Last Updated: April 29, 2022

Understanding health care coverage

What is health insurance?

Health insurance is a way to get medical care paid for. Health insurance options include: Medicaid (“Apple Health”); Medicare; Qualified Health Plans; employer-based insurance; and private health insurance.

How does health insurance work?

Health insurance covers all or part of your medical costs, as long as the healthcare provider is within your health plan (i.e., “in-network”). Health insurance covers essential services such as doctor visits, urgent care, maternal care, and more, as well as preventive services.

How much will I have to pay if I have insurance?

If you have Apple Health, you do not have to pay for medical care if it is covered by your plan. If you do not have Apple Health, you will have fees that depend on your insurance plan, including:

  • A premium, the amount of money you pay the insurance company every month (like car insurance).
  • An annual deductible, the amount you must first pay before you can start receiving insurance benefits.
  • Cost-sharing for part of your medical bills, including co-pays (a fixed amount of the bill) and coinsurance (a percentage of the bill).
  • Out-of-pocket maximum, the total amount of money you can pay each year before your insurance company starts to pay 100% of your covered services.

What differences are there between my old prison health care and health care after I am released?

While you are in prison, you typically only receive medical care if you are already sick or injured. When you are released, you will have more access to primary care services and preventive health care. You cannot keep your prison health care once you are released.

Can I get the insurance I had before I was in prison?

If you entered prison after 7/5/2017, and you had Apple Health coverage, your coverage should be “suspended” and then restored once you are released. If you entered before 7/5/2017, then your coverage ended. However, you might be able to apply for Apple Health while in prison and have the coverage be “suspended.”

Can Department of Corrections Staff help me apply for new coverage when I am released?

Yes, unless: you are married; you will gain custody of a child; you make more than 130% of the federal poverty guideline; or you reside in a county or city jail. In addition, the DOC can only act on behalf of incarcerated individuals and can’t help you apply for your whole family. If you do apply with DOC, it is important that you provide a valid mailing address so you will be able to receive important insurance documents. If DOC can’t help you, then you can wait until after release to apply (see #13).

What can I do if my application is denied?

Upon release, you can appeal within 90 days of the denial. If you live in King County, you can apply for help by calling 2-1-1. If you live outside King County, you can contact the Northwest Justice Project for legal advice at 1-888-201-1014 or on their website.

What else should I do to prepare to apply?

Ask for any medical records generated while you were in prison to help your new doctor. Although there are some restrictions, such as notes from a therapy or psychiatry session, generally the prison hospital must grant you access to your private health information.

What happens if I don’t have health insurance?

If you don’t have insurance, you will be charged a penalty, but you cannot be arrested or sent to prison. You will also have to pay for medical care by yourself, which can get very expensive and have limited access.

How do I avoid paying the penalty?

The simplest way is to get health insurance. Your employer or insurance company is required to provide you information to help you prove you have insurance. You may qualify for exemptions from having insurance: https://www.healthcare.gov/exemptions-tool/.

Applying for health coverage after release

How can I apply for health coverage after release?

You should apply for health insurance immediately after release. Use WA Health Plan Finder to apply online. If you need language assistance or other help, call toll-free at 1-855-923-4633. If you are hard of hearing, you can call 1-855-627-9604.

If you are 65+ or if you are on Medicare, you can apply through Washington Connection; contact your DSHS Community Services office for help.

What is Medicaid/Apple Health?

Medicaid, called “Apple Health” in WA, is a federal program that pays for healthcare if you are low income, aged, blind, or disabled. It covers essential services, substance abuse treatment, mental health services, and more.

What happens once I’ve signed up for Apple Health and been accepted?

If you are accepted, you will receive a “ProviderOne” card that has your assigned ID number. You will also be notified of your assigned managed care plan and given a health care plan ID card. If you get Apple Health and your income or household size changes, you will need to report these changes at the Washington Healthplanfinder website. You can access health care services immediately after getting your ProviderOne number. If your card hasn’t arrived yet, your provider can look up your number using your name, date of birth, and SSN.

What kind of plans other than Apple Health can be found on Washington Healthplanfinder?

If you don’t qualify for Apple Health, you can shop for Qualified Health Plans from private companies with the WA Healthplanfinder. It is important to compare plans and pay attention to the different costs.

Can I get help with paying for my health insurance?

If you got health coverage through Washington Healthplanfinder, you may be eligible to receive tax credits (PDF). You may also be eligible for lower cost health care depending on your income level and also if you are American Indian or Alaska Native.

When does my Qualified Health Plan start?

The new coverage will start on the 1st day of the next month after your previous health care coverage ends.

Can I get health insurance from my employer?

Under the Affordable Care Act, employers with 50+ employees must offer insurance to full-time employees. If your employer offers a choice of plans, you should consider what services they offer and any required cost-sharing.

Using your health care coverage

What is an insurance card and what do I do with it?

Your insurance provider will mail you an insurance card. You will need to bring it to your health care appointments so they can verify your insurance coverage.

How do I get medicine?

Medicine can be over-the-counter or by prescription. Over-the-counter medicine, like aspirin or Tylenol, can be bought like any other store item. Prescription medicine requires a prescription from your medical provider to buy medicine at a pharmacy. You can find pharmacies near you by searching the Internet or asking your provider. You will need to bring your insurance information and payment, if needed.

What do I do if I can’t pay a bill?

Do not ignore any bill. Read it carefully and make sure you know what it is for, any mistakes, and what your insurance paid. Follow up with your insurer. Be sure to consider your options before paying with a credit card, especially given high interest rates for loans. After you look at payment options, call the hospital billing office, explain your financial situation, and offer a proposed payment plan. (See “Resources” below for more help.)

What if I have a medical emergency and do not have health insurance?

The most important thing to do is to get help. You cannot be turned away from an emergency room or urgent care because of inability to pay. If you cannot safely transport yourself, call 911. The hospital will bill you, but you will have payment options and potential aid (see above).

How do I make a doctor’s appointment?

Your insurance company should have a list of available doctors, and you should choose one to be your primary care provider. Call the office to make an appointment, and tell them your reason and your health insurance provider. Make sure to bring identification, your insurance card, payment (if you don’t have Apple Health), and copies of your medical records if you have them.

How do I obtain medical records?

You almost always have the right to look at and get copies of your medical records. To do so, give your health care provider a written request to look at and get copies of your medical records. They generally have 15 days to honor your request, and they may charge a fee.

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