Health Insurance

Basic Health and Basic Health Plus

The Basic Health program is the Washington state-funded and administered program providing affordable health care coverage — through private health plans — to adults, children and pregnant women. Everyone meeting the requirements listed below is eligible, including people who are not U.S. citizens.

For adults, Basic Health covers only medical care. (No dental or vision care.) For children, Basic Health Plus covers medical, dental and vision with no deductibles or coinsurance payments.

Participants may choose their own health plan among those offered in their county. They may also choose their own doctor among those affiliated with the health plan chosen.

Benefits cover doctor and hospital care including preventive care, emergency services and prescription drugs. All participating health plans provide roughly the same benefits package although the premiums, doctors, prescriptions and preventive care services do vary among plans.

Monthly premiums range from $17 to $266 per month and are based on household size, income, age and the health plan selected. Co-payments and co-insurance costs are based on type of service.

The Basic Health Plan’s $150 annual deductible and annual out-of-pocket maximum is $1,500 for each family member enrolled, except for those enrolled in Basic Health Plus or the Maternity Benefits Program.

Pre-existing conditions are not covered for nine months after acceptance into the program, unless enrolled in Basic Health Plus or Maternity Benefits Program. Some of the nine-month wait may be waived if you have been covered by another insurance company in the three months prior to enrolling in the Basic Health Plan.

To be eligible, Washington residents:

• Must have a family or household income less than 200 percent federal poverty level
• Cannot be eligible for free or purchased Medicare
• Cannot be institutionalized (in a hospital mental health ward or prison) at the time of enrollment
• Cannot be attending school full-time in the United States on a student visa

Visit the Basic Health and Basic Health Plus web sites for more information.