En español | The majority of Washingtonians are eligible to buy health insurance through Washington Healthplanfinder, the state’s Affordable Care Act (ACA) marketplace, during open enrollment, which opens Nov. 1, 2023, for 2024 health insurance coverage.
Residents who experience a qualifying life event, such as a marriage, divorce, the birth of a child, a move or lost health insurance, may be eligible to buy or change coverage outside the open enrollment period. Or you may qualify for a special enrollment period for other reasons, including if you’ve experienced domestic violence or believe there’s been an error in the enrollment process.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households that qualify for them. Every household that pays more than 8.5 percent of its income qualifies for federal tax credits to help afford coverage. These enhanced subsidies are available through 2025.
Before the new law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person).
Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
Who is eligible?
- Most Washingtonians, including U.S. citizens and lawfully present immigrants with a wide range of statuses, as outlined on the Washington Healthplanfinder website, are eligible to buy health insurance regardless of whether they are currently insured.
- You may also qualify for Washington Apple Health (Medicaid), which offers free or low-cost coverage to low-income people and families. Children and pregnant individuals may qualify for Washington Apple Health coverage, regardless of their immigration status. If you’re not a U.S. citizen, check eligibility requirements on the Washington State Health Care Authority website to see if you qualify.
When can I enroll?
- Washington Healthplanfinder open enrollment for 2023 health insurance coverage has closed. Open enrollment for 2024 coverage begins on Nov. 1, 2023, and runs through Jan. 15, 2024.
- You can enroll during a special enrollment period if you experience a qualifying life event, but in most situations you only have 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
- If you have experienced domestic violence or abandonment, think there’s been error in the enrollment process or have any other circumstances you’d like to discuss, call Washington Healthplanfinder customer support toll-free at 855-923-4633. You may qualify for coverage during a special enrollment period.
- Year-round enrollment is open to Washingtonians who qualify for Washington Apple Health and to members of a federally recognized American Indian/Alaska Native tribe or a shareholder in an Alaska Native Corporation.
How do I sign up?
After you submit an application for coverage, you’ll receive an email invitation to select a plan online, by phone or in person. If you select a plan by the 15th of a month, your coverage will go into effect on the 1st of the following month. If you select a plan later in the month, your coverage will be delayed another month.
To apply and enroll:
- Online: Go to the Washington Healthplanfinder website, where you’ll find steps to apply and can click on the Apply Now button.
Click on the blue Virtual Help button on the website’s home page or send an email form if you need help or have questions.
- By phone: Call Washington Healthplanfinder customer support toll-free at 855-923-4633, where assistance is available in 175 languages. If you’re hard of hearing, call the TTY line at 855-627-9604. Customer service is available 7:30 a.m. to 5:30 p.m. PT, Monday through Friday.
- In person: Insurance brokers can help you choose a plan, while “Navigators” can answer general questions and help you navigate the enrollment process. Both are typically available for free by phone, virtually or in person. Contact an enrollment center or supporting organization in your area to set up an appointment. The Washington Healthplanfinder website also lets you search for an insurance broker or navigator in your area to arrange a one-on-one meeting.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Washington Apple Health, you’ll be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Washington Healthplanfinder plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health and substance use treatment
- Chronic disease management
- Prescription drugs
- Lab work
- Pediatric care
- Preventive services, including counseling, screenings and vaccinations
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family. Deductibles and out-of-pocket costs vary between plans.
Washington law requires children to have dental coverage. Dental is included for children and adults in Washington Apple Health (Medicaid) plans, but dental policies need to be purchased separately if you enroll in a Washington Healthplanfinder plan. You can select a dental coverage plan while shopping for your health plan.
What about federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have seen average annual savings of over $950.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
Washington Healthplanfinder offers several kinds of plans, including new Cascade Care plans, developed exclusively for the state. The Cascade Care plans offer on average $1,000 lower deductibles, easier access to pre-deductible care and more transparency.
All plans offered through Washington Healthplanfinder, Cascade and otherwise offer three tiers of coverage:
- Bronze plans have the lowest monthly premiums, the highest deductibles and copays, and cover roughly 60 to 65 percent of care costs.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of care costs.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
Washington Healthplanfinder’s Smart Planfinder tool helps you browse your options, estimate costs and benefits of various plans and check whether you might qualify for financial assistance.
What if I already have health insurance?
If you already have coverage directly through an insurance provider but are eligible for lower premiums, you can switch to a Washington Healthplanfinder plan. But you may need to wait until open enrollment.
You may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage to qualify for the tax credits.
If you lose your COBRA coverage, you may be able to sign up for a Washington Healthplanfinder plan during a 60-day special enrollment window. Try to apply and select your plan through Washington Healthplanfinder before your COBRA coverage ends to make sure there’s no gap in coverage.
Will I need to get a new doctor?
That depends. Major insurance providers, including Premera Blue Cross, Lifewise Health Plan, Coordinated Care, Kaiser Permanente and others, offer Washington Healthplanfinder plans, but not all doctors accept them. The insurance company websites include links to search for doctors in their networks, but you should double check with your doctor’s office to see whether a certain doctor or practice will accept a Washington Healthplanfinder plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status. Such families, if they choose to enroll in different programs, may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
If you’re not sure what makes the most sense for your family, get free advice from a certified insurance broker.
This guide was updated on Feb. 3, 2023, with information about open enrollment.