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Health Reform

How the ACA Impacts WSHIP

As the state high risk pool, WSHIP serves as a safety net to offer health coverage to individuals who have been denied coverage because of their medical status.  This need partially went away in 2014 when insurance companies could no longer deny individual coverage due to pre-existing conditions.

Because the Affordable Care Act (ACA) does not apply to Medicare supplements, insurance companies can continue to reject or limit Medicare supplement coverage based on medical status.  This means the ACA did not impact or change WSHIP’s Medicare coverage – but it did impact and change WSHIP’s non-Medicare coverage. 

Impacts to WSHIP Non-Medicare Coverage

Eligibility Limitations for WSHIP’s Non-Medicare Coverage
Beginning January 1, 2014, only individuals enrolled in a WSHIP non-Medicare plan prior to December 31, 2013, and individuals residing in a county where an individual benefit plan is not offered during defined open enrollment or special enrollment periods will be eligible for WSHIP non-Medicare coverage.

Minimum Essential Coverage Recognition
The following WSHIP plans are recognized by the federal department of Health and Human Services (HHS) as Minimum Essential Coverage:

  • WSHIP Preferred Provider Plan
  • WSHIP HSA Qualified Preferred Provider Plan
  • WSHIP Standard Plan

WSHIP Non-Medicare Coverage will be Discontinued on December 31, 2017
By law, WSHIP is required to discontinue all non-Medicare plans on December 31, 2017.  This transition period was established by the Washington State Legislature to allow WSHIP enrollees adequate time to enroll in new coverage that best meets their needs.

Reminders about WSHIP Medicare Coverage

No Changes to Eligibility Requirements for WSHIP’s Medicare Coverage
There are no changes to the eligibility requirements for WSHIP’s Medicare-eligible plan (Basic):

  • You must be a resident of Washington state;
  • You must be enrolled in Medicare Part A and Part B;
  • You must provide evidence of rejection for medical reasons, a requirement of restrictive riders, an up-rated premium, or a pre-existing conditions limitation on a Medicare supplemental insurance policy, or not have comprehensive Medicare Supplement coverage available to you; and
  • You must not have access to a reasonable choice of Medicare Advantage Plans (Part C).

 
Medicare Advantage Plans May Be A Lower Cost Coverage Option
Medicare Advantage Plans are an alternative to Medicare supplement plans and may be a lower cost option than WSHIP’s Medicare plan.  These plans (also called Part C) are offered by private companies that contract with Medicare to provide you with all your Part A and Part B benefits.  If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan.  Most Medicare Advantage Plans also offer prescription drug coverage (Part D).  Note:  You cannot enroll in a Medicare Advantage Plan if you have End Stage Renal Disease.

You can join a Medicare Advantage Plan during its annual enrollment period: October 15 - December 7.  To enroll, you can call the plan directly or contact Medicare at 1-800 MEDICARE (1-800-633-4227) or visit www.Medicare.gov.

Information About Washington Healthplanfinder
Click Here to learn about Washington Healthplanfinder, the online marketplace to shop for health insurance.