|Open Enrollment Period for the Exchange
The open enrollment period for Washington’s Exchange starts on October 1st for coverage beginning January 1, 2014. In Washington State alone, close to 1 million uninsured will be able to search for affordable plans that address their needs. This page will provide you with more information, answers to frequently asked questions, and resources you may need during the Open Enrollment period. If you have any further questions, please call either my office at 425-793-5180.
How do I get health insurance in Washington State?
Washington State has set up its insurance marketplace and begins enrollment on October 1, 2013. The new marketplace is called, "Washington Health Benefit Exchange" and can be accessed at http://www.wahbexchange.org/. At this site, you will be able to shop for and compare plans, find information about whether you may be eligible for help to pay your premiums and enroll in the plan of your choice.
This is the official site for enrollment. Look-alike sites have popped up, so make sure you follow steps to protect yourself from fraud or scams.
What if my health insurer is changing my plan?
Insurance Commissioner Mike Kreidler addressed this directly in a blog post.
Here is information from the Washington State Office of the Insurance Commissioner:
“Under health reform, all health insurance plans are required to add certain new health benefits. If you buy your own health insurance, chances are you’ve just received a notice from your health insurer telling you of the changes and about the new plan that most closely resembles your current coverage. This includes your new monthly rate, only if you opt to move to the plan your insurer suggests.
Many of these letters can be alarming and we understand your concerns, but here are some important things to consider:
• Starting Oct. 1, you have the right to choose any plan sold inside the new Exchange – www.wahealthplanfinder.org or directly from an insurance company, regardless of your health status. If you buy from the Exchange, you could qualify for subsidies depending on your income. In the past, many people were forced to keep their current plan even if the costs increased because they couldn’t pass a heath screen.
• If you’re an individual earning less than $45,960 a year ($94,200 for a family of four) you could qualify for a subsidy to help you buy a plan in the Exchange. Also, individuals under age 30 or anyone who can show a financial hardship can buy a catastrophic plan.
• Most heath plans sold in the old individual market only covered 30 percent to 40 percent of your medical services – leaving the rest to you to pick up through copays and deductibles. And most plans’ deductibles did not count toward your out-of-pocket maximum, meaning once you met your deductible, you continued to pay cost-sharing and copays up to $10,000 or $15,000 a year in some cases.
• Starting Oct. 1, all health plans must cover at least 60 percent of your medical services. Also, your out-of-pocket maximum includes your deductible and your cost sharing. In most cases, this amount is limited to $6,350 a year. If your health plan does not include a specialty provider, they must allow you to see that provider at in-network costs.
• All plans must include, at a minimum, 10 essential health benefits:
o Ambulatory patient services
o Emergency services
o Maternity and newborn care
o Mental health and treatment of substance abuse disorders, including behavioral health treatment
o Prescription drugs
o Rehabilitative and habilitative services and devices
o Laboratory services
o Preventive and wellness services and chronic disease management
o Pediatric services, including oral and vision care
In the past, individual health plans didn’t cover many of these benefits, such as maternity and prescription drugs. Washington state’s essential health benefits are based on the benefits in our state’s largest small employer plan, the Regence Innova plan and ensure that individuals buying their own health insurance have meaningful benefits critical to their wellbeing.
• All health plans now include approximately $500 worth of free preventive services including a wellness visit, immunizations and cancer screenings.
• There 46 different health plans from eight insurers available in the Exchange, starting Oct. 1. And there are additional plans being added for sale outside the Exchange. If you have questions about your options or why your health plan is changing, contact the Insurance Commissioner’s office at 1-800-562-6900.
• Don’t just take your insurance company’s best guess of what’s right for you and your family, shop around. Take a look at this map of all health plans by county approved for sale in the wahealthplanfinder and outside the Exchange, or starting Oct. 1, go to www.wahealthplanfinder.org to see your new options. “
How can I get help paying for my health insurance?
The Affordable Care Act provides help for eligible individuals, families and small businesses to pay for health insurance. These programs range from tax credits that lower the cost of premiums to subsidy payments covering out-of-pocket costs like co-payments for medical procedures.
For help finding how much assistance you may be eligible for, check out The Kaiser Family Foundation's subsidy calculator.
If you are a business owner, check out the Small Business Majority’s tax credit calculator to help find out how much help you can get providing health insurance for your employees.
For more information:
Affordable Care Act benefits
General Questions on Affordable Care Act Nationally, or call 1-800-318-2596
General Info and Questions on health care in Washington State
To compare plans in Washington State