Three companies offer coverage in Okanogan County
By Marcy Stamper
It’s open-enrollment period, the once-a-year opportunity for people to sign up for — or make changes to — health coverage if they purchase their insurance through the state’s insurance marketplace.
The Washington Health Benefit Exchange is the state-run exchange developed in conjunction with the Affordable Care Act (also called ACA or Obamacare). Many Washington residents who get their insurance through the exchange are eligible for subsidies or tax savings.
The deadline to make sure you are covered by Jan. 1 is coming up soon — the exchange recommends that people act by this Thursday (Dec. 15) to be sure they have all the paperwork for their coverage by the start of the year. Nevertheless, anyone who completes the sign-up process by Friday, Dec. 23, will be covered starting Jan. 1, according to Ben Spradling, media communications associate with the exchange.
People who had a policy in 2016 should have received a letter from their insurance company informing them that they can automatically renew the policy or that the policy is no longer available. Even people who have the option to continue their existing policy can check out other plans and select a different one during open enrollment.
Three insurance companies are offering medical insurance in Okanogan County in 2017 — LifeWise Health Plan, Molina Health Care and Premera Blue Cross. In addition, Delta Dental is offering adult dental insurance and Delta, LifeWise and Premera are offering pediatric dental insurance.
For coverage starting in February, people have until Jan. 23 to enroll. Open enrollment for 2017 ends on Jan. 31. People who already have insurance and have qualifying life events, such as adding or losing a dependent or losing other health coverage because of job loss or divorce, can make changes later in the year.
Choosing a plan
Signing up for insurance is done through the Washington Healthplanfinder website, through an authorized navigator, or by phone. On the website, people can compare health plans, which are available in four levels, designated by metals: bronze, sliver, gold and platinum.
In general, the premium for bronze plans is the lowest, but the out-of-pocket costs with bronze plans are highest. Premiums for platinum plans cost more, but deductibles and co-pays are lower.
Regardless of plan type, all policies cover 10 essential health benefits, including doctor visits and hospital stays, emergency room visits, prenatal and well-baby care, mental health and substance-use treatment, prescription drugs, lab tests and preventive services.
According to the exchange, most plans cover screenings for the following at no cost: depression, diabetes, drug and tobacco counseling, cholesterol screening, mammography, and tests for sexually transmitted diseases. They also cover vaccinations and other tests.
There are three ways to get financial help to pay for insurance and health care: lower costs on monthly premiums (tax credits), lower costs at the doctor’s office (cost sharing), or free coverage through Washington Apple Health (Medicaid).
All plan types (metal levels) can provide tax credits that lower the monthly premium, but cost-sharing reductions are available only for silver plans. These reductions lower the amount people pay for a doctor’s visit or prescriptions.
People whose income is between 100 and 250 percent of the federal poverty level can qualify for cost sharing. Depending on income, the insurance company will pay from 94 to 73 percent of a person’s health care expenses, with the patient paying the rest. People earning less may be eligible for Apple Health.
As is often the case with health insurance, terminology and policy types can be confusing. This year, Healthplanfinder is offering three types of plans: preferred provider organizations (PPOs), health maintenance organizations (HMOs) and exclusive provider organizations (EPOs).
• With a PPO, people pay less if they use doctors in the plan’s network. Doctors, hospitals and specialists outside the network cost extra without a referral.
• With an HMO, coverage is usually limited to care from doctors who work for or are under contract with the HMO. HMO plans generally don’t cover out-of-network care except in an emergency.
• With an EPO, services are covered only if you use doctors, hospitals or specialists in the plan’s network, except in an emergency.
The ACA requires people to have health insurance, whether through an employer, as a dependent, or an individual policy. Fines for not having insurance are paid when people file their income tax returns.
To sign up for insurance or compare options, people should visit Healthplanfinder at www.wahealthplanfinder.org, or call 1-855-923-4633. More information and resources are on the exchange website at www.wahbexchange.org. Navigators are available through Room One at 997-2050.