Open Enrollment

Open Enrollment Timeline

The Open Enrollment Period starts November 1 and ends on January 15. Washington Healthplanfinder carrier/plan changes made November 1 through December 15 will have a January 1 effective date. If you are enrolled on a carrier direct (outside of the Washington Healthplanfinder) deadline dates may vary. Please contact our office with any questions regarding carrier direct enrollments.

Washington Healthplanfinder income / household changes made November 1 through November 15 will have a December 1 effective date of change.
To have income / household changes take effect January 1, updates must be submitted November 16 through December 15.

Carrier / plan changes made December 16 through January 15 will have a February 1 effective date.

We strongly encourage any enrollment changes be made prior to the December 15 deadline for January 1 effective dates of coverage. If a February 1 change is made to a different carrier, any out-of-pocket expenses applied toward the first plan would not carry over to the second plan. This increases your total exposure for the year.

2025 Individual Health Insurance Rate Changes

The Office of the Insurance Commissioner (OIC) has announced that 11 health insurers have been approved to sell in Washington's 2025 Exchange health insurance market. The approved average rate increase is 10%. Actual rate adjustments vary by carrier and plan and do not take into consideration annual age-band changes. Links will open in a new tab.

OEP Tutorial

This presentation is focused on enrollment through Washington Healthplanfinder. If you are enrolled on a Grandfathered or carrier direct plan, please contact our office to discuss in more detail.

2025 Considerations and Changes

Disclaimer: Not all carriers offering plans in Washington are listed below. Carrier and plan availability varies depending on county of residence. We have included carrier provider and RX formulary search links which may require specific plan information be listed to obtain accurate results. Please contact our office with any questions.

Please view our tutorial on navigating of the renewal process, along with our short videos on the most accurate process of confirming provider network participation and using prescription drug formularies in our Video Tutorials, under ‘More Information’ to check drug coverage and tier classification.

Ambetter Coordinated Care will experience an average rate increase of 9%. They have consistently offered some of the lowest premium plans and their service area includes all 39 counties of Washington. Ambetter offers both Cascade Care Select (public option plans) along with Cascade standardized and non-standard plans. Cascade Select Public Option plans have a more limited provider network than non-Cascade Select Plans. Please Confirm provider and facility network participation carefully when reviewing the Cascade Select Public Option plans. Their Pharmacy Benefit Manager (PBM) is Express Scripts.

Ambetter allows self-referrals for specialty care (this does not mean the provider can't require a referral). Their primary facility contracts are with Swedish, Providence, and Virginia Mason Franciscan Health facilities, to include Kitsap County, and are less likely to contract with independent providers. They offer reciprocity in most states that their parent company offers coverage, excluding California and New York. Washington state networks have no reciprocity with the Select and Value networks offered in CA, FL and TX. Members should call Ambetter customer service to confirm coverage when traveling outside the WA service area.

Ambetter Online provider search tool

CCCWA Exchange
This provider network supports Washington’s Cascade plans and non-standard plans (Essential, Balanced, and Secure).
Cascade Complete Care
This exclusive provider network supports the state’s Public Option plans (Cascade Select). It is important to note that this network is only available within certain areas of Washington State.

Ambetter RX Formulary

Note that Cascade & Cascade Select plans use the Cascade specific drug list.

CHPW will experience an average rate increase of 9%, includes 26 counties in their service area and is a Washington based company. They offer only Cascade Select Public Option plans, do not contract with many independent providers, and may require the use of Community Health Centers for primary care in some service areas. Please confirm providers and facilities are in-network if looking at the CHPW Cascade Select Public Option plans.

Community Health Plan of Washington Online provider search tool

Community Health Plan of Washington RX Formulary

Kaiser will experience an average rate increase of 8%. Kaiser is a health maintenance organization (HMO) that may require the use of Kaiser facilities depending on county of residence. Kaiser is a managed care plan that requires primary care referrals for specialty care. Kaiser has a limited footprint in Washington and is not available in all counties. Kaiser will be discontinuing all their Virtual Plus plan options for 2025. Members enrolled on these plans should be on the lookout for plan mapping information, review 2025 coverage options, and make any changes during the open enrollment period.

Online provider search tool

Individual and family plans will use the Core Network.

Kaiser RX Formulary

Use the Individual & Family Plans formulary.

LifeWise will be experiencing an average rate increase of 8% with no major changes in benefits or provider networks. LifeWise will be exiting Clallam, Jefferson and Mason counties in 2025. The LifeWise Essential Bronze HSA plan will be discontinued in all counties. We advise reviewing renewal information, checking provider networks, and prescription drug formularies if being cross mapped to a new plan. Plan discontinuations only pertain to LifeWise plans purchased through the Washington Healthplanfinder and not LifeWise Grandfathered plans that were obtained carrier direct.

LifeWise offers in-network coverage with contracted providers in Alaska and is contracted with Swedish and Providence medical systems. They are contracted in Kitsap County with St. Michaels but not Virginia Mason in King County. They have a high number of in-network independent providers in their network. LifeWise uses Express scripts as the Pharmacy Benefit Manager.

LifeWise offers Cascade Select Public Option plans in some counties which have a more limited provider network than their Cascade and non-standard plans. Please Confirm provider and facility network participation carefully when reviewing the Cascade Select Public Option plans.

Online provider search tool

LifeWise Essential & Cascade Plans will use the LifeWise Primary Network
Cascade Select Plans will use the LifeWise Alpine Network

Rx Formulary

The Metallic M1 Drug list is used by these plans:
- Cascade Gold
- Cascade Silver
- Cascade Bronze
- Cascade Select Gold
- Cascade Select Silver
- Cascade Select Bronze
- Essential Gold AI/AN
- Essential Silver Low Deductible AI/AN
- Essential Bronze AI/AN
The Metallic M2 Drug list is used by these plans:
- Cascade Bronze
- Cascade Select Bronze
The Metallic M4 Drug list is used by these plans:
- Essential Bronze Essential Bronze AI/AN 300%
- Essential Gold Essential Gold AI/AN 300%
- Essential Silver Low Deductible
- Essential Silver Low Deductible AI/AN 300%
- Essential Silver Low Deductible CSR1
- Essential Silver Low Deductible CSR2
- Essential Silver Low Deductible CSR3
- Cascade Gold Cascade Silver
- Cascade Silver CSR1
- Cascade Silver CSR2
- Cascade Silver CSR3
- Cascade Bronze
- Cascade Select Bronze
- Cascade Select Silver
- Cascade Select Silver CSR1
- Cascade Select Silver CSR2
- Cascade Select Silver CSR3 Cascade Select Gold

LifeWise Grandfathered (GF) Plans will see a 7% rate increase. LifeWise GF plans are not required to meet all the provisions of the Affordable Care Act (ACA) but have a broader provider network than the LifeWise ACA compliant plans. LifeWise GF plans are PPO plans that offer limited out of network benefits. LifeWise GF plans do not offer prescription drug coverage.

If you would like to review other options: Click her to review ACA plans and rates.

As a reminder, all grandfathered plans are closed to new sales.

Click Here for a Grandfathered rate sheet
Click Here for to access GF plan summary of benefits and coverage and benefit booklets. Click the Off Exchange link to access.

Use the LifeWise online provider search tool to review provider network for GF plans.

LifeWise Grandfathered Plans will use the LifeWise Health Plan of Washington Preferred Network

Molina will experience an average rate increase of 6% and has no major benefit or provider network changes for the upcoming plan year. Molina allows self-referrals for specialty care (this does not mean the provider can't require a referral). Note that Molinia is contracted with CHI Franciscan Facilities but not Virginia Mason in King County.

Online provider search tool

Molina ACA plans use the Molina Marketplace network

RX search tool

Go to the 'Members' tab in the top navigation,
Click 'Search Drugs'
Select your plan in the pop-up window

Premera will experience an average rate increase of 15% and continues to offer one of the broadest provider networks, but they are still the most expensive. Anyone enrolled on Premera should weigh the benefits of the provider network against the increased cost. Premera uses Express scripts as the Pharmacy Benefit Manager.

Premera is offered only in Franklin, Grays Harbor, King, Kitsap, Pierce, Spokane, and Yakima counties.

Online provider search tool

Premera Preferred and Cascade plans use the Individual Signature Network

RX formulary

Premera (non HSA) Preferred and Cascade individual plans use the M4 drug list
Premera (HSA Qualified Plan Only) Preferred Bronze HSA individual plan uses the M2 drug list

Regence Blue Shield will be experiencing an average rate increase of 22%. They offer a four-state network (Washington, Idaho, Oregon and Utah) and nationwide urgent and emergent care though the National BlueCard Network. Regence ususes Express Scripts as their Pharmacy Benefit Manager.

Their primary contracts in King County are with the UW, Virginia Mason, Evergreen, and Overlake Medical Systems. Regence tends to be a good choice for people that spend significant time out of Washington and/or want access to UW Medicine, Harborview, and Seattle Cancer Care Alliance/Fred Hutch Cancer Centers. They also contract with many independent providers.

Online provider search tool

Regence individual plans use the Individual and Family Network

RX formulary

Regence Individual Plans use the 4-tier drug list

United Healthcare (UHC) will experience an average rate increase of 24%, which is the highest of all carriers in Washington for 2025.

United Healthcare is contracted with the UW Medical system, including Harborview and Seattle Cancer Care Alliance/Fred Hutch Cancer Centers. They are NOT contracted with CHI Virginia Mason in Kitsap and King Counties.

Online Provider search tool

Plans use the Washington Charter EPO Network

RX formulary

More Information

Dental coverage obtained through the exchange requires enrollment during either the open enrollment period or under a special enrollment period, is preventive care focused and does not provide coverage for major dental services.

Carrier direct dental enrollment is available any time of year. Most plans require a 12-month contract, provide coverage for major dental services, and may impose waiting periods.

Enrollment in pediatric dental is generally included in carrier direct policies and separate enrollment is required through the exchange. Pediatric dental works more like a medical plan, where there is a out of pocket maximum (the most you would pay) instead of a benefit maximum (the most an insurance company would pay).

Click here to go to the Dental page of our website

Most individual and family medical plans do not include vision benefits (routine eye exams, prescription eyeglasses, contact lenses). Medical plans will cover eye related medically necessary care, to include treatment for cataracts, glaucoma, and trauma to the eye and require the use of in-network providers except for emergencies.

Pediatric vision is embedded on all in and off Exchange qualified health plans for enrolled children under the age of 19. Coverage will require use of an in-network provider.

If you are looking at vision plan as well as a dental plan, we encourage you to consider DeltaVision through Delta Dental. It uses the VSP network and offers more robust benefits for the cost that enrolling on a stand-alone VSP plan.

Click here to go to the Vision page of our website

How to Work With Us

If you are new to Healthplanfinder or need information on how to create an account or link to our office, please use the instructions found by clicking the button below. We also have a tutorial on how to link to a broker in the Video Tutorials section above. For more information about the insurance carriers and agencies we work with, use the button below to access the Individual and Family Resources page.

How to Create an Account in HPF or Link to a Broker

Individual & Family Resources page