Individual policies available through state exchange or from insurers
By Marcy Stamper
People have just two more days — until Friday (Dec. 15) — to buy an individual health insurance policy for coverage to start Jan. 1, 2018.
If you miss that deadline, you can still buy a policy — or change your coverage for next year — until Jan. 15, but then coverage won’t start until Feb. 1.
Individual policies can be purchased through the state’s Obamacare marketplace (Health Benefit Exchange) or directly from an insurer. Buying a policy through the exchange is the only way people who qualify can receive subsidies. There are two types of subsidies — tax credits that lower the monthly premium, and cost-sharing reductions, which can lower copays for doctor’s visits and reduce a deductible.
Washington residents are actually lucky to have extra time to choose a health plan. The Trump administration shortened the open-enrollment period to just six weeks, so in most states it ends Dec. 15. Washington Insurance Commissioner Mike Kreidler added an extra month to the open-enrollment period, said Jeff Lindstrom, an insurance adviser with Seattle-based Health Insurance Team and a certified broker through the exchange.
After Jan. 15, the open-enrollment period for health insurance for 2018 ends and only people with certain situations — such as getting married or having a baby, or losing health coverage provided by an employer — can get health insurance for 2018. People whose income is low enough to qualify for Apple Health can enroll at any time, as can Native Americans, said Lindstrom.
For people whose income is low enough, policies on the exchange offer tax credits, which can be applied to any type of plan — bronze, silver or gold. Bronze plans have the lowest monthly premium but the highest deductible and out-of-pocket costs, and gold plans have higher premiums but lower deductibles and lower out-of-pocket costs. Cost-sharing is only available on silver plans.
Tax credits are typically available to individuals earning between $12,000 and $48,000, according to the Kaiser Family Foundation, a nonprofit organization that provides information on national health issues. Cost-sharing reductions are available to individuals earning up to $31,000.
In some ways, the choice is easier this year, because Okanogan County residents have just eight plans to choose from in the exchange — four from LifeWise Health Plan of Washington and four from Premera Blue Cross — in bronze, silver and gold categories. Both companies offer one plan that allows the policyholder to establish a health-savings account (HSA) to pay for medical expenses.
In addition, Asuris Northwest Health is selling five plans outside the exchange, two with health-savings accounts. They do not provide subsidies.
“For those who’ve been on the exchange, the frustration is finding plans that meet their needs,” said Lindstrom. All the plans offered this year, both inside and outside the exchange, cover providers only in a limited network, except for emergencies.
All plans, whether through the exchange or not, are required to provide 10 essential benefits, including preventive care, emergency services and screenings.
Deductibles for 2018 plans range from about $1,500 to more than $6,000, but the cost-sharing reductions can cut them in half — or even to as little as $100 — for people who qualify.
HSA plans can be a good option for people with either very low health or very high medical expenses, said Lindstrom. Healthy people with low medical costs could choose a plan with a high deductible and put money in an HSA and spend that instead of paying a higher premium. People who know they’ll meet their deductible or out-of-pocket maximum can benefit from setting money aside tax-free, he said.
The maximum annual contribution to a health-savings account is $3,400 for an individual and $6,900 for a family. Money put in an HSA is not taxed. The money in the account must be used for health expenses — including vision or dental care, drugs, or even a spouse’s copays. It can be used in the future, even if you no longer have an HSA health plan. But it cannot ever be withdrawn to be spent on anything else, said Lindstrom.
“HSAs are awesome — if you know how to use them and can budget the money,” he said.
For more information:
Open enrollment ends Jan. 15, 2018. If you want coverage to start Jan. 1, 2018, you must enroll by Dec. 15. If you enroll after Jan. 15, your coverage will not start until Feb. 1.
Visit the exchange at www.wahealthplanfinder.org to research plans or find a navigator or a broker to help. Call the exchange at 1-855-923-4633, weekdays 7:30 a.m. to 8 p.m. and Saturdays 10 a.m. to 2:30 p.m.
There is also a free mobile app called WAPlanfinder, which can be downloaded from www.wahbexchange.org.
In Okanogan County, the only insurer selling outside the exchange is Asuris.