Washington Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
August 18, 2020

Washington Affordable Healthcare Insurance

When it comes to health insurance plans, the residents of Washington have several options. It’s best to understand your health insurance coverage options so you can compare rates carefully. If you’re an individual or you’re buying coverage for a family, you can buy the health coverage you need at for best value by comparing your options with SmartFinancial. In most cases, you may only enroll in a health plan during open enrollment. However, in certain circumstances, you are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in Washington?

November 1, 2020 - December 15, 2020. Coverage begins January 1, 2021.

How to Get Health Insurance in Washington

Consider how many times you visited a health care provider in the past year or had any services that insurance covers. Based on this information, you can estimate your health care needs for 2021. This information can help you decide which type of coverage is right for you, and which level tier will be more cost effective. A higher premium health insurance plan may end up saving you money if you have frequent doctor visits.

The smartest way to get the best rates for the coverage you need is to compare health insurance companies and health insurance quotes. You’ll get several health insurance rates, and we’ll connect you with a knowledgeable agent in your area so you can learn more about the plan you’re considering.

What Types of Health Insurance Are Available in Washington?

HMOs, EPOs, PPOs and POS plans are available in Washington. You also have the option of a bronze, silver or gold plan, with bronze being the cheapest monthly premiums and gold being the most expensive. However, with a bronze plan you will pay more when you see a provider or have a procedure. That is why it’s important to consider your needs before choosing the plan that saves you the most money in the long run. Consider that 60% of your costs are covered by a bronze plan versus 80% with a gold plan. You’d probably save money with the gold plan if you see your doctors frequently.

Does Health Insurance Cover Pre-existing Conditions?

Under the Affordable Care Act, it is now illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • Lost or quit a job. Did you start a new job or open a new business? Did you lose a job and your health insurance? If so, you qualify for the special enrollment period. If you changed jobs and are not offered health insurance, you qualify to buy health insurance too.
  • Turned 26. When you turn 26, you can enroll in an individual health plan.
  • Moved out of state or out of the coverage area Your health plan may only be valid in certain areas. If that’s the case, you can buy a new health insurance plan outside the enrollment period.
  • Cobra coverage ended. Did you elect Cobra coverage when you left your job? The Cobra extension has a deadline. When you reach the deadline, you can enroll in a new health plan.
  • Divorce. If you used to be married and shared health insurance coverage but are now divorced, you can enroll in a new plan.
  • Marriage. Did you just get married? If so, you’re eligible to start a new health plan together or be added to a spouse’s plan.
  • Birth or adoption of a child. As soon as you have a baby (or when you bring your baby home), you can buy health insurance for that baby.
  • Death of spouse or partner. If you share a health insurance plan with your spouse or partner and they pass away, you can enroll in an individual plan.
  • Spouse of partner loses coverage. If you had insurance through a partner or spouse and they lost coverage for a qualifying reason, you may buy an individual plan or buy coverage together.

Is Health Insurance Required in Washington?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Washington?

The average cost of health insurance in Washington for a 40 year old is about $370 a month. Health insurance only gets more expensive as you age. Tobacco use increases health insurance premiums considerably.

How to Save on Health Insurance in Washington

The best way to save on health insurance in Washington is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.


Medicare in Washington

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Washington?

18% of the population in Washington is on Medicare

How Much Is Medicare in Washington?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Washington

If you are already receiving Social Security payments, you may automatically enroll in Medicare. Otherwise, you need to sign up. The best way to enroll in Medicare is by working with a trusted insurance agent to learn about the coverages available to you. Enter your zip code and answer a few quick questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Washington?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.


Washington State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2019 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Washington Health System is listed below:

  • Washington: Overall State Ranking: 4 of 50
  • Washington: Overall Performance: Above Average
  • Washington: Access & Affordability: 13
  • Washington: Prevention & Treatment: 18
  • Washington: Avoidable Hospital Use & Cost: 3
  • Washington: Healthy Lives: 8
  • Washington: Health Care Disparities: 6
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Washington Health Insurance Coverage

The people of Washington have different kinds of health insurance while some residents are not insured at all. See the breakdown below:

  • Private coverage: 43.6%
  • Medicaid: 19.4%
  • Medicare: 18%
  • Uninsured: 18%

Report: America's Health Insurance Plans

Washington Health Insurance Companies

The following carriers offer health insurance and/or medicare in Washington.

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