Asuris Northwest Health

Group Health Cooperative

KPS Health Plans

LifeWise Health Plan of Washington

Premera Blue Cross

Regence Blue Cross Blue Shield of Oregon

Regence Blue Shield

In Washington, medical underwriting is allowed with limitations. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior coverage.

 

In Washington, those exercising their HIPAA rights may acquire health insurance from any individual carrier in that state. Those medically uninsurable may apply for the state’s high risk pool. To be eligible for the high risk pool, you must be a resident of Washington, have been denied coverage due to a medical condition, and do not qualify for Medicaid.

 

Coverage under the high risk pool includes doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, and speech and occupational therapy. 

In Washington, premium rates are based on a community rate based on age, geography, and family composition. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior health coverage.

Washington offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce. 

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Children

Children (ages 1-5)-200% of the Federal Poverty Level
Children (Ages 6-19)-200% of the Federal Poverty Level

 

Pregnant Women and Infants

Pregnant Women-185% of the Federal Poverty Level
Infants (ages 0-1)-200% of the Federal Poverty Level

 

Parents

Non Working Parents- 200% of the Federal Poverty Level

Working Parents- 200% of the Federal Poverty Level

 

Other populations

Medically Needy Individual- 78% of the Federal Poverty Level

Medically Needy Couple- 61% of the Federal Poverty Level

Supplemental Security Income Recipients- 74% of the Federal

Poverty Level

 

 

Inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing services, laboratory and x-ray services, pediatric and family nurse practitioner services, nurse-midwife services, federally qualified health-center services, early and periodic screening, diagnostic, and treatment services for children under age 21.

 

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

 

Washington offers the CHIP program to children under the age of 19 whose family income is up to 250% of the Federal Poverty Level. The children must be residents of Washington, U.S. citizens or legal residents, and ineligible for Medicaid. Please visit the CHIP program website for more detailed information at http://fortress.wa.gov/dshs/maa/CHIP/Index.html.