Clarifying Information
Payment of Private Health Insurance Premiums
HCA has a Premium Payment program to help pay for Washington Apple Health (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:
- Private health insurance (plans purchased through the Washington Health Benefit Exchange or the Washington Healthplanfinder receiving Premium Tax Credits are not eligible for reimbursement).
- Employer sponsored insurance made available through your employment
- COBRA continuing your job's health insurance if you become unemployed
The program does not apply to Medicare-eligible individuals.
How to Apply
- Individuals or workers can call the toll-free line at 800-562-3022 Ext 15473
- Or visit and download the application at the HCA website.
- Any applicant who declares ‘other medical coverage’ on the Medicaid application must complete the DSHS 14-194 Medical Coverage Information form.
Making a Referral for a Premium
Download and complete an application for the Premium Payment program, HCA 13-705.
Mail: Send all mail requests to Premium Payment program, P.O. Box 45518 Olympia WA 98504-5518
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. The individual will be notified by mail with a copy to the CSO.
Contact the Premium Payment program:
Melissa Bruce melissa.bruce@hca.wa.gov 800-562-3022 Ext. 15473
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 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.
After April 2009, Medicare Part C premiums were 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.
Related Link
Premium payment program
