Health care reform

Many more Washington residents now have access to affordable health care under the Affordable Care Act.

The Affordable Care Act (ACA)

The Affordable Care Act (ACA) became law in 2010. It has brought major improvements to our health care system, giving millions of Americans access to high-quality, low- or no-cost health care coverage.

In Washington, health care reform has allowed more than half a million adults who were previously uninsured to enroll in Apple Health (Medicaid). Under the Health Care Authority’s leadership, we have experienced an unprecedented 10-point drop in the uninsured rate in Washington—one of the highest drops in the rate of uninsured in the country. In fact, Gov. Jay Inslee set a goal of reducing Washington’s uninsured rate to 6 percent by the end of 2017. We reached that target two years early.

The Affordable Care Act (ACA) ensures that:

  • Parents can keep kids on their insurance until they are age 26.
  • There is no lifetime cap (or limit) to how much insurance will pay.
  • There is no annual cap (or limit) to how much insurance will pay.
  • You cannot be denied coverage if you have a pre-existing condition.
  • You cannot be dropped from your insurance if you get sick.

The ACA requires that almost everyone have health insurance. In Washington, most individuals who needs to get health insurance can use Washington Healthplanfinder — our state’s exchange. Washington residents use it to:

  • Shop for and enroll in high-quality, affordable health care plans.
  • See if they qualify for subsidized health care plans.
  • Apply for Apple Health (Medicaid).

Apply for Apple Health through Healthplanfinder if you are:

  • An adult 18 to 64 years old.
  • Applying for children.
  • A parent or caretaker applying with children.
  • Pregnant or applying for someone who is pregnant.

Apply for Apple Health through Washington Connection if you are:

  • An adult age 65 or older.
  • Blind or disabled.
  • Need long-term services and supports.

Essential health benefits

All qualified health insurance policies and Apple Health must cover these standard basics:

  • Hospitalization — A stay in the hospital, including inpatient surgery and recovery.
  • Emergency services — Visits to the emergency room, including ambulance services or treatment at an urgent care center.
  • Ambulatory services — Doctor visits when you’re sick or injured, or outpatient clinic visits.
  • Prescription drugs — Medicine your doctor orders.
  • Laboratory services — X-rays, MRIs, blood tests, etc.
  • Maternity and newborn care — For women who need prenatal care or help with pregnancy, complications and delivery.
  • Pediatric services, including oral and vision care — Dental check-ups, routine eye doctor visits, eyeglasses, immunizations, and more.
  • Preventive and wellness services, including chronic disease management — Screening tests for things like osteoporosis and mammograms, and help living with long-term illnesses like diabetes.
  • Mental health and substance use disorder services, including behavioral health.
  • Rehabilitative services and devices — Physical therapy, speech therapy, artificial limbs and other medical equipment.
  • Habilitative* services and devices — Helping people with disabilities learn life skills.

*Only available for Apple Health adult clients eligible through the ACA.