The nation’s largest producer of apples, birthplace of Starbucks, and headquarters of Microsoft, Washington state is home to a myriad of major businesses. The state also is known for its busy port and ecosystem, the Puget Sound, as well as mountain ranges including the highest point in the state, Mount Rainier. Natural preservation is a high priority for Washingtonians due to their beautiful, massive rainforests occupying much of the state, and in contrast, a desert region to the east optimized for farming.
Those who live in Washington have a few options for individual health insurance, with plans offered through LifeWise Health Plan of Washington, Assurant Health, and Group Health. While we are not yet licensed in Washington, we can serve as a resource for the various outlets for coverage available to you. There are also government health programs to allow those without the means for a private policy to have some kind of health care.
The state of Washington has continually been a fairly healthy region of the country, remaining within the top 19 most healthy states for the past 10 years. However, in the past year, it has declined due to several factors. Most of the state’s health statistics are average compared to other states, falling in the upper-middle range for obesity, the size of the state’s uninsured population, public health funding, and available primary care physicians. Obesity has increased, as in every state, now affecting over 1.3 million adults in the state.
Smoking has also increased over the past year in Washington by 3 percent, making the population of smokers 782,000. Overall, Washington still has a significantly lower percentage of smokers than other states at 15.2 percent. Diabetes is also less common than many other states, despite an increase over the years. Preventable hospitalizations for Medicare beneficiaries is very low in Washington, as well. These factors were based on the UnitedHealth Foundation’s annual rankings survey of each state’s current health.
Health Insurance Plans
LifeWise Health Plan of Washington
- WiseSimplicity plans offer coverage on a select few but important services, such as inpatient and outpatient hospital care and physician office visits. Ideal for those who do not anticipate using medical services much throughout the year, these plans cover one preventive care exam with the deductible waived. With a deductible of $10,000, monthly premiums are lower, and all covered services are available at no cost after deductible. Out-of-network care is also covered at 50 percent after a $20,000 out-of-network deductible.
- WiseEssentials Copay have deductible options of $5000 and $7500 for individuals, with the great advantage of first-dollar benefits. Services covered for a copay before meeting the deductible include three PCP or specialist visits for $25 and emergency care. Prescriptions are covered through the LifeWise discount card program, and major medical care is covered by your plan at 75 percent coinsurance after deductible. Premiums are also relatively low with Copay plans due to the high deductible.
- WiseEssentials 6 plans are available in deductibles of $1880, $2500, and $3500 for individual applicants, and provide a greater amount of benefits than the Copay plan. With the deductible waived, your first six office visits for either primary care or specialist services are covered at 75 percent. Once your deductible is met, all covered hospital services including outpatient surgery and inpatient stays. Preventive care is covered for no cost with no visit limit when your plan begins. Prescriptions are also only covered through the discount card.
- WiseAdvantage plans have an $1800 deductible, and offer immediate coverage for a copay with higher cost sharing. These plans cover prescription drugs after meeting your deductible, at 20 percent for generics and 50 percent for brand names. Office visits with any type of physician is covered for a $30 copayment, and preventive care for no charge as soon as your plan begins. These plans have an $8300 out-of-pocket limit, which includes the deductible. WiseAdvantage plans cover your major medical costs at 65 percent after deductible.
- WiseSavings plans are HSA-qualified plans with 20 percent coinsurance on a wide range of services after deductible. For individuals, deductible choices are $1880 and $3000. Out-of-pocket limits vary based on your deductible, and non-network care is covered at 60 percent after deductible. These plans cover hospital care of various sorts, as well as chiropractic care and mental health care for 20 percent coinsurance after deductible. Using a health savings account gives plan members responsibility and control over medical expenses, which results in tax benefits.
- Assurant Catastrophic plans are available in deductibles ranging from $2,000 to $10,000, with various options to customize your coverage. Covering the first four doctor’s office visits for a $35 copay before meeting the deductible, these plans also offer a full array of preventive care services instantly. After deductible, these plans cover 75 percent of major medical care including emergency care, outpatient surgery and labs, and hospitalization. Chiropractic care and mental health are also covered.
- Assurant Comprehensive plans cover prescription drugs, preventive care, and your first four physician office visits before meeting the deductible. Generic prescriptions are a $15 copay, and primary care or specialist visits are $35. Brand name prescriptions are covered at 50 percent by your plan. Once the deductible has been satisfied, you pay 25 percent coinsurance for all hospital services, inpatient or outpatient. Maternity care is included in the benefit set for these plans.
- Assurant HSA plans are available in a $2700 deductible for individuals, with a $9400 out-of-pocket limit. All types of preventive care are covered at no charge when your plan begins, and all other covered services are 20 coinsurance after deductible. These plans allow members the option of opening a health savings account to help fund their medical care with tax advantages. Prescriptions can be covered through the discount card program. These plans cover emergency care, surgery, inpatient stays, lab work, and more.
- Balance plans are available in catastrophic or standard coverage, with the traditional Balance plan covering 80 percent after deductible, and catastrophic covering 50 or 60 percent. Deductibles for individuals are $1750, $2500, or $5000. Each of these options cover unlimited primary care visits for a $30 copay, and specialist visits for $50. Preventive care is also covered in full when using in-network providers with the deductible waived. These plans cover most major medical care, including prenatal and postnatal office visits at 100 percent as a preventive benefit.
- Welcome plans also offer either catastrophic or traditional coverage, in deductibles of $1000, $2000, or $3000. Welcome 1000 plans cover 80 percent of your hospital care after deductible, and the higher deductibles cover 50 or 60 percent. All Welcome plans provide the first four office visits to a primary care doctor for a $30 copay, and the first four specialist visits for $50. Prescriptions are not covered with these plans, though all preventive care services are for no cost including pre and postnatal office visits. After deductible, Welcome plans cover emergency care, inpatient and outpatient care. Chiropractic care is covered as a primary care office visit, limited to 10 visits per year.
- HealthPays HSA plans are available at annual deductibles of $2000 and $2750 for individuals, with the ability to pair your plan with an HSA. Once you meet the deductible of either level, your plan coves 80 percent of most medical services, including physician visits and all of the hospital care covered by Assurant catastrophic plans. As soon as your plan begins, preventive care is covered at 100 percent when using in-network providers. If you choose to opten a health savings account, there are various tax benefits available.
Public Health Options
Washington State has many services and programs available to its residents who cannot afford health insurance on their own. Families and children, as well as disabled, blind, elderly, or pregnant individuals can apply for Medicaid if their income falls within in a certain range of the federal poverty level. Uninsured children of all income levels are accepted for the Children’s Health Insurance Program, Apple Health for Kids. Other services and programs are available through the state for individuals with medical or financial needs. View a more complete list of programs at the Washington State Department of Social and Health Services.
- Medicaid: health care coverage for low-income individuals and families in Washington.
- Apple Health for Kids: medical insurance for uninsured children living in Washington of any household income.
- Pre-Existing Condition Insurance Plan: coverage administered by the Washington State Health Insurance Pool for high-risk individuals who have been uninsured over 6 months.
- Immunizations: programs available to individuals of all ages to prevent illnesses and diseases.
Health Insurance Laws
Insurance companies in Washington are more lenient than some states in regards to pre-existing conditions, with a look-back period of six months to determine qualification for such a condition. In Washington, if an individual has had any sort of illness or condition six months prior to applying for health insurance, whether they treated it or not, they are subject to rejection. If an insurer decides to provide the individual with a plan, they can impose a waiting period of up to 9 months before they will cover the care of the condition.
Also, individuals who have a pre-existing conditions can receive a credit for previous coverage if they had paid they premiums on time and not experienced any coverage gaps. Those who have pre-existing conditions and have been turned down for coverage or uninsured for at least six months can apply for Washington’s high-risk pool, PCIP. This system replaced the former health insurance pool, and offers health insurance to eligible adults with health problems.
In the individual market in Washington, insurers must guarantee issue of all their products to those who earn a minimum score on a state mandated health status questionnaire, or a physical exam. Individuals who do not qualify for guaranteed issue are then directed to the PCIP for coverage. HIPAA eligible individuals in Washington have the right to guaranteed issue coverage with private insurance companies, though only in counties where such policies are actively marketed. Those who live in counties without access to the private market are also referred to the high-risk pool.
Washington state also has limitations based on certain individual characteristics for rate restrictions. This means they cannot increase premium rates based on an applicant’s health status, gender, or occupation. The state operates on the “Adjusted Community Rating,” where premiums can increase based on age and tobacco use in Washington. In 2014, the laws are due to change drastically, with many alterations to current policy which will directly affect the individual insurance market in every state.