Frequently Asked Questions
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Individuals and Families
Why do I need health insurance?
Having quality health insurance means that you and your family can get the care necessary to stay healthy. And when an accident or illness happens, a quality health plan can offer protection from huge medical bills.
Under the Affordable Care Act, individuals who do not have health insurance will have to pay a fine of $95 or 1 percent of household income in 2014, whichever is higher. The penalty increases to $325 or 2 percent of household income in 2015 and $695 or 2.5 percent of household income in 2016.
How is Washington Healthplanfinder different from websites that sell insurance now?
Washington Healthplanfinder is redefining people’s experience with health care. Unlike other websites that sell one company’s specific health insurance plan, Washington Healthplanfinder is a central location where multiple health insurance companies compete for your business. Depending on how much you earn, you can get access to financial help that lowers the cost of your premiums.
Washington Healthplanfinder also allows you to make side-by-side comparisons of health insurance plans, so you can choose the right plan based on cost, coverage, convenience and other factors. Plus, Washington Healthplanfinder gets rid of the fine print and makes it easier to understand what a plan covers and how much it costs. Every plan offered through Washington Healthplanfinder has been certified to meet the requirements under the Affordable Care Act.
What kind of plans are offered through Washington Healthplanfinder?
Washington Healthplanfinder offers private health insurance plans – Qualified Health Plans – and Washington Apple Health (Medicaid) for those who qualify. Every Qualified Health Plan offered through Washington Healthplanfinder has been certified to meet the requirements under the ACA and covers the 10 essential benefits.
If you are an employer who would like to offer employer-sponsored plans to your employees, please refer to our Small Business frequently asked questions.
Washington Healthplanfinder does not offer Medicare coverage. Visit the Washington State Office of the Insurance Commissioner website for more information regarding Medicare.
When can I purchase coverage through Washington Healthplanfinder?
The next open enrollment period for consumers to purchase a Qualified Health Plan runs from Nov. 15, 2014, to Feb. 15, 2015, for coverage beginning Jan. 1, 2015. You may be eligible for a special enrollment period to purchase coverage outside the open enrollment period if you have a qualifying life event. Enrollment for Washington Apple Health and enrollment for American Indians/Alaska Natives continues year-round.
What if I need coverage now?
While open enrollment for Qualified Health Plans doesn’t begin until Nov. 15, you may be eligible for a special enrollment period through Washington Healthplanfinder if you have a qualifying life event, such as losing other health coverage, moving to a new coverage area or getting married. You can read our special enrollment FAQ for a full list of qualifying life events and necessary documents for applying. If you are eligible for Washington Apple Health or are an American Indian/Alaska Native, you can enroll through Washington Healthplanfinder year-round.
If I buy a plan on Washington Healthplanfinder, will I still be able to go to my same doctors?
Washington Healthplanfinder offers a health provider search so you can see whether your doctor or hospital is in-network. Contact your carrier for the most current list of in-network providers.
How will Washington Healthplanfinder make coverage more affordable?
Depending on how much you earn, you can qualify for a free or low-cost health plan, or be eligible for financial help that can lower the cost of your premiums and copays. About 85 percent of Washingtonians that enrolled for coverage through Washington Healthplanfinder qualified for free or low-cost health insurance. Washington Healthplanfinder gives you the option check out the health coverage options available to you before you apply.
How does the Health Insurance Premium Tax Credit Work?
Also known as an Advanced Premium Tax Credit, this tax credit can be used to lower the health insurance premium costs of Washington Healthplanfinder Qualified Health Plans. If you are eligible, this tax credit provides you the option to either reduce the amount of your monthly health insurance premium or have a lump-sum deduction when you file your annual income tax return.
Your Advanced Premium Tax Credit is dependent on your household modified adjusted gross income. The household income and tax filing information you provide in your Washington Healthplanfinder application will determine how much tax credit you are eligible for. Any income changes should be reported to Washington Healthplanfinder in order to make a re-determination of your eligibility.
How much will each health plan cost?
Washington Healthplanfinder allows shoppers to find a plan that fits their needs and budget by offering side-by-side comparisons of health plans based on a variety of factors such as cost, quality and physician networks. Plan options are organized by metal tiers including Gold, Silver and Bronze based on the level of coverage they provide:
- Gold Plans: Gold plans cover 80 percent of the cost of essential health benefits, while the patient pays 20 percent.
- Silver Plans: Silver plans cover 70 percent of the cost of essential health benefits, while the patient pays 30 percent.
- Bronze Plans: Bronze plans cover 60 percent of the cost of essential health benefits, while the patient pays 40 percent.
All plans on Washington Healthplanfinder limit the out-of-pocket costs, including deductibles and co-payments, of $6,350 for an individual and $12,700 for a family. Use the Washington Healthplanfinder anonymous browsing tool to see how much a health plan could cost.
What if I need help choosing a health plan offered through your site?
Help is available online, over the phone and in person through a navigator or insurance broker. Experts will answer your questions and help you enroll in a health plan. Brokers help you choose a plan that fits your needs and budget. To find help, visit wahealthplanfinder.org and click on “Customer Support” or call the toll-free Customer Support Center at 1-855-WAFINDER (1-855-923-4633). Help is available in up to 175 languages.
I have insurance through my employer. Will I have to change plans?
Most individuals will be able to stay on their company’s health insurance plan. There is no requirement that you use Washington Healthplanfinder to purchase health insurance.
What is the Washington Health Benefit Exchange?
The Washington Health Benefit Exchange is a public-private partnership with the mission to redefine people’s experience with health care. As part of the Affordable Care Act, the Exchange is responsible for Washington Healthplanfinder – an easily accessible, online marketplace for individuals, families and small businesses to compare and enroll in qualified health insurance plans. The Exchange works in close coordination with our state agency partners, including the Health Care Authority (Washington Apple Health), Office of the Insurance Commissioner and Department of Social and Health Services.
How was the Exchange created and established?
The Exchange was created in state statute in 2011 (SSB 5445) and was established as a “public-private partnership,” separate and distinct from the state. The Exchange complies with open public meetings and public disclosure guidelines but is not subject to other laws that govern state agencies. In 2012, legislation was passed (ESSHB 2319) that established market rules, requirements for Qualified Health Plans, essential health benefits and more. The Exchange initially started in the state’s Health Care Authority (HCA) and has transitioned to an independent organization.
How is Washington Healthplanfinder funded?
Washington Healthplanfinder is currently funded by two federal Exchange Establishment grants through 2014. However, beginning Jan. 1, 2015, the Exchange is required to be financially self-sustaining. The Exchange worked closely with industry experts to formulate a projected operating budget and expected enrollment numbers. Senate House Bill 1947, which outlines a secure funding source for the Exchange and is most similar to the “hybrid” funding model the Exchange Board presented to the legislature in December 2013, was signed by Gov. Inslee on June 30, 2013. The state allocated the Exchange a $40 million annual budget that is generated from a current 2 percent premium tax on all plans sold through Washington Healthplanfinder. Any remaining funding needs will be generated through an assessment on participating insurance carriers. The Exchange Board is currently discussing additional funding needs for 2015. For more information, visit our Exchange Board page.
What’s coming up next for the Washington Health Benefit Exchange?
- Qualified Health Plans: Insurance carriers have submitted their plans to the Washington State Office of the Insurance Commissioner for approval to be offered through Washington Healthplanfinder for the next open enrollment period, which runs from Nov. 15, 2014, through Feb. 15, 2015. The Office of the Insurance Commissioner will review and approve these health plans and rates, and the Washington Health Benefit Exchange Board will certify the plans in August.
- Funding for 2015: The Exchange is working through several possible budget scenarios to craft a budget for 2015 that will maintain essential services such as the Customer Support Center, the functionality of Washington Healthplanfinder and IT infrastructure. The Exchange Board will vote on a budget proposal that will then be submitted to the legislature for review and approval.
How can the public get involved?
We work with consumers, community organizations, small businesses, insurance carriers, brokers and navigators to gather valuable input on our work. Examples include:
- Consumer Workgroup: The Consumer Workgroup includes community members and organizations seeking to offer input on a variety of issues related to Washington Healthplanfinder. You can find information about participating here.
- Public Comment: All Washington Health Benefit Exchange meetings are open to the public and open for public comment. These include our monthly Board meetings and technical advisory committees Click here for more information about submitting a public comment.
- Email Sign-Up: Consumers interested in receiving regular updates from Washington Healthplanfinder may sign up for our electronic mailing list page.
Why should my business use Washington Healthplanfinder Business?
Washington Healthplanfinder Business, which is currently available in Clark and Cowlitz counties, makes it easier to compare and shop for plans all in one place. Business owners will be able to see side-by-side comparisons of state-certified health plans, including the costs, premiums and what is covered. All plans will cover essential health benefits such as visits to the doctor and emergency room, prescriptions, and preventative care. In addition, plans will be offered in metal tiers based on the costs covered.
Washington Healthplanfinder Businessalso gives employers the freedom to determine their own level of contribution toward their employees’ coverage, and make a single monthly payment rather than payments to multiple plans. Consolidated billing will also be available so employers can provide workers a choice without the hassle of contracting with multiple insurers
Why are you only offering coverage options in Clark and Cowlitz counties?
Kaiser Foundation Health Plan of the Northwest was the only insurance carrier that filed to sell health plans through Washington Healthplanfinder Business. Plans are available for small businesses in Clark and Cowlitz counties with up to 50 employees. Rather than delay Washington Healthplanfinder Business, the Exchange debuted Washington Healthplanfinder Business to continue to our commitment to providing health coverage options for Washington’s small businesses.
A more robust business marketplace is expected for 2015. Two health insurers have submitted plans to sell through Washington Healthplanfinder Business. Kaiser Foundation Health Plan of the Northwest intends to continue selling small business plans in Clark and Cowlitz counties, while Moda Health Plan Inc. submitted small business plans that would be available statewide.
When can I enroll in Washington Healthplanfinder Business?
Open enrollment for Washington Healthplanfinder Business continues year-round. New plans will be offered on Washington Healthplanfinder Business starting Oct. 1, 2014, for coverage beginning Jan. 1, 2015.
What if I have questions or need help?
Washington Healthplanfinder Business provides personalized support for your small business to help answer questions as you choose the best coverage for you and your employees. Employers needing application assistance can contact Washington Healthplanfinder Business Support at 1-855-256-9598. You can also work with a registered Washington Health Benefit Exchange broker to choose plans and enroll through the website. Brokers are free and can offer advice on choosing the right plan for your business.
Will I still be able to use my broker to get health insurance?
Yes, you will be able to continue using your broker as long as they have been trained and registered with the Washington Health Benefit Exchange to sell health plans through Washington Healthplanfinder; however, brokers must also be appointed by respective health insurance carriers to sell specific health plans.
Do I have to get insurance for my employees? What happens if I do not cover my employees?
If you have fewer than 50 full-time employees, you are not required to provide them with health insurance coverage. However, good benefits can help recruit and retain good employees
Can I use Washington Healthplanfinder Business if my company has more than 50 employees?
Employers with more than 50 employees may be eligible to purchase coverage through Washington Healthplanfinder Business in 2016.
What if I am self-employed?
Because a small business is defined as having up to 50 employees, self-employed individuals may purchase health insurance through Washington Healthplanfinder Business or through the individual market on Washington Healthplanfinder.