Tax breaks, subsidies offered through state benefit exchange
By Marcy Stamper
Lots of things about health insurance are shrinking for 2019 — the open-enrollment period, which started last week, is shorter; people have fewer policies to choose from; and the network of covered physicians and hospitals is limited to Washington state, except in emergencies.
But the policies offered through Washington’s Health Benefit Exchange still provide tax breaks and subsidies for those who qualify, and they cover 10 essential services, including doctor and emergency-room visits, maternity care, preventive screenings, and medications. And no one can be denied coverage because of a pre-existing condition.
Okanogan County residents have fewer choices of insurers for 2019. Only LifeWise Health Plan of Washington is selling policies through the exchange, the only place to get a subsidy. LifeWise is selling one bronze, two silver (one with a health-savings account, or HSA), and one gold plan.
Bronze plans have the lowest premiums but higher deductibles and out-of-pocket maximums. Gold plans require more money up-front, but have lower deductibles and out-of-pocket maximums.
For next year, premiums on LifeWise bronze plans range from $273 for a 20-year-old nonsmoker to $765 for a 60-year-old. A gold plan will cost that 20-year-old $397 and the 60-year-old $1,111. But the deductible for a gold plan is just $1,000, whereas it’s $6,350 for a bronze plan.
People will also find a range for out-of-pocket caps. For people with bronze coverage through LifeWise, out-of-pocket top out at $7,850, whereas for bronze plans, it’s $6,000.
People whose income qualifies can get tax subsidies for all three metal categories, but only silver plans offer cost-sharing reductions, which lower copays and deductibles, in addition to providing a tax credit.
Subsidies are generally available for people earning between 100 and 400 percent of the federal poverty level. For an individual, that would be from about $12,000 to just over $48,240; for a family of four, that would be $24,600 to more than $98,000.
Asuris Northwest Health is selling individual policies outside the exchange. Asuris is selling five plans — two bronze, two silver, and one gold, two with health-savings accounts.
The Asuris plans cover the same essential benefits, but aren’t eligible for subsidies. Asuris premiums range from $300 for a bronze plan for a 20-year-old to $1,371 for a gold plan for a 60-year-old.
On average, both LifeWise and Asuris had the lowest premium increases of all companies in Washington.
Money put in a health-savings account is not taxed. It 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.
Another thing that’s shrinking in the world of health care is the duration of some health insurance plans. This year, the Trump administration allowed insurers to sell more short-term plans, which in many states can be renewed for up to three years.
Short-term plans provide temporary catastrophic coverage, such as for an accident or surgery. These plans tend to be less expensive, but the coverage often has limitations, according to the Washington Insurance Commissioner. Short-term plans can deny coverage or charge higher premiums, based on medical history and pre-existing conditions.
The Trump administration also let states set limits on these plans. Washington has limited the plans to three months and won’t let people renew them.
In Washington, short-term plans must cover at least $1 million in medical expenses and can’t ask the insured to pay more than half of his or her medical costs. Insurers must offer at least one plan with a deductible of $2,000 or less. The plans also can’t look back at pre-existing conditions more than two years old.
In addition, insurance companies who sell these plans must disclose the limits of the coverage and direct consumers to the exchange before they purchase a short-term plan.
While the restrictions imposed by Washington may appear to reduce consumer choices, Insurance Commissioner Mike Kreidler said he supported them so that consumers are aware of the limits of short-term coverage.
“Some consumers may be caught in a coverage gap and really need a short-term medical plan,” he said. “But they need to beware of the limits of the coverage…. We’ve heard horror stories from people who either had or developed a serious medical condition while covered by one of these plans and were left with huge medical bills.”
Currently, only one insurer, LifeMap, sells these plans in Washington state.
Another change: Starting in 2019, there will no longer be a tax penalty for people who don’t have health insurance.
About 266,000 Washingtonians — about 4 percent of the population — do not get insurance through their employer or a government-sponsored program and must purchase their own coverage. More than 1,400 Okanogan County residents buy insurance through the exchange, and nearly 14,000 are covered by Apple Health.
Apple Health provides insurance to Washingtonians with lower incomes. Individuals earning about $1,400 a month and a four-person family earning $2,890 can qualify.
People can also get free assistance from navigators at Room One at 997-2050.