Washington is a U.S. state that was named after President George Washington and was admitted into the union in 1889. The state boasts a booming economy, as it is home to Amazon.com and is a mature tech sector led by Microsoft. It is also one of the healthiest state of the U.S. and residents of this state in order to maintain its good position need to keep up with their health. Undoubtedly, eating healthy and staying active is one of the way of healthy lifestyle but residents should also not ignore the significance of right health insurance plan that not only protect them from high medical bills in case of medical emergency but also make their life much more better and organized. By having a comprehensive health coverage, residents can directly work with the primary care physician to come up with preventive health care plan that will keep them in best shape. Residents who are new to health insurance market of the state should know that the state runs its own exchange, known as Washington Healthplanfinder. Though, the state has a strong off-exchange health insurance market too but subsidies can only be availed through the Washington Healthplanfinder. Open enrollment period for the 2020 health insurance plans ended on December 30, 2019 and nine health insurance carriers are offering health plans in 2020. Washington has enacted legislation in which it has directed the state to come up with standardized health plans for the individual market and a public opinion in which the state will contract with private insurer to offer health plan from 2021.
Washington Health Insurance Marketplace Highlights and Updates
- The next open enrollment period will commence from November 1, 2020, for 2021 coverage, as open enrollment for 2020 coverage ended on December 30, 2019.
- For health insurance coverage 2020, more than 212,000 people enrolled in Washington.
- The average health insurance rates slightly decreased in 2020.
- The state has enacted a legislation to to create the standardized health plans that will be available by 2021. The standardized plan designs was approved by the exchange in late 2019.
- A legislation was enacted in 2018 to ensure health plan availability in exchange and another legislation was enacted in 2019 to prevent consumers from surprise balance billing. Both these bills came into effect in 2020.
- In 2020 a legislation was introduced to create state-based premium subsidies for residents with income up to 500% of the poverty level. However, the subsidies will be available as of 2022 for people buying plans from Washington’s exchange.
- In Washington short-term plans can be sold only for a period of up to three months.
- Nine insurance carriers are offering health plans in 2020.
Individuals & Family Health Plans
Residents of Washington who do not receive coverage from their employers or government programs or who are currently unemployed, or students who are no more covered under their parent’s plan can shop for individuals and family plan either through private insurance carriers or through participating insurance companies offering plans through the state exchange. Thus, residents who are without the access to employer-sponsored coverage can shop for individual and family plans either in the private marketplace or through the federal marketplace exchange. All the qualifying individual and family plans available in the health insurance market should offer all the standardized essential benefits like hospitalization, emergency services, ambulatory patient service, maternity and newborn care, prescription drugs, mental health, preventive & wellness, chronic disease management and pediatric services. Beside these benefits, the Washington state has also mandated additional benefits like reconstructive surgery and diabetes care management. Some of the individuals and family plans available in the state are:
Preferred Provider Organizations or PPO Plans – Preferred Provider Organization is a medical care arrangement in which a large network of hospitals, specialists and doctors and medical facilities are maintained to provide healthcare services to subscribed members at reduced rates. Healthcare providers and medical facilities included in the network are called preferred providers. PPO plans are the most popular plan in the individual and family segment because these plans are more comprehensive in their coverage and offer a wider range of providers compared to HMO plans. Though these plans may come at an increase price, as these plans are costlier to administer and manage. PPO is a managed-care organization comprising of medical professionals having contract with the insurance provider who agree to render medical services at an agreed-upon reduced rates to the members. Members of the PPO plans are encouraged to use the insurance company’s network of preferred doctors and they are not required to choose a primary care physician. Members of the PPO plans have an annual deductible to pay before start receiving coverage for their medical bills and they may also have a co-payment of a fixed amount for certain services or may require a certain percentage of their medical bills.
Health Maintenance Organization Plan – Health Maintenance Organization has a network of healthcare providers offering basic and supplemental health services to its members. The healthcare entities such as physicians, clinical facilities and specialists enter into contracts with the HMO on an agreed-upon fee to offer a range of medical services to the HMO’s members. Due to the agreed-upon fee, HMO plans have lower premiums compared to other health insurance plans while maintaining the quality of healthcare from its network. Members of the HMO plans are required to first receive healthcare from their primary care physicians, as their PCP will take care of most of their healthcare needs and also provide a referral to see a specialist. Members of the HMO plans have lower out-of-pocket healthcare expenses, as co-payments are minimal and there is no deductible to pay before the start of the coverage. However, members of HMO plans should keep in mind that there will be no coverage for healthcare services received from out-of-the-network providers and for services rendered without a proper referral from their PCP. Members do not require to submit any of their claims to the insurance company, as healthcare providers submit the claims on their behalf.
High Deductible Health Plan with HSA – Individuals can manage their health care expenses by enrolling in a High Deductible Health Plan along with opening a Health Saving Account. Individuals enrolled in HDHP with an HSA can pay their deductibles along with other qualified medical expenses using the money kept in their tax-free Health Saving Account. Enrollees of this plan benefit from a lower monthly premium and they can even use the money saved in their HSA to pay for additional healthcare received. The balance saved in the HSA rolls over year to year, thereby allowing individuals to build up reserve to later pay for their healthcare services if required. A high-deductible health plan comes with lower insurance premiums that allows individuals to qualify for a tax-advantaged Health Savings Account. This type of individual plan is considered best for younger, healthier people, who generally don’t require healthcare coverage except for the medical emergency. This plan is also recommended for wealthy individuals and families who are well capable of paying high deductible out of pocket and want to have the benefits of HSA.
Flexible Spending Account – FSA is an account in which individuals contribute a specific amount of money every year to pay for certain medical expenses, dental care and vision. The amount which the individuals decide to contribute for the year is deducted from their salary before income taxes, thus the taxable income of the individuals are reduced that also save their money on taxes. To pay for the medical expenses, individuals either have a debit card or they need to submit receipts and documentation for reimbursement. The amount saved in the account can be used by the individuals for their own medical expenses or their spouse or any dependent medical expenses. Individuals need to decide that whether FSA is right for them or not. If they are ongoing any treatment or they expect medical needs later in the year, then FSA will prove beneficial as they will be able to use the amount to pay for their future medical expenses. Individuals who are not undergoing any treatment and don’t expect any medical expenses later in the year then they should not put their money in FSA.
Short-term Plans in Washington
In Washington though short-term plan is technically allowed but it is not available in the state, as no insurance carrier has come up with the short-term plan in the state. As per the federal laws short-term plans in Washington too lasts up to 36 months but like many other U.S. states even Washington follows its own rules regarding the short-term plans. According to law, short-term plans in Washington cannot last longer than 90 days, the plans should meed minimum benefit requirements and short-term plans cannot be issued during the annual open enrollment period. Individuals are not not allowed to renew their short-term plans after three months duration and purchasing a short term health plan in Washington will make individuals ineligible for any guaranteed issue health plans referred as COBRA or HIPAA plans. Due to several limitations, insurance carriers are reluctant to offer short-term health plans in Washington. No insurance carriers were offering short-term plans in the state in 2019 but for 2020 coverage LifeMap’s short term plan are available for purchase after December 15, 2019. As per the new regulations, short-term plans cannot be sold to individuals who have had three months coverage in the past 12 months.
Dental Insurance Plan in Washington
Dental insurance plans in Washington usually cover most preventive and basic dental procedures and some of the dental care services which are generally included in dental insurance plans are regular check-ups, teeth-cleanings, standard X-rays and some of the plans even cover root canals, extractions, crowns and bridges. Dental plans offered by different insurance carriers differ in terms of benefits, costs and out-of-pocket expenses, so individuals shopping for dental insurance in Washington are advised to carefully read the plan details before enrolling in any dental plan. Dental insurance plans available in Washington include:
Dental Health Maintenance Organization Plan – DHMO works exactly like a HMO health insurance plan. DHMO maintains a network of dental care providers who offer dental care services to members. Members of this plan are required to see a dental service provider within their network to avail dental benefits offered by the insurance carriers. Dental health Maintenance organization plan is the most affordable dental plan compared to other but these plans do not offer much flexibility to the members in terms of choosing a dentist is concerned for availing dental treatments.
Preferred Provider Organization Plan – With a Preferred Provider Organization dental plan, members can visit dentist of their choice, irrespective of the fact that whether the dentist is in their plan’s network or not. However, members of the PPO dental plan avail more discount on dental services upon visiting an in-network dentist. However, members should be aware that PPO dental plans are expensive compared to dental HMO plan but the extra cost provide members more flexibility and freedom in choosing the dentist of their choice.
Dental Discount Plan – Dental discount plan is not actually a type of dental insurance, as these do not cover any cost of dental care services, rather it allows individuals to save money on dental care by offering discount ranging from 10%-60% on dental treatments and services they receive.
Vision Insurance Plan in Washington
Washington residents must be aware of the significance of a good vision plan, as it helps them maintain optimal vision and eye health. With frames, lenses and contact being fairly expensive, vision insurance plans become essential to offset those costs. Individuals whose qualified health plan does not include adult vision coverage then they should purchase a stand-alone vision plan that provides coverage on eye-exams and glasses. Individuals having vision insurance plan get personalized care at low out-of-pocket costs and stylish eye-wear of their choice at discounted rates.
In Washington currently following nine Health Insurance Carriers are offering Health Insurance Plans in 2020 through Healthplanfinder:
- BridgeSpan Health Company
- Coordinated Care Corporation
- Kaiser Foundation Health Plan of Northwest
- Kaiser Foundation Health Plan of Washington
- LifeWise Health Plan
- Molina Healthcare
- PacificSource Health Plans
- Premera Blue Cross
- Providence Health Plan