Health insurance in Washington state costs more than many expect—even with state efforts to expand access. Several key factors drive these high prices.
Market Competition and Provider Costs
Washington has limited competition among hospitals and insurers. A few large health systems dominate, allowing them to charge higher rates. Those costs pass directly to insurers—and then to you through premiums. Specialty care and hospital services in urban areas like Seattle are especially pricey.
State Regulations and Benefits
Washington requires insurers to cover essential health benefits beyond federal minimums. These include autism therapy, acupuncture, and mental health parity. While beneficial, broader mandates increase plan costs. The state also prohibits medical underwriting, meaning everyone pays similar rates regardless of health—raising premiums for younger, healthier people.
High Cost of Living
Washington’s overall cost of living is elevated, particularly in the Puget Sound region. Medical staff salaries, facility operations, and administrative expenses are all higher. Insurers factor these into premium calculations.
Risk Pool Imbalance
If too many enrollees have high medical needs—and not enough healthy people sign up—the risk pool skews expensive. Washington’s individual market has struggled with this balance, pushing premiums up.
Tobacco Surcharge and Plan Design
Insurers in Washington can charge tobacco users up to 50% more. Even non-users may face higher base rates due to market-wide pricing. Additionally, many affordable plans come with high deductibles, making out-of-pocket costs feel even steeper.
Efforts like the Washington Healthplanfinder and state subsidies help lower costs for qualifying residents. Yet, without federal-level reforms or increased provider competition, premiums remain high.
In short, health insurance in Washington state is expensive due to concentrated provider power, strong consumer protections, high operating costs, and risk pool dynamics. Shopping during open enrollment and checking subsidy eligibility can ease the burden—but systemic factors keep prices elevated.