Washington Basic Health Income Guidelines

Washington Basic Health is a state-supported health insurance plan that contracts with health insurance companies statewide to provide reduced-cost health insurance for qualifying individuals and families. The state pays part of the premium based upon a family's size and gross monthly income before taxes and other deductions.

What It Provides

• The Washington Basic Health plan offers doctor care, including preventive care, plus hospital and emergency room coverage and prescription drugs. In most counties (those with more than one participating plan), participants can select their own health insurance plan and then their own doctor affiliated with that plan. All the health insurance plans offer the same benefits, but details such as premiums, providers, preventive care and prescription drugs can vary.

How It Works

• A Basic Health member must choose a primary care provider and must get care from the plan's authorized health care providers. Family members may have different primary care providers. Emergency room care is allowed without prior approval from your primary care provider. You still must report it within 24 hours, or as soon as you are able. Women do not need prior approval for "medically necessary" services or follow-up care (reproductive care, maternity care and routine gynecological exams) from an approved or designated women's health-care provider. If you receive care not approved by your Basic Health plan, you must pay its entire cost.

Income Guidelines

• Washington Basic Health's income guidelines are based upon your family's gross monthly income before taxes and deductions. Details are available at the Income Table section of the program's website. The "income bands" are based upon family size and divided into eight categories, A through H. So, a single person in Health Plan A can earn up to $586 per month and qualify. The same person in Health Plan H can earn between $1,669 and $1,805. A family of five can earn up to $1,396 per month for Health Plan A and between $3,975 to $4,298 monthly for Health Plan H.

  If you are self-employed, a one-year history of income and expenses is used. Other income, such as odd jobs, is calculated by "income averaging," or your income for the past month.

  You are not eligible if you also are eligible for free or purchased Medicare.

  Your family size means you, your spouse, your children and any legal dependents (including students younger than age 23 and the disabled), even if they are not living with you. Your monthly premium depends upon all your family members, even those not enrolled.

Monthly Premiums

• Your monthly premiums are based upon your income, age, family size and health plan. Washington Basic Health offers a $250 annual deductible and $1,500 annual out-of-pocket maximum, no co-payments for preventive care, and low co-payments on some other services.

Waiting List

• The Washington Basic Health program has a waiting list, for which you can register online at the agency's website. Applicants are notified when space becomes available. However, some groups can bypass the waiting list, including personal care workers, foster parents, tribal-sponsored accounts, Washington National Guard or Reserve members who served in Operation Iraqi Freedom, Operation Noble Eagle or Operation Enduring Freedom. To see if you qualify to bypass the waiting list, visit the agency's website or contact a caseworker.