Jane Dotson
If you're a resident of Washington state and are looking to get medical insurance, there are a few options available to you. Most residents get health insurance through an employer or government source. You can compare and shop for health insurance through the state Health Benefit Exchange website, Washington Healthplanfinder, which offers health and dental plans that meet the health reform standards of the Affordable Care Act. You can also apply for Apple Health (Medicaid), which is free or low-cost health insurance coverage for those who qualify. Additionally, if you are over the age of 65 or have received Social Security Disability Insurance benefits for more than two years, you are likely eligible for Medicare.
How to get medical insurance in Washington state
| Characteristics | Values |
|---|---|
| Official health plan marketplace | Washington Healthplanfinder |
| Other health care coverage options | Medicaid (Apple Health), Medicare, Employer-Sponsored Insurance |
| Eligibility for Apple Health | Available to those under a certain income level. Must be a citizen or legal resident of five years under the age of 65. |
| Apply for Apple Health | Any time |
| Apply for After-Pregnancy Coverage | Must report pregnancy before it ends |
| Apple Health Expansion | Available to people aged 19 or older with certain immigration statuses |
| Protection from out-of-network "surprise bills" | State Balance Billing Protection Act and federal No Surprises Act |
| Free, unbiased health care coverage counseling | Call 800-562-6900, 8 a.m. to 5 p.m., Monday to Friday |
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What You'll Learn
Medicaid (Apple Health)
To get medical insurance in Washington state, you can apply for Apple Health (Medicaid). This is a health insurance plan for people who are considered low-income or who need additional help with healthcare costs.
You can apply for Apple Health (Medicaid) by calling 1-877-644-4613 (TTY: 711), pressing 2 for Member Services, and then pressing 1. You will then receive a welcome packet and can start using your benefits. Alternatively, you can enroll through the ProviderOne Client Portal website or by calling the Health Care Authority at 1-800-562-3022 (TRS: 711).
Apple Health offers a range of benefits, including 24/7 access to healthcare services. To be eligible for Apple Health, you must meet certain income and residency requirements. You can check your eligibility and compare plans on the Washington Healthplanfinder website. This website also provides resources to help you apply for, renew, or update your coverage.
If you are not sure which health insurance plan is right for you, you can get free, unbiased healthcare coverage counseling in your local area by calling the Washington state Office of the Insurance Commissioner at 800-562-6900, Monday through Friday, 8 a.m. to 5 p.m. They can help you understand your options and choose the plan that best meets your needs.
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Employer-sponsored insurance
If you are an employee in Washington State, your employer may offer you health insurance as an employment benefit. This is known as employer-sponsored insurance. Group health insurance is a single plan that covers a group of people—in this case, a company's employees and their families.
According to a 2019 report by the Society for Human Resource Management, 82% of companies offer company-paid group life insurance benefits to employees. However, it is not a requirement for businesses to offer healthcare coverage. In Washington State, businesses with fewer than 50 full-time equivalent employees are not obliged to provide health insurance for their employees. Nevertheless, about half of employers with fewer than 50 employees still provide some health benefits.
If your employer does offer health insurance, they will typically pay a portion of the monthly premiums, with the remainder taken out of your paycheck. Most employers in Washington State pay 75% of the premium, with the employee paying the remaining 25%. However, some employers pay as little as 50%, while others cover the full cost (100%) of the premium.
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$14.97 $22.79
Medicare
There are Medicare Savings Programs available to help pay for all or part of the Medicare premiums. In 2025, your out-of-pocket costs for covered drugs will be limited to $2,000, but this only applies to drugs included in your Part D plan.
You can find out more about Medicare and your eligibility by referring to the official government handbook, 'Medicare and You', and 'Medicare Basics: A Guide for Families and Friends of People with Medicare'. You can also get free, unbiased Medicare help from the Washington SHIBA program, which provides information on Medicare options for people with disabilities, as well as counseling and events in your area. The Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine is another free service that can provide additional information about health insurance, healthcare access, and prescription access.
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Individual health plans
Washington state offers a variety of individual health insurance options through Washington Healthplanfinder, the state's health insurance marketplace. This is the best place to start when looking for individual health coverage in the state.
When to Enroll for an Individual Health Plan in Washington
Washington Healthplanfinder offers an open enrollment period each year when anyone can sign up for a health plan, typically from November to December for coverage beginning the following January 1st. Outside of this period, you generally must qualify for a You may want to see also Eligibility for health insurance in Washington State is dependent on several factors, including age, income, and citizenship or residency status. Here are the detailed eligibility requirements: Medicaid (Apple Health) Medicaid, known as Apple Health in Washington, is a free or low-cost health insurance program for eligible individuals. To qualify for Apple Health, you must meet specific income requirements and be a citizen or legal resident of the United States. Apple Health is available to individuals under the age of 65, and it covers a range of services, including primary care, emergency visits, maternity and pediatric care, dental, vision, and prescription medications. You can apply for Apple Health at any time through the Washington Healthplanfinder website. Medicare If you are over the age of 65 or have received Social Security Disability Insurance benefits for more than two years, you are likely eligible for Medicare. While Medicare provides valuable coverage, it may not cover all your healthcare costs, and you may want to consider supplemental insurance. Employer-Sponsored Insurance Most Washington residents receive health insurance through their employer or a government source. If you have access to affordable employer-sponsored insurance, you can still choose to purchase individual insurance as supplemental coverage. However, purchasing individual insurance in addition to employer-sponsored insurance may make you ineligible for government financial assistance. Qualified Health Plans (QHPs) Washington residents can also explore Qualified Health Plans (QHPs) through the Washington Healthplanfinder. These plans are available to those who meet the eligibility requirements, have a projected income at or below 250% of the Federal Poverty Level, and are not currently enrolled in a Cascade Care Silver or Gold Plan. QHPs offer health and dental plans that comply with the Affordable Care Act, and you can apply to see if you qualify for free or reduced-cost coverage. You may want to see also You can get medical insurance in Washington state through the state’s official health plan marketplace, Washington Healthplanfinder, or "off-Exchange" directly with an insurance company. Washington Healthplanfinder is the state Health Benefit Exchange website, where Washington residents can compare and shop for health insurance plans that meet the health reform standards of the Affordable Care Act. When you apply through Washington Healthplanfinder, you will be asked questions about your household and finances to see if you qualify for different health coverage programs, including the free Apple Health (Medicaid) program or a reduced-cost private plan.Medical Insurance and Rehab: What's Covered and What's Not
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Frequently asked questions
