Before you start

Washington residence
Income information for subsidy or Apple Health eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date. Compare the deductible and out-of-pocket maximum, not just the premium — the large Seattle employers usually offer several tiers and the differences are material if you use care at all.
Via employerWho: YouFirst 30 days of employment
2
Apply for the WA Cares exemption if you are on a temporary visa
Separate from health insurance, Washington deducts 0.58% of gross wages for long-term care. Non-immigrant visa holders can apply to the Employment Security Department for a conditional exemption. You must apply yourself and provide your employer with the approval letter — the deduction runs until you do.
OnlineWho: YouMonth 1
3
Without an employer plan, use Washington Healthplanfinder
Washington runs its own exchange rather than HealthCare.gov. Open enrolment for 2026 plans ran from 1 November 2025; state-based exchanges often run longer windows than the federal one, so check current dates on the site.
OnlineWho: You
4
Check Apple Health eligibility first
Washington expanded Medicaid, so Apple Health covers adults up to 138% of the federal poverty level with no premium. Washington also created Apple Health Expansion, providing coverage regardless of immigration status for a limited number of enrolees. Newcomers on modest early incomes frequently qualify and never check.
OnlineWho: You
5
Register with a primary care physician
Your PCP gates specialist access in most plans, and finding one accepting new patients in-network can take weeks in Seattle. Confirm network status with the practice directly — insurer directories are frequently out of date.
OnlineWho: You
6
Learn the urgent care versus emergency room distinction
An ER visit for something a clinic could treat can cost thousands even with insurance. Urgent care handles fractures, stitches and infections much more cheaply. Find your nearest and save it now.
In personWho: You

Documents you’ll need

Proof of Washington residence
Income documentation for subsidies or Apple Health
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

The WA Cares exemption for visa holders is the most valuable unclaimed thing in Washington.

0.58% of gross wages, uncapped, funds a long-term-care benefit you may never be resident long enough to use. Non-immigrant visa holders may apply for a conditional exemption. Nobody prompts you, the deduction is small enough per paycheque to go unnoticed, and it compounds — on a $200,000 salary it is over $1,100 a year.

Source: WA Cares Fund — exemptions

Washington expanded Medicaid, so there is no coverage gap.

Apple Health covers adults up to 138% of the federal poverty level, and Washington went further with Apple Health Expansion, providing coverage regardless of immigration status to a capped number of enrolees. Compared with Texas and Florida — which never expanded — this removes the band of people who qualify for neither Medicaid nor subsidies.

Source: Washington Health Care Authority — Apple Health

The deductible is what surprises newcomers, not the premium.

US plans commonly require you to pay the first several thousand dollars of care each year before the insurer contributes. Someone from a national health service reads 'I have insurance' as 'I am covered', then receives a $2,800 bill for a scan. Read the deductible and out-of-pocket maximum first.

Source: community-reported

Losing job-based coverage opens a special enrolment window.

You do not have to wait for annual open enrolment if you lose employer coverage, move to Washington, marry or have a child. Each triggers a limited special enrolment period, typically 60 days.

Source: HealthCare.gov — dates and deadlines