs can be very cumbersome. The first step is to understand the difference between public health insurance vs. private health insurance. Which one is right for you?

Overall, most Americans are enrolled in a private health insurance plan, according to the US Census Bureau.

The rest may have health coverage through a public or government program like Medicaid or Medicare.

Employer-based coverage continues to be the most common, followed by 19% of Americans with Medicaid and 17% with Medicare.

Private Health Insurance

Private health insurance can be said to be any health insurance coverage that is offered by a private entity instead of a state or federal government. Insurance brokers and companies both fall into this category.

Here below are ways through which you can enroll in a private plan:

  • Licensed agents, such as e-Health
  • Health insurance offered through an employer (such as a group health plan)
  • Federal or state market place plans

Some private health insurance plans offer benefits that meet the minimum coverage requirements of the Affordable Care Act (also known as Obamacare). Other plans might offer different benefits, such as short-term or catastrophic coverage.

These plans may not count as private health insurance options, such as short-term plans and catastrophic coverage, may offer different benefits, but may not count as a qualified Health Plan under the Affordable Care Act.

Until 4 years ago, you might have had to pay a tax penalty if you had a plan that did not count as qualifying coverage. As at 2019, that penalty no longer exists.

Public vs. Private Health Insurance

Public health insurance is a choice for some Americans and includes these options:

Medicare:  federal program for adults over the age of 65 and certain disabled people.

Medicaid: a state-run public health insurance program that caters to low-income individuals.

The Children’s Health Insurance Program (CHIP), a subset of Medicaid, which offers a highly subsidized low- or no-cost health insurance for children.

One difference between public and private health insurance is eligibility. Qualifying criteria for public health insurance options include age and income. If you do not qualify, you can get private health insurance, and eHealth can help!

There are specialized brokers to help you find plans in any state, as well as a wide range of plans and a variety of services to help you manage your healthcare coverage.

Types of private insurance

Another difference between public and private insurance is the various types of private insurance plans that are available.

  • Enroll in a group plan through an employer
  • Select your own private plan through licensed agents at eHealth
  • Choose a plan through the state or federal marketplace
  • Enroll in short term coverage if you qualify

Finding the best health insurance coverage in Washington State 

The best health insurance coverage you can go for will depend on your income bracket and medical needs.

Besides individual health insurance, Washington offers Medicaid coverage through its Apple Health program.

Furthermore, the state has passed legislation that expands Medicaid coverage under the Affordable Care Act (ACA).

Households with incomes that fall below the federal poverty level can sign up for the federal government funded health care.

Before choosing a plan, make sure you analyze the premiums and deductibles for each tier and make your decision based on affordability bearing in mind your income level and savings.

Below, we have provided an in-depth look at each metal tier and broken down situations in which they make the most sense.

Start with Silver plans

It is best you start your search with Silver plans, as these policies have moderate premiums and deductibles. This policy would work best in most situations unless you are very healthy or expect a number of expensive medical bills.

In that case, Bronze or Gold coverage may work better for you. Silver policies are the only health insurance plans that offer cost-sharing reductions if your income is below the federal poverty level.

A cost-sharing reduction is an added benefit that decreases the amount you pay for co-pays, co-insurance and deductibles. For this reason, Silver tier policies can sometimes be the most cost-effective plan offered on the health insurance exchange.

Bronze: Best for young, healthy individuals

Bronze plans are the cheapest plans offered on the Washington Health plan finder marketplace. Even though these plans have a low premium, they have high deductibles and out-of-pocket maximums, which make reaching the co-insurance level difficult.

For this reason, Bronze tier policies are best if you are healthy and want coverage in case of an extremely expensive, unexpected medical expense. Bronze plans are available to anyone in Washington.

Gold plans: Best if you have high medical expenses

The top and most expensive tier offered in Washington is Gold. These plans works best if you expect to have high medical costs during the year in view.

In this case, since the deductible is the lowest available, you would be able to reach it quickly and then have access to co-insurance with your health plan provider.

Private Health insurance in Washington State 

How Much Does Private Health Insurance Cost? Insurance companies decide on premiums based on several factors.

These include:

Your age: The older we are, the more likely we are to need healthcare. To account for this, insurance companies charge higher premiums to older plan members.

Whether you use tobacco: Smoking and using tobacco increases the risk of developing health issues.

Your location: Where you live has an impact on your health. It also impacts how much competition there is among insurance companies and how expensive it is to provide healthcare.

The number of people on your plan: An individual plan is less expensive than a family plan.

Insurance companies can’t charge you a higher premium based on your gender or on your specific health history. You can’t be charged a higher rate if you have diabetes, for example.

Many people get private health insurance through an employer. Employers typically pay for part of the costs of health insurance and employees pay for the rest.

Employees paid an average of $1,427 annually for individual coverage in 2018, according to The Commonwealth Fund.

They paid an average of $5,431 for a family plan. This comes to $118 per month for an individual plan and $452 per month for a family plan.

Private health insurance purchased on your own (not through an employer) is significantly more expensive.

According to eHealth Insurance, the average cost of an individual plan purchased on your own is $440 per month. The average cost of a family plan is $1,168. This comes to $5,280 per year for an individual and $14,016 per year for a family.

The first step to finding affordable health insurance is getting multiple quotes. There are sites that have a simple tool that allows you to get quotes fast by entering your ZIP code.

As you review your quotes, keep in mind that every insurance company determines its rates differently. The cost of health insurance is about more than just your premium, though. Here are a few other costs to consider:

Deductible: Your deductible has a big influence on your health costs. Your deductible is the amount you pay for covered health care before your plan starts paying.  The average deductible in 2018 was $4,328 for an individual plan and $8.352 for a family plan, according to eHealth Insurance.

Copayment: Your copayment, or copay, is a fixed amount you pay for a service. You might have  $10 copay for a doctor’s visit and a $20 copay for a specialist visit.

Coinsurance: Coinsurance is like a copay, but instead of paying a fixed amount, you pay a percentage of the cost. If your plan has a coinsurance of 20% and your doctor visit costs $200, you would pay $40.

Out-of-pocket maximum: Your out-of-pocket maximum is the most you would pay out-of-pocket in a year.

This total doesn’t include your premiums. Plans sold on your state’s health insurance Marketplace have a maximum out-of-pocket limit of $8,200 for individual plans as of 2020. The maximum out-of-pocket limit for family plans is $16,400.

HMO vs. PPO vs. EPO vs. POS

Another factor to consider when it comes to how to get health insurance is the plan type. Here are the 4 most common types of plans:

HMO: An HMO is a health maintenance organization. With an HMO, you choose a primary care doctor.

If you need to see a specialist, you typically need to get a referral from your primary care provider. HMOs have a provider network. You may not be able to see providers outside of your network. If your plan allows you to see out-of-network providers, you will have to pay more.

PPO: A PPO is a preferred provider organization. It allows you more flexibility than an HMO. You typically don’t need a referral to see a specialist. You can see providers outside of the provider network, but you will pay a bit more.

EPO: An EPO is an exclusive provider organization. It combines aspects of an HMO and a PPO. You have the more restrictive network associated with an HMO.

If you see an out-of-network provider, you pay significantly more. You also have the freedom to see specialists without a referral.

POS: A POS is a point-of-service plan. You can see any provider in your network without getting a referral. If you want to see an out-of-network provider, you do need a referral.

Private Health Insurance carriers in Washington State 

Choosing private health insurance is a big decision. You can get multiple quotes fast using your ZIP, but which plans are the best?

It all depends on your health needs. You can choose from 15 Washington health insurance companies for 2022 individual and family plans.

Thirteen offer plans on the exchange. Here are the 15 health insurance companies, based on our research:

2022 Washington Health Insurance Carriers

  • Asuris Northwest Health
  • Bridge Span Health
  • Community Health Network of WA
  • Coordinated Care
  • Health Alliance North West*
  • Kaiser Foundation Health Plan of the Northwest
  • Kaiser Foundation Health Plan of Washington
  • Life Wise Health Plan
  • Molina Healthcare of Washington
  • Pacific Source Health Plans
  • Premera Blue Cross
  • Providence Health Plan
  • Regence BlueCross BlueShield of Orego
  • Regence BlueShield
  • United Health care of Oregon

The Comparative Advantages of some key insurance firms in Washington state

  1. Best for Travel: Blue Cross Blue Shield

If you’re somebody who often travels for work or who splits time between locations, Blue Cross Blue Shield is the plan best suited for you. Blue Cross Blue Shield has plans and network providers in every state.

It also has reliable coverage options if you travel or live overseas. Blue Cross Blue Shield is made up of independent companies, so you choose a plan that serves your area and get the local company informed about your travel or other needs. This one of the most things to consider about health insurance in Washington state.

  1. Best for HMO: Kaiser Permanente

Kaiser Permanente isn’t available everywhere, but if you fall under one of its service areas, it’s worth considering. Kaiser Permanente is unique in that it’s both an insurance plan and a care provider.

This means better coordination when it comes to your welfare. In some of Kaiser’s service areas, you can go to a Kaiser facility for routine check. You can see multiple providers and pick up prescriptions all in the same place.

  1. Best for senior citizens: United Health care

Do senior citizens need private health insurance? Most of them have Medicare, right? Medicare covers a lot, but it has a lot of out-of-pocket costs, too.

Many senior citizens purchase a private Medicare Supplement or Medicare Advantage plan to work with their public Medicare coverage. United Health care has partnered with AARP to offer a variety of plans for senior citizens.

It offers Medicare Advantage plans, which typically have low premiums and include prescription coverage. It also offers Medicare Supplements, which typically have higher premiums but lower deductibles.

  1. Best for Preventive Care: Molina Healthcare

Molina Healthcare has been in business since 1980. It was founded by a doctor to serve the needs of low-income patients.

Today, Molina serves patients of all income levels with an emphasis on preventive care and wellness. It has an extensive network of providers and hospitals. Its plans provide affordable coverage for your day-to-day healthcare needs.

  1. Best for Availability: Cigna

Some insurance companies can be pretty difficult to contact. They might only be available during business hours, which is when most of us are actively at work.

Cigna is available 24/7, which makes it easy to talk to someone when the need arises. It also offers a user-friendly mobile app so that you can access your insurance info on the go. Cigna offers affordable co-pays and low-cost preventive care.


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