Cascade Care Implementation Updates

Many Washingtonians don't get the health care they need because it is too expensive. The state's Cascade Care efforts aim to make health care accessible and affordable for every Washington Healthplanfinder customer.

Cascade Care does this by:

  • Addressing costs through lower premiums, lower deductibles, and providing access to services before having to pay the deductible. This includes leveraging federal and state-based financial assistance, state purchasing power, and provider reimbursement expectations;
  • Encouraging meaningful consumer choice with products of better value and like benefits across all participating carriers;
  • Growing enrollment by attracting new enrollees and retaining current customers; and
  • Ensuring continued market health through stable carrier participation, competitive product offerings, and a larger and more diverse risk pool.
  • Learn more about Cascade Care.

Cascade Care News 

Cascade Care legislation, Senate Bill 5526, was passed by the Washington State Legislature in 2019. The bill created new standard plans and public option plans to be offered through Washington Healthplanfinder. Cascade Care is a multi-agency effort by the Exchange, Health Care Authority (HCA) and Office of the Insurance Commissioner (OIC). 

During the 2021 legislative session, the Washington State Legislature passed Senate Bill 5377, directing the Exchange to establish a state premium assistance program, now named Cascade Care Savings, for Washington residents. In the 2021 State Operating Budget, funding was provided to provide premium assistance to Washington residents earning up to 250% of the federal poverty level, beginning in 2023.

2025 Standard Plan Design

The Exchange annually develops standard plan designs by working with a wide variety of implementation partners — including agency partners, Cascade Care Workgroup members and Exchange actuarial consultants. Standard plans are called Cascade plans. All Cascade Care plans make it easy to compare by price because every plan has the same benefits regardless of the insurance company .

Standard plans are offered in every county in Washington. Every carrier on the Exchange is required to offer at least one standard Silver plan and one standard Gold plan in every county in which they offer coverage. Carriers that offer Bronze plans on the Exchange are also required to offer a standard Bronze plan. 

Public Comment Period

The Exchange held a public comment period on the draft 2025 Standard Plan (Cascade Care) from Oct. 26 - Nov. 27, 2023. Read more information about how the 2024 Standard Plan Design options were developed, detailed proposed plan design charts, and instructions for submitting public comment:

2024 Cascade Care Savings Policy

Cascade Care Savings provides state premium assistance to Washington residents earning up to 250% FPL who enroll in Cascade Care Silver or Gold plans through Washington Healthplanfinder

From July 19, 2023–Aug. 18, 2023, the Exchange held a public comment period about the Draft 2024 Cascade Care Savings Amount Methodology.

2024 Standard Plan Designs

Standard plan designs for plan year 2024 offered on Washington Healthplanfinder

HCA Cascade Select

Cascade Select plans are Washington state's public option plans, available exclusively through Washington Healthplanfinder. For more information about the procurement process, visit the Health Care Authority's Cascade Select (public option) page.

Stay updated

This page will be periodically updated with information about Cascade Care implementation. If you are interested in following this work, please subscribe to receive emails with information about updates to this page, upcoming meetings, stakeholder input opportunities and other relevant announcements. The public is also invited to attend Cascade Care Workgroup meetings to learn more about specific elements of Cascade Care implementation.

For more information on the Exchange’s Cascade Care implementation work please contact Cascade Care Workgroup at [email protected].

What is Cascade Care?

Cascade Care is the Exchange's primary affordability initiative. Cascade Care legislation, Senate Bill 5526, was passed by the Washington State Legislature in 2019. The bill created standard plans and public option plans offered through Washington Healthplanfinder for Washingtonians. These plans options are intended to improve the stability and affordability of the individual market and provide better value for Exchange consumers. Standard plans and public option plans are offered exclusively through Washington Healthplanfinder.

The Washington State Legislature passed Senate Bill 5377, directing the Exchange to establish a state premium assistance program, now called Cascade Care Savings, for Washington residents. 

What are the main components Cascade Care

There are three main components:

  1. Cascade (standard) plans: The Exchange develops standard plan designs annually. Standard plans are qualified health plans with a standard benefit design across carriers. These plans are more understandable, aim to be more affordable, and offer more value for Washington Healthplanfinder
  2. Cascade Select (public option) plans: The Health Care Authority procures public option plans available on Washington Healthplanfinder.  Public option plans are qualified health plans that have a standard benefit design and meet additional quality and value requirements.
  3. Cascade Care Savings: The Exchange implemented a state-funded premium subsidy available to Washington Healthplanfinder consumers with income up to 250% of the federal poverty level (FPL). 

What are Cascade (standard) plans?

Cascade (standard) plans are a type of qualified health plan offered by insurance carriers on the Exchange. These plans have a standard cost-sharing design, meaning they have the same deductible, co-pays, and co-insurance for medical services, and offer the same services before the deductible, no matter which carrier is offering it. As a result, consumers can more easily and accurately compare plans based on premium price, provider networks, customer service, and quality. Standard plans are intended to:

  • Lower deductibles;
  • Improve access to pre-deductible, evidenced-based services across insurers; 
  • Provide transparent, predictable cost-sharing; and
  • Increase the value of the federal premium subsidies.  

What are Cascade Select (public option) plans?

Public option plans are qualified health plans designed by the Exchange and selected by the state. These plans, offered exclusively through Washington Healthplanfinder, provide the same predictable benefits as all other Cascade Care plans. Additionally, carriers are required to meet higher quality standards and state-defined reimbursement rates for providers, including hospitals and doctors.  

Through competitive procurement, the Washington State Health Care Authority (HCA) can be more selective in contracting with Exchange carriers interested in competing to offer public option plans that are highest quality and offer the lowest premiums. This promotes healthy competition on the Exchange and lower premiums for Washingtonians.

What is Cascade Care Savings?

Based on household income, Cascade Care Savings provides additional financial assistance to lower the premium cost of Cascade Care Gold or Silver plans. This extra premium help is added to the consumer’s federal tax credit to lower monthly premiums. To qualify, an individual or household must meet the following requirements:

  • Have a household income up to 250% of the federal poverty level;
  • Apply for and accept all available federal tax credits;
  • Not be eligible for minimum essential coverage through federal or state programs, like Medicare or Washington Apple Health;
  • Enrolled in a high-quality Cascade Care Silver or Gold plan through Washington Healthplanfinder; and
  • Be a qualified health plan-eligible resident of Washington state.

American Indian/Alaska Native (AI/AN) individuals may enroll in any plan that allows them to take advantage of their $0 cost-sharing reduction benefit.

Cascade Care Workgroup 

The Cascade Care Workgroup, which represents a broad spectrum of stakeholder perspectives, is working with the Exchange to implement Cascade Care. This group has regular open-public meetings during which policy and  design considerations are discussed.

 

Plan Certification Workgroup 

The Plan Certification Workgroup, which is comprised of Washington’s health and dental insurers, routinely meets to provide technical feedback to the Exchange. This group of will provide technical feedback on standard plans throughout the design process.

 

Exchange Board Meetings 

The Exchange Board has open-public meetings every other month. High-level updates on Cascade Care implementation will be routinely provided. Standard plans designs will be presented to the Exchange Board for their review and approval in December 2019.

 

Public Comment 

The Exchange is conducting a formal public comment period on the 2022 draft standard plan designs that will run from November 30, 2020 through December 29, 2020. Feedback from all interested stakeholders on the draft standard plan designs will be solicited. For more information and to submit public comment, see Cascade Care Standard Plan Public Comment.

Plan year 2024 materials

Plan year 2023 materials

Stakeholder Feedback

Plan year 2022 materials

Plan Year 2021 Materials

Archived 2020 materials

Archived 2019 materials