The ACA is changing the way health care is delivered in Washington state. It will impact every employer and employee in the state, bringing increased government regulation, higher taxes and fewer personal choices.
One of the most important changes is requiring that insurance companies sell coverage to everyone, regardless of pre-existing conditions. This is called guaranteed issue, and it places everyone in a community-rated risk pool.
The ACA
The Affordable Care Act (ACA) was passed in 2010 to ensure that everyone has access to affordable health insurance. It has made major strides in improving healthcare and helping millions of Americans get the care they need at a reasonable cost.
The ACA created the national Marketplaces, where you can shop for health insurance plans and apply for premium subsidies that lower your monthly cost. These are in the form of cost-sharing reductions and advance premium tax credits.
The ACA also requires insurance companies to sell insurance without pre-existing conditions limits or questionnaires about your health status. This concept is called guaranteed issue, and it’s meant to make health insurance more affordable.
Buying Health Insurance
Buying health insurance is an important step to ensure you have access to high-quality, affordable coverage. It also helps protect you from large out-of-pocket expenses when you need care.
ACA marketplace plans offer premium tax credits, which lower your costs for coverage. These subsidies are available to anyone with an income between 100 percent and 400% of the federal poverty level.
The state has a Health Benefit Exchange website called Washington Healthplanfinder where you can compare and shop for individual or family health insurance. You can also find out if you qualify for Medicaid, Apple Health or other financial assistance to help pay for your coverage.
The Health Planfinder website also has a tool that estimates the cost and benefits of different plans, whether you’re looking for an Apple Health plan or a traditional health insurance policy. You can also apply for Medicaid if you are an undocumented immigrant, or if you don’t qualify for Apple Health.
Employer-Sponsored Insurance
Employer-sponsored insurance is the primary source of health coverage for more than half of the non-elderly population in the United States. Its high volume of beneficiaries allows large employers to wrest better deals from insurers and providers than individuals can on their own.
In addition, employer-sponsored health plans can offer a low monthly premium cost, since most companies contribute a portion of the family’s premium costs. That can make them a more affordable option than individual policies sold in the Marketplace.
However, some of these benefits can be costly if an employee opts for higher deductibles or coinsurance. This is a problem for small business owners, who have more limited funds to support their employees’ healthcare needs.
Individual Health Insurance
There are a number of ways to buy individual health insurance in Washington, including through the state’s Exchange. These plans are available through Washington Healthplanfinder and can be purchased during the open enrollment period or during a special enrollment window.
The cheapest insurance plans are in the Silver metal tier. They have the lowest monthly premiums, but they have higher deductibles and out-of-pocket maximums.
However, some people may be eligible for a cost-sharing reduction, which lowers their deductible, copayment or coinsurance. For a two-person household earning 138% to 250% of the federal poverty level in 2021, this could save them a significant amount of money each month on their health insurance costs.
These tax credits are paid directly to the insurer to reduce your monthly premium payment, or you can receive them as a lump sum within your tax return. These discounts can help you afford the highest quality medical coverage at a price you can afford.
Medicaid Expansion
The ACA Medicaid expansion expanded coverage to people with incomes up to 138 percent of the federal poverty level, making it possible for low-income adults to get health insurance. Washington’s Medicaid program is a joint state-federal program that provides medical insurance to low-income children and adults.
The Medicaid expansion has been associated with increased access to and affordability of care for those covered, including an increase in having a personal doctor and a regular source of care. It also reduces worry about health care costs and delay of needed medical services.
A significant number of Washingtonians lose affordable health coverage when they qualify for Medicare as they age or become disabled, a phenomenon known as the “Medicare affordability cliff.” Governor Inslee’s supplemental budget proposes to address this by removing an asset test that bars some Medicare enrollees from affordability assistance programs.
