Only LifeWise Health will offer a plan in Okanogan County
Okanogan County residents who buy their own health insurance through the state exchange — the only way to get a tax break or subsidy — won’t get to choose the insurance company next year.
While most people in Washington can choose between at least two insurers, the only company that applied to sell health insurance in Okanogan County is LifeWise Health Plan of Washington. LifeWise is offering four plans through the exchange — one gold, two silver (one with a health savings account, or HSA), and one bronze.
The Washington Health Benefit Exchange Board certified premiums for plans offered through the exchange last week. Statewide, seven insurance companies are offering 40 plans, but 8 percent of Washingtonians will see just a single carrier when they sign on to Washington Healthplanfinder.
Bronze plans have the lowest monthly premium but the highest deductible and out-of-pocket costs. Gold plans have higher premiums but lower deductibles and out-of-pocket costs. Subsidies are based on income.
The LifeWise policies for next year range from a $1,000 deductible with a maximum of $6,000 in out-of-pocket costs for a gold plan, to a $6,350 deductible and a $7,850 out-of-pocket limit for bronze.
“People ask why so many people living in rural counties in Washington — and across the country — have such trouble getting coverage,” said Jeff Lindstrom, principal broker with Health Insurance Team in Seattle. “It’s cost. Doctors are not willing to lower their fee schedules.”
The problem is magnified in rural areas because there are so few providers, said Lindstrom. “Why would physicians lower their fee schedule or worry about health metrics when they’re the only gastroenterologist in town?” he said.
In areas with more competition, insurers have negotiated contracts that pay physicians for metrics beyond patient visits and procedures, such as reducing costs through comprehensive health management, he said.
Since the two independent clinics in the Methow Valley were bought by Confluence Health and Family Health Centers, there is less incentive for concessions to insurers, said Lindstrom. “The more consolidation that happens in medicine, the less they want to negotiate. Now Confluence says, ‘Take it or leave it,’” he said.
The plans include some free primary care and mental health visits before the deductible kicks in but, in the HSA plan, only diabetes and nutritional counseling are covered before the deductible applies. Copays for doctor’s visits range from $30 to $50.
All plans are for a limited provider network. In fact, almost no insurers in the individual market include an out-of-state network, which means that anyone who gets sick or has an accident outside Washington will be on the hook for a big chunk of his or her medical care, said Lindstrom.
Okanogan County residents who purchase their own insurance can also buy from Asuris Northwest Health, but can’t get a subsidy. Asuris intends to sell five plans outside the exchange — two bronze, two silver, and one gold, two with health-savings accounts. The exchange also approved Delta Dental.
While Okanogan County residents won’t have many choices, the LifeWise premium increases are lower than for some other insurers. The Office of the Insurance Commissioner, which must review all rate requests to be sure they’re justified, approved a 6.5-percent increase for LifeWise. The average hike in Washington is almost 14 percent, and one insurer was granted a nearly 19-percent increase.
All plans offered through the exchange meet strict benefit and quality standards. Essential services include doctor and emergency-room visits, maternity care, preventive screenings, and medications. No one can be denied coverage because of a pre-existing condition.
Insurance options have been narrowing each year since the Affordable Care Act (ACA, or Obamacare) went into effect six years ago. In 2017, Okanogan County residents had three insurance companies to choose from and, in 2018, two companies offered plans through the exchange.
Almost 270,000 people in Washington buy their health insurance through the individual market and more than 115,000 received financial assistance in 2018. Single households earning less than $50,000 may qualify for tax subsidies, according to the insurance commissioner.
The open-enrollment period starts Nov. 1 and runs through Dec. 15 for coverage to start in January. Anyone who has a life-changing event, such as getting married or having a baby, or losing health coverage provided by an employer, can buy insurance outside of the open-enrollment period. People who qualify for Washington Apple Health (Medicaid) can enroll year-round, as can Native Americans.
Changes create uncertainty
Under Pres. Trump, there have been numerous changes to Obamacare. In 2017, the administration stopped the federal government from reimbursing insurance companies for cost-sharing reductions — the subsidy that lowers out-of-pocket costs for doctor’s visits and medications and is available only with silver plans. People who qualify for cost-sharing still get the savings but, because insurance companies aren’t being reimbursed, insurers raised premiums to make up the difference.
Starting in 2019, there will no longer be a tax penalty for people who don’t have health insurance.
In August, the Trump administration expanded the options for short-term health-insurance policies. The federal law now allows these policies to last for a year or more.
Insurers who offer short-term plans can deny coverage based on pre-existing conditions or exclude benefits for certain illnesses. The plans are not automatically renewable and, unlike Obamacare policies offered through the state exchange, don’t have to cover 10 essential services.
Washington Insurance Commissioner Mike Kreidler has proposed rules (see box) that would restrict short-term policies in Washington to three months and set minimum standards for coverage.
Some industry analysts believe these changes will drive up costs. “Repeal of the individual mandate penalty … combined with the likely expansion of loosely regulated short-term insurance plans … could siphon off healthy enrollees from the ACA-regulated individual market,” according to the Henry J. Kaiser Family Foundation, a nonprofit organization that provides information on national health issues. “These changes will increase uncertainty for insurers and likely push premiums higher, all else being equal.”
To Lindstrom, these changes have had little effect on costs, since the largest factor remains doctor and hospital fees.
“Here’s what’s super-ironic,” said Lindstrom. “For all his blustering and bravado for wanting to repeal the ACA, Trump has done very little, to date, to cause the rate increases. He’s caused uncertainty, but he hasn’t pulled away money.”
Short-term health insurance options considered
Washington state Insurance Commissioner Mike Kreidler has proposed new rules to protect consumers who buy short-term health insurance plans. The rules would restrict short-term policies to three months and set minimum standards for coverage, including in- and out-patient surgery and diagnostic procedures.
The rules would limit the “look-back” period for pre-existing conditions to 24 months. Deductibles would have to be $2,000 or less. The plans couldn’t be offered during the open-enrollment period (when people can buy a regular policy with comprehensive coverage through the exchange).
Short-term plans would have to include a minimum disclosure saying, “This plan may not cover pre-existing conditions, including any medical or mental health condition you’ve been treated for in the past … It’s temporary and may not cover your costs for most hospital or other medical services, or some essential health benefits.”
People can comment on the proposed rules for short-term health insurance plans until Monday (Sept. 24). For more information or to comment, visit https://www.insurance.wa.gov/short-term-medical-plans-r-2018-01.