Premium Payment Program

What is the Premium Payment Program?

• Helps people on Apple Health take advantage of private health insurance in a way that saves the state money.
• Reduce health care costs to the state.
• Provides reimbursement for private health insurance coverage when an Apple Health client has access to qualifying private health insurance coverage, such as through an employer or private policy.

How can the Premium Payment Program help?

• Keep Apple Health and private health insurance.
• Family members not covered by Apple Health may also be included in the premium payment if it is determined to be cost effective.
• Apple Health coverage does not terminate by enrolling in the program.

Do I qualify for premium payment assistance?

You must have Apple Health coverage before applying for the Premium Payment Program.

If no one in your family receives Apple Health coverage, go to wahealthplanfinder.org to see if you qualify.

Private health insurance that qualifies for the Premium Payment Program includes:

• Employer sponsored insurance available through your employer
• COBRA continuing your employer sponsored health insurance if you become unemployed or have retired
• Private health insurance purchased through the Health Benefit Exchange

Types of private health insurance that do not qualify for the Premium Payment Program may include:

• A health savings account or flexible health spending arrangement
• A high-deductible plan
• A limited or supplemental plan, including a Medicare supplemental plan
• A Medicare Advantage plan (Medicare Part C)
• An individual health plan purchased through the Health Benefit Exchange with a premium tax credit
• An individual health insurance plan that was not purchased through the Washington Health Benefit Exchange

See WAC 182-558-0030 for more information.

How do I apply for premium payment assistance?

Complete, print out, and sign this intake form for premium assistance.

Complete, print out, and sign the IRS W-9 form. This form is required information for the subscriber's private insurance plan.

Mail these documents to:

Premium Payment Program
Health Care Authority
PO Box 45518
Olympia, WA 98504-5518

Fax: 877-893-3810 (toll free)

It may take up to 30 days to process your application after we receive all the necessary paperwork.

Eligibility phone consultation for those enrolled in Individual Health Plans

Effective March 1, 2024, new Premium Payment Program applicants who are enrolled in an individual health plan purchased through the Health Benefit Exchange must complete an eligibility telephone consultation. The eligibility phone consultation must occur within 30 calendar days of submitting a completed intake form.

• The phone consultation must occur between the Premium Payment Program staff and the client, or the client's legal representative, or both.
• After you submit your completed intake form Premium Payment Program staff will attempt to reach you by phone, to schedule the phone consultation, within seven business days.
• You must schedule your phone consultation by responding to the agency by telephone or email within 10 business days of the HCA’s outreach. See Premium Payment Program contact information below.
• HCA may deny your application if you do not complete the phone consultation.