Don’t Qualify for Washington Medicaid? Need Health Insurance?

Health Insurance Options to Consider in Washington if You are Not Eligible for Medicaid

If you don’t qualify for Medicare and Individual Health Insurance Plans are to expensive for your income, the Washington Health Program may be an option for you. If you choose this option, you do have to apply, be approved based on your health statement and may be subject to pre-existing conditions, conditions that aren’t covered for a specific period of time.

Individual health insurance plans can be found HERE.

Short term medical insurance is worth considering as a lower cost option. It is, as its name implies, just a temporary solution. It usually excludes coverage for anything you have been treated for in the last five years.

Short Term Medical Insurance plans can be found HERE.

Washington Health Program may be the best low cost option specifically designed for these circumstances.

The Washington State Health Care Authority offers Washington Health Program through Community Health Plan of Washington. If you qualify, you and your family can get comprehensive, high quality care for low premiums and cost sharing. For most provider visits and prescriptions, your copay is $10 and your annual deductible is $500. You can choose a plan with an annual benefit maximum of either $75,000 or $100,000.

Community Health Plan of Washington members get services from more than 2,365 primary care providers and 13,571 specialists at more than 540 primary care clinics and more than 100 hospitals. It is a statewide, comprehensive delivery system of primary care providers who are dedicated to the mission and who focus on treating the entire person. Community health centers often provide translation, transportation, dental, and mental health in addition to primary, preventive care.

In general, Washington Health Program covered benefits include:

Routine office visits and immunizations
Prescription drugs
24-hour nurse advice line
Preventive screenings such as mammograms and Pap smears
Diagnostic imaging and lab work
Emergency room and hospital care
Maternity (separate $5,000 deductible if delivery occurs in the first six months of enrollment)

For more detailed information about coverage and costs, see the Washington Health Program Benefit Grid.

Washington Health is available to anyone who lives in Washington and:

Is not eligible for free or purchased Medicare.
At the time of enrollment, is not confined to an institution.
Is ineligible for coverage under the Washington State Health Insurance Pool (WSHIP) or qualifies to bypass the standard health questionnaire under state law.
Is not receiving Washington Department of Social and Health Services (DSHS) medical assistance (Medicaid) or subsidized Basic Health benefit.

Community Health Plan of Washington members get services from more than 2,365 primary care providers and 13,571 specialists at more than 540 primary care clinics and more than 100 hospitals. It is a statewide, comprehensive delivery system of primary care providers who are dedicated to your health and who focus on treating the entire person.

You can find more information and enroll in the Washington Health Program HERE.

Applying for Washington Health Program Coverage

Ehealthlink can send you an information and enrollment packet or help you through the online enrollment process. You can apply online through our website or call us at 1-888-957-5001.

All family members, even children 18 or younger, must complete the SHQ when applying for Washington Health Program. On page 2 of the SHQ you will see a list of questions to help you decide whether you might be exempt from submitting a complete SHQ. The first question — "Are you under 19 years of age?" — does not apply to Washington Health Program. SKIP THIS QUESTION when you are applying for Washington Health.

Applicants applying for Washington Health coverage who are required by law to complete and pass the Standard Health Questionnaire (SHQ) or health screen may do so HERE. Washington Health uses the SHQ to determine eligibility for coverage. Developed by the Washington State Health Insurance Pool (WSHIP), the SHQ asks about applicants' recent coverage and medical history.

After you submit an application and a completed SHQ, if you do not pass the health screen you will be denied coverage for Washington Health and referred to WSHIP for coverage. Applicants who are denied coverage may appeal to the Health Care Authority.

Basic Health is a subsidized option for those who qualify.

Basic Health offers quality, low-cost health coverage to eligible people who live in Washington State. The Washington State Health Care Authority (HCA) contracts with Community Health Plan of Washington and other health plans to offer Basic Health and Basic Health Plus coverage.

Applying for Basic Health: Basic Health is not currently processing or screening applications for eligibility. New applicants are placed on a waiting list in the order they come in. (There are some exceptions.) When space becomes available in the future, Basic Health will release names from the list in the order of the date they came in. Basic Health will notify applicants when this happens.

To find out more about eligibility or to get on the waiting list, see the Basic Health web site or call 1-800-660-9840.