Buying an individual plan
The Affordable Care Act has changed the way individuals buy and qualify for health insurance in WA State. We're here to help you navigate this new environment so that you can access the best coverage available.
When can I enroll?
Most individuals must enroll during the Open Enrollment Period each year from November 1st to January 31st. You may also qualify for a Special Enrollment Period based on certain life events (e.g., losing employer coverage). Short-term medical plans are available outside of the Open Enrollment Period.
How should I enroll?
There are two ways we can help you purchase an individual health plan:
1) WA Healthplanfinder is the online marketplace where you can purchase health plans and/or qualify for Medicaid. You must apply through the WA Healthplanfinder to receive tax credits and financial help.
2) Directly from an insurance company. The application process is faster and there are some additional options available. There are no tax credits available when you purchase directly from an insurance company.
What is covered?
All Qualified Health Plans must include at least these 10 essential health benefits:
Inpatient hospital care
Maternity and newborn care
Mental health and substance use disorder services
Rehabilitative care and devices
Preventive and wellness services
Pediatric services, including oral and vision care
What if I don't have coverage?
If you do not have minimum essential coverage for 2014 and beyond, and don't receive an exemption, you may owe a Shared Responsibility Payment (the "penalty") for each month without coverage.
What does it cost?
It's important to determine whether you qualify for tax credits and financial help. Monthly premiums are based on the following factors:
- Whether or not you smoke
- Where you live
- Household size and income
- The health plan you select (e.g., deductible, HMO vs PPO, etc.)