Background and Purpose

The Washington State Health Insurance Pool (WSHIP) is an independent non-profit entity established by the Washington State Legislature in 1987 to serve as the state’s high-risk pool. WSHIP is not a public agency or state-funded program. It is funded solely through premiums and assessments to Member Plans (carriers).

WSHIP plays an important role in fostering market stabilization and averting disproportional impacts to Washington communities caring for high-risk residents. As the state’s high risk, WSHIP has two separate health insurance programs - Non-Medicare coverage for high risk individuals (enrolled before 2014) and Medicare supplemental coverage for high risk Medicare enrollees without access to a supplement or Medicare Advantage plan.

Programs

• Non-Medicare Coverage (Enrollment closed)

Under the Affordable Care Act (ACA), insurers can no longer deny coverage to persons with pre-existing conditions seeking individual health coverage; therefore, very few enrollees remain in WSHIP’s Non-Medicare program and no new enrollment has been accepted since 2014. The remaining individuals who have elected to keep their WSHIP coverage include some of our state’s most vulnerable and medically high-cost residents.

WSHIP is also the safety net for the state’s individual health insurance market in the event coverage is not offered in all counties (coverage is currently offered in all counties).

• Medicare Supplemental Coverage

WSHIP’s Medicare program ensures access to supplemental coverage for those Medicare enrollees who do not have access to a supplement or Medicare Advantage Plan. (The Affordable Care Act did not change market rules for Medicare supplements where barriers to supplemental coverage still exist for some high-risk enrollees.)