Washington Benefit Exchange

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 Click here to apply for subsidy:

Breaking News 11/14/2013!

President Obama announced that people can keep their current health insurance for another year even if doesn’t have the 10 essential benefits for January 2014 moving forward.

Breaking News 11/14/2013!

The Washington state insurance commissioner announced that Washington residents cannot keep the 2013 health insurance plans moving forward.

(1-855-923-4633)

What is The Affordable Care Act or “Obamacare” ?

The Affordable Care Act (ACA) – signed into law in 2010 and upheld by the U.S. Supreme Court in 2012 – drives the greatest expansion of health care benefits in 50 years, reaching almost all Americans.

The Goal of the Affordable Care Act if To:

Get more people covered by health insurance, through employers or new health insurance exchanges, with tax incentives and penalties that promote coverage.

Change insurance rules to get more people covered and to cover more benefits.

Encourage providers – through incentives and penalties – to deliver better-coordinated and more evidence-based care, to improve health and reduce wasteful spending over the long term.

Drive widespread adoption – through incentives and penalties – of new technology that better connects all components of the health care delivery system to provide better care and reduce spending growth.

These incentives are funded largely through through new taxes on the health care sector

Open Enrollment for 2015:

Open Enrollment for 2015 will be from November 15  2014 until February 15 2015

Special Enrollment Period for Qualifying Events:

If you experience a qualifying event, then you can apply for health insurance during the special enrollment.  Special enrollment period is usually 60 days from your qualifying event.

What is a Qualifying Event?

  • You become unemployed/layoff  or you experience reduction in the number hours of work
  • Change in income
  • Change in Marriage Status (Marriage / Divorce)
  • Change in Dependents (Birth of new baby, adoption)
  • You moved to a new state that has different insurance coverage
  • Basically any life-changing events

 

The Washington Health Benefit Exchange:

is a place people can search and apply for Federally subsidized health insurance. More people than ever before are now eligible for low-cost or free health insurance. Middle-income and low-income individuals and families generally qualify. Healthplanfinder is the only way you can access these savings

 

The Washington HealthPlan Finder:

The Washington website used to access health plans for people who have access to Federal subsidy.

How Much Will A Could a Family Save?

Under the Affordable Care Act, beginning in 2014, many individuals and families will be eligible to receive subsidized coverage in the Exchange if they are not eligible for Medicare, Medicaid or the Children’s Health Insurance Program and are not offered affordable coverage through their employer.

  1. Enter household size and income for all individuals included on your tax return (yourself and spouse and dependents, if applicable).
  2. Enter age information only for those household members who need coverage.
  3. This interactive calculator estimates how much eligible individuals and families will spend on premiums for an Exchange health plan under the law. The calculator also indicates income-eligibility for Medicaid in states that choose to expand eligibility, including Washington.

The estimated tax credit from the government shown below indicates the amount a family will save on monthly premiums, compared to what they would pay in the individual market without subsidies. Premiums are an average for a “silver plan” in Washington state, but individuals can choose to purchase a more generous or less generous plan. Silver plans offer a more generous level of benefits than most plans in the current individual market.

Are You Eligible for Assistance?

You may be able to save on premiums and other costs if:

  • You are under age 65 and are not eligible for Medicare, Medicaid, Children’s Health Insurance Program (CHIP, an employer-sponsored plan, a grandfathered plan, or other coverage recognized by Health and Human Services (HHS).
  • You are a lawful U.S. resident.
  • Your income is 139% – 400% of the federal poverty level. Many middle-income households fall within this range.
  • Your employer’s coverage is “unaffordable” (your plan premiums would be greater than 9.5% of your household income) or “inadequate” (the plan pays less than 60% of covered benefits).

 

Do I Qualify for Subsidy?

  • Your employer does not offer a health plan.
  • Your family income is less than 400% of the federal poverty level.

Example:

Household:  If you make less than..

For 2014-2015

Just you                          $46,680

Family of 2                     $92,920

Family of 3                     $79,120

Family of 4                     $95,400

OR…

Federal Poverty Level Chart 2014/2015

 Family Size

25%

50%

75%

81%

100%

133%

175%

200%

250%

300%

1

$2,918

$5,835

$8,753

$9,453

$11,670

$15,521

$20,423

$23,340

$29,175

$35,010

2

$3,933

$7,865

$11,798

$12,741

$15,730

$20,921

$27,528

$31,460

$39,325

$47,190

3

$4,948

$9,895

$14,843

$16,030

$19,790

$26,321

$34,633

$39,580

$49,475

$59,370

4

$5,963

$11,925

$17,888

$19,319

$23,850

$31,721

$41,738

$47,700

$59,625

$71,550

5

$6,978

$13,955

$20,933

$22,607

$27,910

$37,120

$48,843

$55,820

$69,775

$83,730

6

$7,993

$15,985

$23,978

$25,896

$31,970

$42,520

$55,948

$63,940

$79,925

$95,910

7

$9,008

$18,015

$27,023

$29,184

$36,030

$47,920

$63,053

$72,060

$90,075

$108,090

8

$10,023

$20,045

$30,068

$32,473

$40,090

$53,320

$70,158

$80,180

$100,225

$120,270

OR…

Click The Calculator to Find Out!

calculator

If your income is far below these thresh holds then call 1- 855-923-4633 to see if you qualify for Washington Apple Health ( low or no income benefits )

 

 

The 10 essential health benefits:

are a set of health care service categories that health policies must cover to be certified and offered in the Washington Healthplanfinder marketplace, for sale to small groups and people who buy their own coverage.

  1. Ambulatory patient services ( service provided on an outpatient basis )
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care (except where in conflict with Washington State law)

 Are There Penalties For No Coverage? Yes:

2014

Penalty is $95 per adult and $47.50 per child (up to $285 for a family) or 1.0% of family income, whichever is greater.

2015

Penalty is $325 per adult and $162.50 per child (up to $975 for a family) or 2.0% of family income, whichever is greater.

2016 and Beyond

Penalty is $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5% of family income, whichever is greater.

Are There Any Exemptions? Yes:

  • You are part of a religion opposed to acceptance of benefits from a health insurance policy.
  • You are an undocumented immigrant. ·
  • You are incarcerated. · You are a member of an Indian tribe.
  • Your family income is below the threshold for filing a tax return ($10,000 for an individual, $20,000 for a family in 2013).
  • You have to pay more than 8% of your income for health insurance, after taking into account any employer contributions or tax

 

Small Business

If you are a small business owner with up to 50 employees in Washington, you can provide health insurance through Healthplanfinder and you may be eligible for tax credits.

What are the requirements for small businesses participation?

To participate, businesses may have up to 50 employees, be based in or have an employee worksite in Washington State, and achieve minimum group participation rates. Participation rates include 100 percent for businesses with two to four employees and 75 percent for businesses with five to 50 employees.

If your employer has signed up for coverage through Washington Healthplanfinder, you will receive instructions and log-in information directly from your employer.

This year unfortunately there were no companies that offered plans for small business in the exchange but there will be options in 2015 and beyond

Do I have to get insurance for my employees? What happens if I do not cover my employees?

If you have fewer than 50 full time employees, you are not required to provide them with health insurance coverage. However, good benefits can help recruit and retain good employees. And, the tax credits offered through Washington Healthplanfinder will help put affordable health coverage within reach.

 Small Business Tax Credit