Key Takeaways
- Washington expanded Medicaid (Apple Health) under the ACA, covering adults up to 138% FPL
- Washington Healthplanfinder is the state-based health insurance marketplace
- Washington has the WA Cares Fund - a state-run long-term care program
- Washington Life and Disability Insurance Guaranty Association protects policyholders
- SHIBA provides free insurance counseling for Washington residents
Washington State Health Programs
Washington provides comprehensive state health programs to ensure residents have access to health coverage.
Apple Health (Washington Medicaid)
Apple Health is Washington's Medicaid program:
Eligibility Categories
| Category | Income Limit |
|---|---|
| Children | Up to 210% FPL |
| Pregnant Women | Up to 193% FPL |
| Parents/Caretakers | Up to 138% FPL |
| Adults (Expansion) | Up to 138% FPL |
| Aged/Disabled | Various limits |
Medicaid Expansion
Washington expanded Medicaid under the ACA:
- Covers adults ages 19-64
- Income up to 138% of Federal Poverty Level
- Comprehensive benefits
- Administered through Washington Healthplanfinder
Exam Tip: Washington IS a Medicaid expansion state. Apple Health covers adults up to 138% FPL.
Washington Healthplanfinder
Washington operates a state-based marketplace:
Marketplace Features
| Feature | Description |
|---|---|
| Platform | wahealthplanfinder.org |
| Open Enrollment | November 1 - January 15 |
| Premium Tax Credits | Based on income |
| Plan Tiers | Bronze, Silver, Gold, Platinum |
| Medicaid Integration | Apple Health applications |
Special Enrollment Periods
Qualify for special enrollment with:
- Loss of other coverage
- Marriage or divorce
- Birth or adoption
- Move to new coverage area
WA Cares Fund
Washington's first-in-nation public long-term care program:
Program Overview
| Feature | Detail |
|---|---|
| Funding | Employee payroll tax (0.58% of wages) |
| Benefit | Up to $36,500 lifetime (adjusted annually) |
| Vesting | 10 years or 3 of last 6 years |
| Eligibility | Washington workers 18+ |
Key Points for Producers
- Know the exemption rules for private LTC
- Understand vesting requirements
- Explain limitations compared to private LTC
- Cannot advise clients to avoid the tax
Washington Life and Disability Insurance Guaranty Association
Protects policyholders when insurers become insolvent:
Coverage Limits
| Coverage Type | Maximum Limit |
|---|---|
| Life Insurance Death Benefit | $500,000 |
| Cash Surrender Value | $100,000 |
| Health Insurance | $500,000 |
| Annuity Present Value | $250,000 |
| Disability Income | $500,000 |
Important Rules
| Rule | Description |
|---|---|
| Advertising | Cannot use as selling point |
| Eligibility | WA residents with covered policies |
| Funding | Assessments on member insurers |
| Coverage | Policies from licensed WA insurers |
SHIBA Program
SHIBA (Statewide Health Insurance Benefits Advisors):
- Free insurance counseling
- Help for seniors and people with disabilities
- Medicare and Medicaid assistance
- Long-term care guidance
Exam Tip: Producers CANNOT use Guaranty Association coverage as a selling point. This is a frequently tested rule.
Did Washington expand Medicaid under the Affordable Care Act?
What is the name of Washington's state-based health insurance marketplace?
What is the maximum life insurance death benefit coverage under Washington's Guaranty Association?
What is the WA Cares Fund?
Can Washington producers use the Guaranty Association as a selling point?
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