People in the Evergreen State are spoiled for choice when it comes to healthcare options. According to a study by US News, Washington has the second-best healthcare in the country thanks to accessibility, quality care, and good public health.
Health insurance options in Washington
According to Washington's Office of the Insurance Commissioner, residents can get health insurance through several options:
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do most Washingtonians get their health insurance coverage?
|Individual or family||6%|
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population|
Seven percent of Americans are uninsured, meaning Washington is ahead of the curve. That bodes well for policyholders, as a high amount of uninsured people can boost costs for insured people.
Washington health insurance costs and rate factors
Washington residents spend an average of $7,913 per year on health care expenditures, slightly less than the national average. What determines your health insurance rates in Washington? Health care costs vary quite a bit from person to person, based primarily on these factors:
It's no surprise that more coverage costs more money. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
How much is health insurance in Washington? These are average monthly premiums for each plan type for a 40-year-old non-smoker from Washington in 2020, the most recent year this data is available.
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier|
Premiums for gold plan cost nearly 43 percent more than a bronze plan. That's not surprising considering the fact that gold plans cover 80 percent of healthcare costs, rather than 60 percent coverage with a bronze plan.
Some people qualify for catastrophic plans, the lowest amount of possible coverage. A catastrophic plan, comes with a $8,150 yearly deductible. Even with a higher premium, a bronze or silver plan will likely save you money if you actually need to use your health insurance.
Body mass index
A high body mass makes you statistically more likely to suffer from numerous health problems. That's why health insurance companies analyze your BMI to assess your risk-level. A high BMI leads to high health insurance rates.
In 2018, Washington had a 28.3 percent obesity rate, the 41st highest rate in the country. Out of the thousands of Washingtonians who used QuoteWizard to compare health insurance plans, only 26 percent of shoppers have a BMI in the obese range.
Smokers pay more for health insurance due to the substantial risks from smoking. About 13.5 percent of Washingtonians are smokers, the fifth lowest rate in the country.
A health insurance plan for an older person costs up to three times more compared to a young person. Washington residents who used QuoteWizard to shop for health insurance are, on average, 43 years old.
Your zip code plays a large role in your health insurance premiums. Why? First, each state has different laws, regulations, and health care providers.
Second, health insurance rates are community rated, according to Washington's Office of the Insurance Commissioner. Due to this, rates are based in part on the combined claims everyone files. If your neighbors file claims at an abnormally high rate, you might face a premium hike.
That means living in a health-conscious state can lead to lower premiums. According to America's Health Rankings, Washington is the ninth healthiest state in America.
Best Washington health insurance companies
What are the best health insurance companies in Washington? Thanks to the state's robust healthcare system, residents have many choices when shopping for a policy. These companies offer individual and family plans in Washington:
- Community Health Network
- Coordinated Care
- Premera Blue Cross
- Regence BlueCross BlueShield
Washington health insurance laws
Thanks to the Affordable Care Act, insurance companies can't use certain factors when pricing your policy.
- Pre-existing conditions: Insurance companies can't charge higher rates to people with pre-existing conditions. Before the ACA, people with pre-existing conditions paid considerably more for health insurance.
- Gender: Though women historically pay more for health care, the Affordable Care Act mandates that insurance companies cannot charge men and women different premiums for the same plan.
- Insurance and medical history: Before ACA, insurance companies analyzed your medical history and your past insurance coverage. People with previous medical problems or lapses in insurance used to face steep premiums – if they could even get coverage to begin with.
Marketplace plans have out-of-pocket maximum limits. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Washington state law requires that insurance companies provide some coverage for these services:
- Anesthesia for dental services
- Chemotherapy and cancer medications
- Contraceptive coverage
- Emergency medical services
- Women's health care services
There are additional health care services that providers must offer. To see more, read the full list from insurance.wa.gov.
Medicare and Medicaid in Washington
Medicare and Medicaid are both government-funded health care programs, with each option catering to different types of people. Medicare provides health coverage to seniors, while Medicaid assists low-income families and children.
Washington residents ages 65 and up qualify for Medicare. There are numerous coverage options within Medicare including parts A, B, C, D as well as supplemental coverage plans. Residents can also qualify for a Medicare Savings Program:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Washington is one of the states with expanded Medicaid. In Washington, Medicaid is called Apple Health. These are the state's Medicaid financial requirements.
|Household Size||Maximum Yearly Income|
Washington State Office of the Insurance Commissioner
- Insurance Commissioner:
- Mike Kreidler
- Insurance Hotline:
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
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