Washington Health Benefit Exchange and Medicaid (Apple Health)

Are you a Washington resident under age 65 and need health insurance? You can find a plan using the Washington Health Benefit Exchange. It’s the marketplace for health plans with affordable rates and, for some, low- or no-cost coverage.

Don’t wait: Get covered! We’ve got information here on where to go for help shopping for and choosing a health plan. Many available plans allow you to seek care from UW Medicine.

The Washington Healthplanfinder (English | Spanish) is a service of the state’s health insurance exchange that can help you: 

• Find out if you may be eligible for federal or state financial help to pay premiums or out-of-pocket costs, such as copays.     

• Browse plans and compare what your costs may be and the doctors and hospitals available with each plan. 

• Enroll in a health plan.

Types of individual and family insurance plans

When you shop through the Washington Healthplanfinder, you’ll be asked for information about your family and income to see if you qualify for financial help or Medicaid coverage.  

Based on the information you enter, you’ll be able to view and compare the coverage and costs for: 

• Washington Health Exchange plans 

• Apple Health (Medicaid) plans, if you qualify

Other good-to-know facts about health insurance

• All Washington residents, regardless of immigration status, will be able to access coverage through Washington Healthplanfinder. Coverage will expand to undocumented immigrants (foreign-born who lack valid documentation to be in the United States. The Exchange plans began January 1, 2024, and Apple Health begins July 1, 2024.
  • Receiving health coverage through Washington Healthplanfinder – including Washington Apple Health (Medicaid) will not affect your or a family member’s immigration status or citizenship application.
  • When you apply for coverage through Washington Healthplanfinder, citizenship or immigration status information is only used to determine health plan eligibility. Federal and state laws protect your privacy. This information is not used for immigration enforcement.
• Under federal law, all plans must cover 10 essential benefits.  
• In addition, Washington requires health plans to include certain benefits. 
• You cannot be denied coverage for having a health condition or health issues in the past.

Option 1-Washington Health Exchange: The Cascade Special Enrollment Period (SEP) is continuing into 2024. This allows individuals and households with income under 250% Federal Poverty Table (FPL) to enroll into a Silver or Gold Cascade Care anytime during the year. This SEP is also available to those who qualify for Immigrant Health Coverage. It allows low-income households additional opportunities to enroll into Cascade Care without a qualifying life event. This option applies if you:

• did not enroll during open enrollment.
• enrolled during open enrollment and selected a plan that is not a Cascade Silver or Gold plan.

If you are currently enrolled in the Cascade Silver or Gold plan, then there is not an option to change plans under this SEP.

Option 2-Washington Health Exchange: There are exceptions to the enrollment deadlines if you have had a significant change in your family or your income. This means you can sign up for a new plan or switch to a plan that better fits your situation. These are called “qualifying life events,” and they include:

• Lose or gain health insurance unexpectedly
  • Coverage from a job or employer
  • Coverage from a public program (such as Apple Health or Medicare)
  • COBRA coverage
  • Coverage from a family member or other household member
     
• Household change
  • Birth or adoption
  • Pregnancy
  • Marriage or divorce
  • Loss of a household member
  • Adding or removing a dependent
  • Change of address
  • Changes of name, date of birth or Social Security Number

You have 60 days after one of these events to enroll in a plan for the first time or change the plan you have for coverage that suits you better.

Option 3-Apple Health (Medicaid): If you qualify, you can enroll any time during the year.

Apple Health Expansion to adults, regardless of immigration status is coming soon. You can start to apply in Spring 2024 for coverage to begin July 1, 2024. More details to come!

Apple Health patients: Update your contact information

Clients will receive a renewal notice prior to the end of their certification period sometime over the next 12 months, based on a client’s renewal date.

To prevent a gap in your coverage, it’s important to verify that your contact information is up to date with Washington Healthplanfinder. Find more information and answers to frequently asked questions about renewals. 

You can also call Washington Healthplanfinder’s customer support at 1.855.923.4633 (TTY 1.855.627.9604) for help. 

You won’t pay anything for certain services — such as preventive care visits, certain cancer screenings and many vaccinations — with health plans available through the exchange. For many other services, you may be responsible for some or all the costs. 

That’s why it’s wise to take your time checking your options and making a choice. Here are three questions to ask yourself before you choose a health plan: 

• What services will you need? – Review what the plans cover for services you expect you may use. Some examples are doctor’s office and urgent care visits, prescriptions, children’s care (including dental and vision services), maternity and birth care, and emergency room visits. 

• Are my doctors in the network? – Check to see if doctors, hospitals and other healthcare providers you visit (or plan to visit) are in the plan’s network. Confirm with both the plan and the healthcare providers. Some plans do not cover any costs if you visit out-of-network providers. 

• What’s ahead for me and my family next year? – Think over if there are any needs you may have in the coming year, such as plans to add a child to your family, a need for ongoing treatment for cancer or a chronic disease, or a scheduled surgery. Compare your costs under each plan you consider. 

UW Medicine is "in-network" for several health insurance plans offered through the exchange, the Washington Healthplanfinder. That could matter to you when choosing a plan. 

Generally, you pay less out of pocket when you visit healthcare providers that are in-network. Going out-of-network may require you to pay more toward your deductible or in a copay – or may not be covered at all.

Exchange plans with UW Medicine in network 

BRIDGESPAN HEALTH COMPANY 

• BRIDGESPAN CASCADE BRONZE 
• BRIDGESPAN CASCADE GOLD 
• BRIDGESPAN CASCADE SILVER 
• BRONZE ESSENTIAL 8500 

COMMUNITY HEALTH PLAN OF WASHINGTON (AUTHORIZED SPECIALTY CARE ONLY DOES NOT INCLUDE PRIMARY CARE)

• COMMUNITY HEALTH PLAN OF WASHINGTON CASCADE SELECT GOLD 
• COMMUNITY HEALTH PLAN OF WASHINGTON CASCADE SELECT SILVER 
• COMMUNITY HEALTH PLAN OF WASHINGTON CASCADE SELECT BRONZE 

LIFEWISE HEALTH PLAN OF WASHINGTON

• Members can receive PCP care at Lopez Island UW Medicine clinic only with the Cascade Select and Essential plans.

MOLINA HEALTHCARE OF WASHINGTON 

• CONSTANT CARE SILVER 1 
• MOLINA CASCADE BRONZE 
• MOLINA CASCADE GOLD 
• MOLINA CASCADE SILVER 

PACIFICSOURCE HEALTH PLANS

• PPO members can access UW Medicine through the First Choice Network with the Navigator and PacificSource Cascade plans.

PREMERA BLUE CROSS 

• PREMERA BLUE CROSS CASCADE BRONZE 
• PREMERA BLUE CROSS CASCADE GOLD 
• PREMERA BLUE CROSS CASCADE SILVER 
• PREMERA BLUE CROSS PREFERRED BRONZE EPO 6650 
• PREMERA BLUE CROSS PREFERRED BRONZE HSA EPO 6400 
• PREMERA BLUE CROSS PREFERRED GOLD EPO 1500 
• PREMERA BLUE CROSS PREFERRED SILVER EPO 4500 

REGENCE BLUESHIELD OF WASHINGTON 

• BRONZE ESSENTIAL 8500 
• GOLD 2500 
• REGENCE CASCADE BRONZE 
• REGENCE CASCADE GOLD 
• REGENCE CASCADE SILVER 

UNITED HEALTHCARE OF OREGON, INC. 

• UHC BRONZE VALUE HSA 
• UHC GOLD ADVANTAGE 
• UHC SILVER COPAY FOCUS 
• UNITEDHEALTHCARE OF OREGON, INC. CASCADE BRONZE 
• UNITEDHEALTHCARE OF OREGON, INC. CASCADE GOLD 
• UNITEDHEALTHCARE OF OREGON, INC. CASCADE SILVER 

Apple Health plans with UW Medicine in network 

UW Medicine is in network with these Medicaid plans, with some exceptions. Ask the health plan about your coverage for services through UW Medicine.

• COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW) APPLE HEALTH (SPECIALTY CARE ONLY, DOES NOT INCLUDE PRIMARY CARE)
• COORDINATED CARE APPLE HEALTH 
• MOLINA (MHC) APPLE HEALTH 
• UNITED HEALTHCARE COMMUNITY (UHC) APPLE HEALTH
• WELLPOINT (FORMERLY AMERIGROUP) APPLE HEALTH