Medicaid & Healthcare Exchanges

Washington_Healthplanfinder_buttonHealth Benefit Exchanges are a  key provision of the Affordable Care Act that creates a new marketplace for each state to offer health benefits.

The Washington Health Benefit Exchange is an easily accessible, online marketplace that allows users to shop around for insurance coverage that most fits them. This impacts college students because, while the Affordable Care Act now allows students to stay on their parents’ insurance plans until the age of 26, there are now more options for more coverage based on students’ situations, especially when a student might not have insurance through a parent.

Washington Exchange Coverage Comparisons tool
takes you through a process of determining “comparable” plans, their benefits and premiums, and more.

The Affordable Care Act will provide free preventive services, annual check-ups and prescriptions to students. Students who earn less than $46,000 annually for individuals or $94,000 for families may be able to access free or discounted coverage through monthly tax credits, depending on their income level.

To help University of Washington students find out more about their options, here is some helpful information:

To talk to someone:

  • wahealthplanfinder.org: 1-855-WAFINDER (1-855-923-4633)
    a toll-free call center that offers  application and enrollment support as well as translation services. Representatives can help you read and fill out all HealthPlanFinder forms. The Customer Support Center is open Monday-Friday, 7:30 a.m. to 8:00 p.m.
  • healthcare.gov:  1-800-318-2596
    a toll-free call center that  is available to help answer questions 24 hours a day, seven days a week.

News

Healthcare Exchanges / Marketplaces FAQ
for University of Washington Students

Q: Am I required to have health insurance?

Under the Affordable Care Act, starting January 1, 2014, most Americans will be required to have health insurance or pay a penalty. This is called the “individual mandate. ” To avoid the penalty, you need insurance that qualifies as Minimum Essential Coverage.

Q: What is the penalty for not having Minimum Essential Coverage?

The penalties are as follows:

  • 2014: $95 per adult and $47.50 per child (up to $285 for a family) , or 1% of family income, whichever is greater
  • 2015: $325 per adult and $162.50 per child (up to $975 for a family), or 2% of family income, whichever is greater
  • 2016: $695 per adult and $347.50 per child (up to $2,085 for a family), or 2.5% of family income, whichever is greater

The important thing to remember is that if you do not get any health insurance coverage, you may be subject to pay the penalty and still be responsible for 100% of the cost of your medical care.

Q: Who is exempt from having to obtain health insurance?

Under certain circumstances, you may qualify for an exemption. You won’t have to make the individual responsibility payment if:

  • You are uninsured for less than 3 months of the year
  • Your income is below the threshold for having to file a tax return
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You are a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • You’re not lawfully present in the U.S.

Q: What options are available for students who wish to obtain health insurance?

Students may be eligible to obtain health insurance through one of the following options:

  • Coverage as a dependent on their parents’ health insurance plan (up to age 26)
  • Coverage through an employer-sponsored health insurance plan
  • Coverage through the State or Federal Exchange/Marketplace
  • Coverage through Medicaid
  • School-sponsored Student Health Insurance Plan

Q: What kinds of health insurance are available through the Exchange / Marketplace?

The Exchange / Marketplace offers a simple online tool to help you search for healthcare coverage. You can compare plans available in your area based on price, benefits and other features. To make comparing easier, the plans are presented in five categories:

  • Bronze
  • Silver
  • Gold
  • Platinum
  • Catastrophic (available to individuals up to the age of 30 years old)

The Marketplace will also tell you if you qualify for free or low-cost coverage through Medicaid (Washington Apple Health), or the Children’s Health Insurance Program (CHIP).

Q: How can I get lower costs on my health insurance through the Exchange / Marketplace?

Under the Affordable Care Act, many individuals will be eligible to get lower costs on their monthly premiums or out-of-pocket costs, or get free or low-cost coverage depending on where they live, family size and ages, tobacco use and their annual household income. Visit the Washington Health Benefit Exchange and use the interactive calculator to estimate your possible costs.

Q: Do I need to be a Washington State resident to apply for coverage through the Washington Exchange / Marketplace?

Yes. Residency means that you intend to live in Washington State on more than a temporary or transient basis.

Q: Will I have access to the University of Washington medical facilities and providers (i.e. Hall Health) through the Exchange / Marketplace plans?

Maybe. Not all plans will have access to the University of Washington providers. It is very important to find and shop for a plan that includes your doctors, clinics, and hospitals in the network.

Washington Healthplanfinder offers a health provider search tool so that you can see whether plans include your doctor or hospital in or out of their networks. The health care provider search is available under “customize my search” on the shopping screens of Healthplanfinder.

Q: I am an international student, do I need to obtain health insurance coverage?

Yes. All matriculating international students are required to purchase the UW Student Health Insurance Plan (UW SHIP) while attending the University of Washington. The requirement that you purchase the UW SHIP may be waived only if you meet certain eligibility criteria and have comparable insurance that is valid in the U.S. For health insurance waiver inquiries, please email inswaive@uw.edu.

Q: How do I apply for coverage through the Exchange / Marketplace?

If you live in Washington, you’ll use the wahealthplanfinder.org website to apply for coverage, compare plans, and enroll. If you need help, you may call the Customer Support Center at 1-855-WAFINDER (1-855-932-4633). The Customer Support Center is open Monday-Friday, 7:30 a.m. to 8:00 p.m.

If you are not a Washington resident, you can visit healthcare.gov, to learn more about your options. To contact the Federal Marketplace, call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)

Q: Are there deadlines for applying for coverage through the Exchange / Marketplace?

Yes. The deadlines* to apply for coverage are as follows:

  • Open enrollment for plans offered through the Exchange / Marketplace starts October 1, 2013 and proceeds through March 31, 2014, with coverage going into effect as early as January 1, 2014.
  • Open enrollment for coverage beginning in 2015 will begin on October 15, 2014 and proceed through December 7, 2014. The same open enrollment period will apply in future years.

*Losing insurance from another source, i.e. parents’ employer based or student health insurance will trigger a special enrollment period for the Exchange / Marketplace in which you may apply for coverage.

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