Medical-plan questions on the Washington exam start with the same national fundamentals every state tests, then layer on Washington's distinctive coverage rules. This guide reviews how plans are built and priced, walks through the federal Affordable Care Act (ACA) floor that applies everywhere, and then makes Washington law the spine — state mandates, small-employer continuation, conversion rights, Washington Apple Health, and the state's own marketplace and Cascade Care plans. Washington's insurance code lives in RCW Title 48, enforced by the Office of the Insurance Commissioner (OIC), whose Commissioner is elected.

The national base: types of medical plans

Most health questions begin with plan design and cost-sharing:

• HMO (Health Maintenance Organization) — care coordinated through a primary care physician (PCP) gatekeeper, in-network only, with referrals; emergencies aside, out-of-network care is generally not covered.
• PPO (Preferred Provider Organization) — a network with lower in-network cost, but out-of-network access without referrals at higher cost.
• EPO (Exclusive Provider Organization) — network-only like an HMO, but usually no referral requirement.
• POS (Point of Service) — a hybrid: PCP/referrals like an HMO, with out-of-network coverage allowed at higher cost.
• Indemnity / fee-for-service — pay any provider; insurer reimburses a share of reasonable charges. Now rare.

Cost-sharing terms are the same everywhere: premium, deductible, copay, coinsurance, and an out-of-pocket maximum. Know the group vs. individual split too — group plans cover an employer's eligible employees under one master contract, while individual plans are bought directly by a person.

The federal ACA floor (applies in Washington)

The ACA sets a national minimum that Washington builds on:

• Guaranteed issue — insurers must accept eligible applicants.
• No health rating — premiums cannot be based on health status or claims history (age, area, tobacco, and family size are the limited allowed factors).
• Pre-existing conditions covered — no exclusion periods.
• Essential health benefits (EHBs) — a required set of categories (e.g., hospitalization, maternity, prescription drugs, preventive care, mental health).
• Dependents to age 26 — young adults may stay on a parent's plan.
• No lifetime/annual dollar limits on essential benefits.

Washington mandated benefits

Washington requires insured plans to cover various state-mandated benefits that often exceed the federal floor. You don't need to memorize the full list — know that Washington adds mandates and recognize representative examples:

• Maternity and newborn care with minimum maternity stays.
• Mental health and substance-use parity.
• Cancer screenings (such as mammography).
• Diabetes supplies and education.
• Reconstructive surgery following a mastectomy.

If asked whether Washington requires more than federal minimums, the answer is generally yes.

Continuation: WA small-employer "mini-COBRA" and federal COBRA

When group coverage would otherwise end, a covered person may continue it:

• Federal COBRA applies to employers with 20 or more employees, generally allowing continuation up to 18 months (longer in some situations, such as disability or certain qualifying events).
• Washington provides small-employer continuation ("mini-COBRA") for groups under the 20-employee federal threshold, so workers at small firms aren't left without a bridge. Treat the exact maximum length as a figure to verify — it is commonly shorter than the full COBRA term, and Washington's continuation rules are partly handled through the policy and the carrier.

The exam hook: 20+ employees → federal COBRA; under 20 → Washington small-employer continuation.

Conversion privilege

Beyond continuation, Washington has historically recognized a conversion privilege — the right to convert group coverage to an individual policy, without new evidence of insurability, when continuation ends. With ACA guaranteed-issue individual coverage and the state marketplace, many people now move to a marketplace plan instead, but the conversion concept remains a tested fundamental.

Washington Apple Health (Medicaid)

Washington Apple Health is the brand name for Washington's Medicaid program — income-based coverage (expanded under the ACA) for eligible low-income residents. Don't confuse it with Medicare, which is the federal age-based program. Apple Health enrollment is handled through the state, often via the same marketplace portal.

Washington Healthplanfinder and Cascade Care (distinctive to WA)

Washington runs its own state-based ACA exchange, the Washington Healthplanfinder, rather than relying on the federal HealthCare.gov platform. Through it, Washington also offers Cascade Care — standardized "public option" plans designed by the state with predictable cost-sharing and offered by private carriers. Cascade Care is distinctive to Washington and a likely exam talking point; it standardizes benefit designs so consumers can compare plans more easily and may pair with state premium assistance.

Provisions and timelines

• Grace period — time after a missed premium before coverage lapses (commonly cited around 31 days for many health policies; verify).
• Free look — individual policies carry a return-for-refund window, commonly cited around 10 days in Washington; verify.
• Incontestability — after the policy has been in force a set period (often two years), the insurer generally cannot contest it except for fraud or nonpayment.
• Prompt-pay — insurers must pay or deny clean claims within set timeframes, with interest on late payments.

Key Washington numbers to memorize

Common exam traps

• Forgetting Washington runs its own exchange. It is Washington Healthplanfinder, not HealthCare.gov.
• Missing Cascade Care. Washington offers state-designed standardized "public option" plans.
• Applying federal COBRA to a 10-employee firm. Small groups use Washington small-employer continuation.
• Capping the dependent age below 26 or assuming WA matches no extra mandates. Washington adds mandated benefits.
• Confusing Apple Health (Medicaid) with Medicare. Apple Health is income-based Medicaid.
• Saying the Commissioner is appointed. Washington's Commissioner is elected.
• Forgetting conversion is without new underwriting.

Quick recap

Washington medical plans use the same national skeleton — HMO/PPO/EPO/POS/indemnity, standard cost-sharing, and group vs. individual — sitting on the ACA floor (guaranteed issue, no health rating, pre-existing conditions covered, EHBs, dependents to age 26). Washington then layers on state-mandated benefits, small-employer continuation for groups under the 20-employee federal COBRA threshold (verify the length), a conversion privilege without new underwriting, and Washington Apple Health (Medicaid). The standout Washington facts: the state runs its own Washington Healthplanfinder exchange and offers Cascade Care standardized "public option" plans, all under RCW Title 48 and the elected Insurance Commissioner. Lock those in and the medical-plans section becomes predictable.