Affordable Care Act

In Washington, the Health Insurance Exchange is called Washington healthplanfinder. This is the marketplace where Washingtonians that qualify for tax credits to help them by a private health insurance plan for themselves and their families.   You are not required to purchase a plan through Washington healthplanfinder.  The plans which are sold in the Exchange, will also be available outside of the Exchange, without having to submit your information to the INS and IRS.  You will also have more options outside of the Exchange.   However, to receive a subsidy you will need to apply through Washington healthplanfinder.  Washington healthplanfinder will help pay for premiums based on income. Below is the maximum monthly premium you would pay for a benchmark plan through Washington healthplanfinder. Costs vary depending on the plan you choose and how many family members are on the plan. Families with income lower than these amounts will likely be eligible for no-cost coverage through Apple Health.

Most current individual plans (except for a few grandfathered plans) do not meet the requirements of the Affordable Care Act and will have to be replaced in 2014. Newly approved plans are currently scheduled to be available on 10/1/2013. Your current insurance company will transfer you to the closest new plan automatically. If you wish to apply for a subsidy, you will have to fill out a subsidy application and reapply for insurance. 

If you apply for a subsidy, you will have to complete a Washington healthplanfinder application annually. If your actual income exceeds your estimated income, you may receive a tax bill in April of the following year to recover any excess subsidy paid on your behalf. You are also signing the application under penalty of perjury and need to fill out the application accurately.

2013 Federal Poverty Levels Based on Number of family members
FPL Range Limit 1 2 3 4 5 6 7 8 Each Additional Family Member
100 % $11,490 $15,856 $19,530 $23,550 $27,570 $31,590 $35,610 $39,630 $4,020
138 % $15,856 $21,881 $26,951 $32,498 $38,046 $43,594 $49,141 $54,689 $5,547
150 % $17,235 $23,784 $29,295 $35,325 $41,355 $47,385 $53,415 $59,445 $6,030
200 % $22,980 $31,712 $39,060 $47,100 $55,140 $63,180 $71,220 $79,260 $8,040
250 % $28,725 $39,640 $48,825 $58,875 $68,925 $78,975 $89,025 $99,075 $10,050
300 % $34,470 $47,568 $58,590 $70,650 $82,710 $94,770 $106,830 $118,890 $12,060
400 % $45,960 $63,424 $78,120 $94,200 $110,280 $126,360 $142,440 $158,520 $16,080

 

What You Pay
Individual (example costs)*   Family of 4 (example costs)*
Annual Income Maximum amount you pay monthly Annual Income Maximum amount you pay monthly
$15,860-$17,253 $57 $32,499-$35,325 $118
$17,253-$22,980 $121 $35,325-$47,100 $247
$22,980-$28,725 $193 $47,100-$58,875 $395
$28,725-$34,470 $273 $58,875-$70,650 $559
$34,470-$45,960 $364 $70,650-$94,200 $746
*Depending on your age, premiums may be significantly lower *Depending on your age, premiums may be significantly lower

Starting in 2014, all health plans will be required to cover essential health services

  • Prevention and wellness
  • Hospitalizations
  • Ambulatory services
  • Rehabilitative and habilitative services and devices
  • Emergency services
  • Prescription drugs
  • Laboratory services
  • Maternity and newborn care
  • Pediatric oral and vision care
  • Mental and behavioral health (substance use disorder services)
WA healthplanfinder / Silver Plan / Individual
Every carrier offering insurance plans through WA healthplanfinder must offer a standard silver plan. Individuals under certain income levels will be eligible for premium assistance; the amount of assistance will be based on the second-lowest cost silver plan. In addition, some individuals will receive help paying for co-pays and co-insurance if they buy a silver plan. Costs are estimated below.
Annual Income $15,856-$17,234 $17,235- $22,979 $22,980- $28,724 $28,725- $45,960
Maximum Monthly Amount You Pay
(Balance paid by federal tax credit; some plans may have lower premiums)
$40 - $57 $57 - $121 $121 - $193 $193 - $364
  Copays in grey sections are not subject to any deductible and count toward the annual out-of-pocket minimum Benefits in blue are covered after the combined deductible is met
Combined Deductible
(Applies to Medical and Drug)
$100 $750 $2,500 $2,500
Preventive Service No Cost No Cost No Cost No Cost
Primary Care Visit Copay
(Applies to Physical, Speech & Occupational Therapy Visits and Pediatric Vision)
$10 $15 $35 $35
Specialty Care Visit Copay $20 $30 $70 $70
Urgent Care Visit Copay $30 $40 $90 $90
Inpatient/Outpatient Coinsurance 10% 10% 30% 30%
Emergency Room & Ambulance Coinsurance 10% 10% 30% 30%
Radiology (MRI, CT, Pet Scans) Coinsurance 10% 10% 30% 30%
Generic Drugs Copay $5 $10 $15 $15
Preferred Brand Drugs Copay $10 $25 $50 $50
Non-Preferred Brand and Specialty Drug Coinsurance 25% 50% 50% 50%
Maximum Out-of-Pocket $750 $1,500 $4,250 $6,350

 

WA healthplanfinder / Silver Plan / Family of Four
Every carrier offering insurance plans through WA healthplanfinder must offer a standard silver plan. Families under certain income levels will be eligible for premium assistance; the amount of assistance will be based on the second-lowest cost silver plan. In addition, some families will receive help paying for co-pays and co-insurance if they buy a silver plan. Costs are estimated below, but they will vary depending on how many family members are enrolled in the plan.
Annual Income $32,499- $35,324 $35,325- $47,099 $47,100- $58,874 $58,875- $94,200
Maximum Monthly Amount You Pay
(Balance paid by federal tax credit; some plans may have lower premiums)
$81 - $118 $118 - $247 $247 - $395 $395 - $746
  Copays in grey sections are not subject to any deductible and count toward the annual out-of-pocket minimum Benefits in blue are covered after the combined deductible is met
Combined Deductible
(Applies to Medical and Drug)
$200 $1,500 $5,000 $5,000
Preventive Service No Cost No Cost No Cost No Cost
Primary Care Visit Copay
(Applies to Physical, Speech & Occupational Therapy Visits and Pediatric Vision)
$10 $15 $35 $35
Specialty Care Visit Copay $20 $30 $70 $70
Urgent Care Visit Copay $30 $40 $90 $90
Inpatient/Outpatient Coinsurance 10% 10% 30% 30%
Emergency Room & Ambulance Coinsurance 10% 10% 30% 30%
Radiology (MRI, CT, Pet Scans) Coinsurance 10% 10% 30% 30%
Generic Drugs Copay $5 $10 $15 $15
Preferred Brand Drugs Copay $10 $25 $50 $50
Non-Preferred Brand and Specialty Drug Coinsurance 25% 50% 50% 50%
Maximum Out-of-Pocket $1,500 $3,000 $8,500 $12,700