Washington has a program to help make health insurance affordable to working people and others who lack health coverage. The Washington Basic Health (WBH) offers individuals and families coverage through a subsidized program, depending on family income. Coverage is made available through private insurers.
- To get the Washington Basic Health (WBH), you must meet certain eligibility criteria. To be eligible for coverage you: 1) cannot be on or eligible for Medicare; 2) cannot be institutionalized at the time of enrollment; 3) must be a Washington State resident; and 4) must have a gross family income less than 200% of the Federal Poverty Level ($34,340 or a monthly income of $2,862 for a family of 3).
Currently, the WBH is enrolling new members. However, enrollment will be available only as long as there is state funding. Depending on future state funding, you may have to wait before can join the Washington Basic Health Plan
- WBH can impose a pre-existing condition exclusion period. Pre-existing condition exclusion periods cannot exceed 9 months.
WBH can count as pre-existing any condition for which you received or was recommended to received - or, in WBH’s judgment, for which you should have sought -medical diagnosis, care or treatment (including medication) or consultation in the 6-month period prior to enrollment.
No pre-existing condition exclusion period will be imposed on the maternity benefit, prescription drugs or oxygen.
- In some circumstances, you will get credit for prior continuous coverage against the imposition of a pre-existing condition exclusion period You will get credit toward your pre-existing condition exclusion period for prior coverage that was “similar” to the Basic Health coverage you have, provided that no more than 3 months lapsed between your old coverage and your WBH. “Similar coverage” includes Basic Health, Medicaid programs, Indian Health Services and most private health insurance plans, among other types of coverage.
- Coverage under the WBH is generally comprehensive. Covered benefits include physician services, inpatient and outpatient hospital services, prescription drugs, primary and preventive health care, emergency services, ambulance services, radiology and laboratory, skilled nursing, hospice, and home health care (health plan’s discretion), out of area emergency care, chemical dependency, mental health, chiropractic/physical therapy and organ transplants. You must be enrolled in WBH for 12 consecutive months before you will be covered for organ transplant procedures (except for newborns or for a condition that is not preexisting).
Maternity benefits for eligible subsidized members are provided through the Maternity Benefits Program through DSHS; these include full prenatal care, delivery, post-partum care, care for pregnancy complications, and termination of pregnancy.
- WBH members face cost sharing for most covered services. The office visit co-payment is $15 and the emergency room co-payment is $100. For services with a coinsurance (most), once a $150 annual deductible has been met, the health plan pays 80% and you pay 20% until you have reached an out-of-pocket maximum of $1500. Co-payment for office visits do not count against the out-of-pocket maximum.
- WBH members must pay a monthly premium. Basic Health premiums are based on age, family size, income and plan option. The minimum premium is $17 per month but can rise significantly if you are older with more income. For example, if you are 60 years old with household income of $1,700/month and you live in Clark County, you would be required to pay just below $280/month for a WBH plan administered by Kaiser Permanente. However, if you were 24 years of age living in the same area and making $850 per month, you would pay $45.90 for the same policy.
- For more information contact the Washington Basic Health at (800) 826-2444 or visit them on the web at http://basic health.hca.wa.gov/.