Wednesday, May 1, 2024

Washington State Government Health Insurance

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Restructuring The Health Care Insurance System

Medical Plans for Retirees Entitled to Medicare

The HSA imposes three major changes in health care insurance. Taken together, these three elements constitute a major restructuring of the State’s health care delivery system.

The HSA first requires that all health care be purchased through CHPs, which, similar to HMOs, combine financial risk with health care delivery. Beginning in July 1995, each CHP, which can be an indemnity insurer, HMO, or risk-bearing provider network, must offer at least the HSC-mandated uniform benefits package for no more than the maximum community-rated premium set by the HSC. CHPs will negotiate fees with providers, but must use some form of scheduled rate-setting, such as capitation, prospective payment, or relative value scales. Each employer must offer at least three CHPs, one of which must be the lowest cost plan in the region, and can offer supplemental benefits beyond the UBP. Employers with more than 7,000 employees can self-insure under regulation as a registered employer health plan.

The State’s HCA, operating as a consolidated State purchasing agency, will purchase health care for all State employees, school employees , the BHP, and eventually Medicaid and Medicare beneficiaries . Any employer or individual may enroll in the BHP at an unsubsidized premium rate. While not technically a HIPC, because it is not required to offer all CHPs in the State, the HCA will operate functionally as a HIPC for its subscribers.

Washington And The Affordable Care Act

The number of Washingtonians without health insurance fell by half since the passage of the Affordable Care Act in 2010.2As of 2019, 7% of Washingtons 7.2 million residents are uninsured.3

The first change in the uninsured rate happened in 2014 when the state adopted Medicaid expansion under the ACA. The rate dropped from 14% to 9%.4

Under Medicaid expansion, adults without dependent children can get benefits if they earn up to 138% of the federal poverty level .5 That amount equals $17,774 for an individual.6

Due to the expansion, 678,000 more adults have Medicaid benefits in Washington. In total, about 1.9 million adults and children are enrolled in Washingtons Medicaid program.

Conversion Of Life Insurance Provision

Retiring employees and their dependents may be entitled to convert their life insurance to an individual policy without evidence of insurability .

The amount of the individual policy will be equal to the amount of coverage as of the termination date of the policy being converted.

MetLife will send information and an application to employees eligible for portability or conversion due to termination or other reasons. Employees can contact MetLife directly at 1-877-275-6387 with any questions about the portability and/or conversion provisions.

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Pacificsource Health Plans Hires Meg Jones As Government Relations Director For State Of Washington

PacificSource Health Plans has hired Meg Jones as its Washington state government relations director. In this role, Jones will work on PacificSources public policy, government affairs, and advocacy activities throughout the state.

Jones brings more than 30 years of health plan and health policy leadership experience to this role as well as a deep working knowledge of state and federal lobbying, legislative and regulatory policymaking, and political processes.

Were very pleased to have Meg join our team. Her extensive health care background and long standing dedication to improving Washington state health care policy will be a true asset to our members, said Todd Lovshin, PacificSource vice president and Washington state regional director.

Jones most recently served as senior health care policy analyst for the Washington state Office of the Insurance Commissioner, and prior to that served as the executive director for the Association of Washington Healthcare Plans. She also served as the associate general counsel for UnitedHealthcare, and as the special assistant to the Commissioner for the Washington state Office of the Insurance Commissioner.

Outside of the office, she enjoys cooking, gardening, exploring new places, and sharing time with her family and border collie.

About PacificSource:

Retiree Term Life Insurance

Washington State Commission on Asian Pacific American Affairs

This insurance is only available to those who meet the PEBB Programs retiree eligibility requirements and had life insurance through the PEBB Program as an employee.

Enrolling requires PEBB receive the Retiree Election/Change form no later than 60 days after the employer-paid coverage ends.

Dependents are not eligible for retiree term life insurance.

Retiree term life coverage is not available to those who:

  • Enroll in COBRA
  • Have a break in life insurance coverage

For more information concerning retiree life insurance options with MetLife please refer to the Certificates of Coverage for Washington and non-Washington residents.

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Basic Health Plan Of 1987

To address the growing problem of the uninsured, Washington enacted the BHP in 1987 as a 5-year pilot program of contracted managed care for residents with incomes below 200 percent of the Federal poverty level. By the early 1990s, approximately 24,000 previously uninsured residents were covered under the BHP . Even though the BHP covered only a small portion of the State’s uninsured population , several opponents of the HSA suggested in the study interviews that they considered the BHP to be a successful program that could be expanded to cover more of the uninsured population instead of enacting the HSA.

In conjunction with the BHP, the State’s Medicaid population was already being shifted into managed care prior to enactment of the HSA. Through the Healthy Options program run by the Medical Assistance Administration , each participant is assigned to a primary-care provider. Two models are being tested: full capitation and primary-care case management. The goal is to enroll all Medicaid recipients in one of these models.

Best Cheap Health Insurance In Washington For 2023

Find Cheap Health Insurance Quotes in Washington

The average cost of health insurance in Washington state is $470 per month for a 40-year-old with a Silver plan.

Ambetter has the cheapest health insurance in most of Washington state. Its low costs and good quality ratings make it the best health insurance company for most people in Washington.

Comparing plans can help you lower your costs. Shoppers save an average of $75 per month by choosing the cheapest Silver plan offered in their county. Additionally, those who have low to moderate incomes are eligible for discounted rates. In Washington, those who receive these subsidies pay an average of $132 per month for health insurance.

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Healthcare Policy In Washington

This article does not contain the most recently published data on this subject. If you would like to help our coverage grow, consider donating to Ballotpedia.

Healthcare policy in Washington
Percent of gross state product: 13.6%
6.5%
State healthcare policy
Healthcare policy in the U.S. Medicare Medicaid Obamacare overview
Years of data :2013: State population, percent uninsured, median annual income, average family premium, average employee contribution, and percent of income.2012: Total Medicaid spending.2009: Total healthcare spending, percent of gross state product, and total Medicare spending.

How Much Does Health Insurance Cost In Washington

Medicaid Update Webinar Session 7

Washington residents can expect to pay more for 2022 premiums. The state approved a slight increase of the average unsubsidized premium.9

These are plans with an effective date of January 1, 2022.

The average lowest cost for a 2021 metal plan sold on Washingtons health benefits exchange is as follows:

  • Average Lowest-Cost Bronze Premium: $280
  • Average Lowest-Cost Silver Premium: $380
  • Average Lowest-Cost Gold Premium: $422

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Benefits Health Plans Must Cover Under The Federal Aca

Under the ACA, the following 10 essential health benefits apply to individual/family and small employer health plans:

  • Ambulatory patient services: Covers outpatient care without being admitted to a hospital
  • Emergency medical services in an emergency department: Covers services provided in an emergency department if a medical provider believes the patient is having an emergency.
  • Hospitalization: Surgery and overnight stays.
  • Maternity and newborn care: Coverage for maternity and newborn health care.
  • Mental health substance abuse disorder services: Behavioral treatment, mental and behavioral health inpatient services and substance abuse disorder treatment.
  • Lab services: Such as blood draws or urinalysis, a medical provider orders.
  • Pediatric services: Health care for children from birth to age 19, including dental and vision care.
  • Prescription drugs: Medications a medical provider prescribes that patients buy through a pharmacy.
  • Preventive and wellness services and chronic disease management: Preventive services, such as shots and screening tests, at no cost to the patient when a medical provider from the plan’s network delivers the service.
  • Rehabilitative and habilitative services and devices: Services and devices to gain or recover mental and physical skills for people with injuries, disabilities or chronic conditions.
  • Washingtons Health Insurance Exchange And Enrollments

    Most states use the federal exchange via Healthcare.gov for Obamacare enrollment. But Washington created its own state-run exchange called Healthplanfinder.7

    You can use Healthplanfinder to shop for individual and family coverage, see if you qualify for financial assistance with health insurance costs, or apply for Medicaid.

    start on November 1, 2021 and end on January 15, 2022.

    Over 222,000 Washington residents enrolled in Obamacare plans for the 2021 open enrollment.8Sign ups were extended to December 30, 2019, instead of the usual December 15 deadline.After the deadline, you can only buy a plan if you have a qualifying life event, such as getting married. Otherwise, youll have to wait until the next enrollment period starting on November 1, 2020.

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    Unitedhealthcare Individual & Family Aca Marketplace Plans In Washington

    Looking for health care plans on the Affordable Care Act Marketplace? UnitedHealthcare Individual & Family ACA Marketplace plans offer affordable, reliable coverage options from UnitedHealthcare of Oregon, Inc.

    As part of the American Rescue Plan Act of 2021 and Inflation Reduction Act of 2022, many individuals and families are now eligible for lower or in some cases $01,2,3 monthly premiums for ACA Marketplace health coverage.

    Call / TTY 711 to talk to a licensed insurance agent.

    Washingtons Medicaid Program For Low

    FY 2017

    Medicaid is called Apple Health in the State of Washington. It includes a childrens health insurance program called Apple Health for Kids. If you qualify, you can enroll any time throughout the year.

    About 1.9 million low-income Washingtonians enrolled in Medicaid as of April 2021.11 This includes children under 19 and their caretakers/parents, foster care youths up to age 21, pregnant women, people with disabilities, the elderly, and childless adults under 65 who qualify due to Medicaid expansion.

    The income requirements to qualify for Medicaid in Washington vary. For instance, seniors and people with disabilities can earn up to 74% of the federal poverty level .This amount comes to roughly $9,531 a year for an individual in 2021. Parents and childless adults can earn up to 138% of the FPL, which is at or below $17,774 for an individual in 2021.12

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    Individual Health Insurance For Washington State Residents

    Washington State residents have several options for obtaining health insurance coverage. If you do not have health insurance through your employer or government programs, you can buy insurance for yourself and your family through the individual insurance market.

    This page provides information about applying for and comparing individual insurance plans in Washington, including through the states official health plan marketplace, Washington Healthplanfinder. You may also find this resource helpful.

    Washington Dental And Vision Plans

    Dental and vision insurance plans, underwritten by Golden Rule Insurance Company, have no age limit restrictions.4 They offer coverage for the dental and vision services many medical insurance plans dont include.

    From Seattle to Spokane, Tacoma to Vancouver, explore these Washington health insurance options and more that may be available now.

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    What Is The Definition Of A Disability

    Disability is defined as being unable to perform with reasonable continuity the duties of your own occupation as a result of sickness, injury, or pregnancy during the benefit waiting period and the first 24 months for which LTD benefits are payable. During this period, you are considered partially disabled if you are working but unable to earn more than 80 percent of your indexed predisability earnings.

    After the first 24 months, disability as a result of sickness, injury, or pregnancy, means being unable to perform with reasonable continuity the material duties of any gainful occupation for which you are reasonably able through education, training, or experience. During this period, you are considered partially disabled if you are working but unable to earn more than 60 percent of your indexed predisability earnings in that occupation and in all other occupations for which you are reasonably suited.

    Related Rules And Policies

    PEBB Retiree Benefits
    • WAC 182-12-171: When is a retiring employee or a retiring school employee eligible to enroll in PEBB retiree insurance coverage?
    • WAC 182-12-146: When is an enrollee eligible to continue PEBB benefits under COBRA?
    • WAC 182-12-200: May a retiring employee, a retiring school employee, or a retiree enrolled as a dependent in a health plan sponsored by PEBB, a Washington state educational service district, or SEBB defer enrollment under PEBB retiree insurance coverage?
    • WAC 182-12-205: May a retiree or a survivor defer enrollment or voluntarily terminate enrollment under PEBB retiree insurance coverage?

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    Awhp Health Plans Also Make Vital Contributions To Washington State’s Economic Health

    AWHP health plans employ your neighbors across Washington state, contribute millions to the stateâs general fund in premium taxes, help fund the stateâs high-risk pool and Health Benefit Exchange, and negotiate lower payments for your health care in all 39 counties in Washington.

    How Do I Reduce Or Decline Employee

    Note: Pierce County, Washington State University, and University of Washington employees use Workday to make changes.

    At any time, you can reduce or decline your coverage by submitting the Long-Term Disability Insurance Enrollment/Change form to your payroll or benefits office. If you later decide to enroll in or increase coverage, you will have to provide evidence of insurability and be approved by the insurer.

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    Washington Health Insurance Plans Fit For Your Needs And Budget

    Your healthcare needs and budget are as unique as you are. Thats why we offer Washington plans across a range of price levels. We can help you find a plan thats right for you, whether youre an individual who only needs emergency coverage or part of a large family with more extensive healthcare needs. Plus, financial assistance to help cover health insurance costs is available for those who qualify, so its easier to stay on budget and on top of your health.

    Qualified Health Plans And Other Individual Insurance

    States Collectively Spend 17 Percent of Their Revenue on Medicaid

    Children and adults can buy Qualified Health Plans if they are US citizens or have an eligible immigration status, are state residents, and are not in jail/prison.

    Children and adults can get subsidies to help with the costs of buying a Qualified Health Plan if they meet other requirements, including: having household income below 400% of the Federal Poverty Level not qualifying for public programs like Apple Health or Medicare and not having an affordable offer of coverage through a parent’s employer.

    You can shop and apply for coverage at Washington Healthplanfinder. Other individual health insurance plans are available outside the QHP marketplace at full price. Learn more here.

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    Brings More Savings And More Affordability

    • With the new Cascade Care Savings program, premiums could be less than $10 a month or as low as $0.
    • Streamlined offerings from the nine insurance carriers makes choosing the plan that is right for you easier than before.
    • Navigators are available in-person, on the phone and online to give you the help you need in selecting your insurance coverage.

    Health Insurance Rate Changes In Washington

    Health insurance in Washington costs 8% more on average for 2023 than for 2022. The largest cost increases were for Bronze plans, which increased by 9%. Insurance companies set their own rates and then send the rates to state regulators for approval.

    Metal tier

    Monthly rates are for a 40-year-old adult.

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    Medicare For Seniors And People With Disabilities In Washington

    Medicare is a health insurance program usually for people 65 and older. Close to nine out of 10 Washingtonians on Medicare qualify based on age. The other beneficiaries are younger adults with disabilities.13

    Among Washingtons roughly 1.3 million Medicare enrollees, nearly 7 out of 10 receive coverage through Original Medicare provided by the federal government.14It includes coverage for inpatient hospital and outpatient medical care. Other beneficiaries get Part A and B through Medicare Advantage, an alternative plan sold by private insurance companies.

    Medicare Advantage plans typically include Part D prescription drug coverage. But individual drug plans are also available. These plans are often paired with Original Medicare because it doesnt cover most prescription drugs. Close to half a million Washingtonians have a separate Part D drug plan.15

    Washington insurers also offer plans that help pay your Original Medicare out-of-pocket costs, including copayments, coinsurance, and deductibles. These plans are known as Medicare Supplement or Medigap.

    Is Individual Health Insurance The Right Option

    HCA Community Based Training Washington Healthplanfinder 2016 HBE Security Training Module 6

    Individual health insurance is one of several health coverage options for Washington residents. Most Washington residents get health insurance through an employer or government source instead. If you have other coverage options, you may not need to buy individual insurance. For example:

    • Employer-Sponsored Insurance. If you have affordable insurance available through an employer, you still can buy individual insurance as supplemental coverage, but you may not qualify for government financial assistance.
    • Medicaid . If you are eligible for Medicaid, called Washington Apple Health, you do not need to buy individual insurance. Apple Health provides free coverage to individuals and families with annual incomes below 138% of the Federal Poverty Level .1 There are higher income levels for children, pregnancy/postpartum, and certain other circumstances see here for an overview and here for details. If you are eligible, you can keep employer or other coverage that you have and still get Apple Health.
    • If you are over the age of 65 or have qualified for Social Security Disability Insurance benefits for more than two years, you are probably eligible for Medicare. You may want to consider supplementing that policy since you are still responsible for some costs. However, Medicare enrollees do not need to purchase full individual insurance.

    Learn more about these and other coverage options here.

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