Healthcare & Insurance Guide

Last Updated: July 22, 2024. Report error / Make suggestion

Understanding Insurance

• Health insurance is required by law (or you will be charged a penalty).
• All health insurance coverage sold in Washington state must cover mental health care.
• DOC can help you apply for Medicaid while in prison (unless you are married or will gain custody of a child after release).
• Companies that employ at least 50 people must provide health insurance to their employees.
• You can apply for free or low-cost coverage through Medicaid and CHIP any time, all year.

Medicaid / Apple Health

1-855-923-4633

First-timers’‌‌Guide‌‌to‌‌Washington‌‌Apple‌‌Health

Helps people with low income and/or aged, blind or disabled. You may qualify for Medicaid/Apple Health if your income is 138% below the federal poverty level. There are no monthly premiums except for children from higher-income families.

You can explore coverage types or talk to a certified navigator.

• If you have Medicaid coverage before you entered prison…
  • And you entered prison after July 5, 2017: your coverage will be suspended during Incarceration and then restored once you are released
  • And you entered prison before July 5, 2017: your coverage is terminated, but you might be able to apply to Medicaid while in prison

Replacing a Lost Insurance Card

To replace a lost‌Apple‌‌Health card,‌‌fill out the Apple Health contact form and‌‌ select‌ ‌“Services‌ ‌Card”‌ ‌under‌ ‌“Select‌ ‌Topic.”‌ ‌For‌ ‌other‌ ‌insurance‌ ‌providers,‌ call‌ ‌their‌ ‌Customer‌ ‌Service‌ ‌number.‌

Medicare

Helps people who are either 65 years and older or are disabled and receive SSDI or have end stage renal failure. This is free to anyone over the age of 65 as long as you have worked and paid taxes to Medicare for at least 40 quarters (10 years). If you turn 65 and qualify for Medicare while incarcerated, you should actively enroll in Medicare Parts A and B during your Initial Enrollment Period (which includes the three months before, the month of, and the three months following your 65th birthday). You will not be eligible for automatic enrollment while you are incarcerated.

How to Apply

To enroll in Part A and Part B, send a signed and dated letter to the Social Security Administration (SSA) that includes your name, Social Security number, clear statement that you want to enroll, and the date coverage should be effective. Be sure to keep a copy of the letter that you send.

How Medicare Coverage works while you are incarcerated

• You will typically need to pay the Part B premium ($144.60 in 2020) each month to avoid being disenrolled, but Medicare typically will not pay for your medical care until you are released.
• It is usually best to keep Medicare Part A and Part B coverage while you are incarcerated. Although Medicare will not cover your care, keeping it will ensure that you avoid late enrollment penalties and gaps in coverage when you are released. Note that if you are under 65 and qualify for Medicare due to disability, you must reinstate your SSDI in order to resume Medicare coverage.

If you cannot afford to continue paying the Part B premium during your incarceration:

1. You should actively withdraw from Part B instead of being disenrolled to avoid owing premiums to SSA. If you do nothing, SSA will continue to bill you for Part Band disenroll you after you fail to pay your premiums. When you re-enroll in Part B upon release, SSA will deduct any unpaid premiums from your Social Security benefits.
2. See whether you qualify for a Medicare Savings Program (MSP). MSPs pay your Part B premiums, help you enroll in Medicare outside typical enrollment periods, and waive premium penalties.

Qualified Health Plan (private insurance)

If you do not receive health insurance through your employer and you do not qualify for Medicaid/Apple Health, you will need to buy private insurance, also known as a qualified health plan (QHP). You cannot apply if you are in jail or prison. Applying for health insurance has an enrollment period (typically from beginning of November to mid December). You may qualify for a Special Enrollment Period to enroll in a Marketplace plan if you experience certain types of life changes, like losing health coverage, getting married, or having a baby. Covers Essential Health Benefits. Does not cover adult dental/vision/hearing care nor certain long-term care.

Need financial assistance? You can qualify for help paying for a QHP if your household gross income is between 100% – 400% of the federal poverty level or you are lawfully present immigrant whose income is at or below 400% of the federal poverty level, you file taxes, you are married and file taxes jointly.

Statewide Healthcare & Insurance Resources

Statewide Health Insurance Benefit Advisors (SHIBA)

800-562-6900

Part of the insurance commissioner’s consumer protection services, SHIBA provides free, unbiased, and confidential assistance with Medicare and health care choices.

Washington Health Plan Finder

855-923-4633

Free state healthcare (Medicaid/Apple Health) and tax credits available to those who meet income eligibility requirements. Assistance in finding health insurance online or over the phone.

Washington Prescription Drug Program

800-913-4146, 800-913-4311

Offers discount prescription drug discounts to those found eligible.

Washington Recovery Helpline

Call 1-866-789-1511‌ ‌for‌ ‌referrals ‌or‌ ‌if‌ ‌you‌ ‌are‌ ‌in‌ ‌a‌ ‌crisis‌ ‌and‌ ‌need‌ ‌immediate‌ ‌help.‌

Mental‌‌health,‌‌addiction,‌‌or‌‌substance‌‌abuse‌‌treatment

Children’s Health Insurance Program (CHIP)

CHIP is an insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women.

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