Health Insurance Premium program

Revised Date: 
July 25, 2014

Clarifying Information

Payment of Private Health Insurance Premiums

HCA has a premium payment program to help pay for Medicaid individuals' private health insurance premiums. For those that have access to private health insurance, the agency may pay premiums for the entire family as long as someone has Apple Health (either MAGI-based or Classic Medicaid). Insurance policies covered include:

  • Individual policies
  • Employer sponsored plans
  • COBRA policies

The program does not apply to Medicare-eligible individuals.

How to Apply

  1. Individuals or workers can call the toll-free line at 800-562-3022 Ext 15473
  2. Or visit and download the application at the HCA website.
  3. Any applicant who declares ‘other medical coverage’ on the Medicaid application must complete the DSHS 14-194 Medical Coverage Information form. The DMS system automatically assigns the DSHS 14-194 Medical Coverage Form to the coordination of benefits unit.

Making a Referral for a Premium

Download and complete an application for the premium payment program, HCA 13-705.

  1. Mail - Send all mail requests to Coordination of Benefits, P.O. Box 45518 Olympia WA 98599
  2. Fax - Application may be faxed toll free to: 877-893-3810

The COB premium specialist reviews for type of program, type of insurance, medical need, and cost effectiveness of paying the individual's premium. Premium payments are prospective and cannot be retroactive for any months they were approved for Medicaid. Allow 30 days for processing. Individual will be notified by mail with a copy to the CSO.

Contact Coordination of Benefits (COB) Premium Unit:

Supervisor Norma Leavitt norma.leavitt@hca.wa.gov 800-562-3022 Ext. 51364

Lead Worker Lorena Delgado lorena.delgado@hca.wa.gov 800-562-3022 Ext. 51572

Early Intervention Program for HIV-AIDS clients

If an applicant who has been diagnosed with HIV or AIDS is not eligible for an Apple Health program, there is another resource available. The Department of Health HIV Client Services Program funds a contract to assist persons who have HIV and/or AIDS with ongoing private health insurance premiums, or to acquire insurance. For more information about this program contact the Early Intervention Program (EIP) at DOH at 877-376-9216, or go to HIV Client Services Program or Evergreen Health Insurance Program.

Worker Responsibilities

Premium payment program and spenddown

Health insurance premiums that are being paid on an individual's behalf by the Premium Payment Program at HCA are still considered an income deduction for the Medically Needy program. Indicate the amount of the health insurance premium on the MEDX screen in ACES. Medicare premiums and related coinsurance expenses are not indicated on the MEDX screen in ACES but may be applied toward spenddown as the expenses are incurred.

All Medicare premium expenses under Part A, Part B, Part C, and Part D are entered as a spenddown expense in ACES online as the expenses are incurred. For initial applications, allow the first 2 months of premiums as a deduction if the individual has incurred the expense and they do not have coverage under a Medicare Savings Program that is paying the expense on their behalf.

Effective April 2009, Medicare Part C premiums are no longer allowed as a health insurance deduction on the MEDX screen.

Some Public Programs use non-federal dollars to purchase private health insurance on behalf of individuals. When a Public program verifies payment of a health insurance premium on behalf of a Spenddown individual, the worker needs to redetermine eligibility under the MN program using the expense as an income deduction and not a spenddown expense. In some cases, individuals will become eligible for Medically Needy (MN) with no spenddown liability and should be approved for a 12 month certification. In other cases, the spenddown liability will be reduced by the health insurance premium amount. Make sure a new letter is generated to indicate this change.

Department of Health (DOH) HIV/AIDS early intervention program and the Evergreen Health Insurance Program are considered Public Programs for Spenddown. DOH will verify expenses incurred or paid by these programs on behalf of Spenddown individuals. These expenses are to be used toward meeting the individual's spenddown liability.