By Phil Castell
The following is a very brief primer on the Affordable Care Act (ACA) which will be accepting 2014 enrollments in less than four months’ time, on Oct. 1.
This is directed toward those who are not on Medicare and are covered by an individual health plan or currently do not have coverage.
All insurance companies wishing to offer plans under the ACA for 2014 had to file their plan details, including premiums, with the State Office of the Insurance Commissioner (OIC) by May 1.
The filings for 2014 are readily available for public review and comments on the OIC website at www.insurance.wa.gov.
I shall summarize my observations and also share with you some thoughts and opinions.
I had heard that some large out-of-state insurers were considering entering the state and offering health plans. Names that were thought to be considering such a move included Aetna, United HealthCare and Humana. Of the 14 plans that have filed for 2014 there was only one from a company not already offering individual health insurance in the state.
That company was called Coordinated Care Corporation, which is an HMO from the Midwest. Its plan has been “Not Approved” by the OIC. I heard secondhand that the OIC was not going to be approving any additional physician networks for 2014 and as the Coordinated Care plan was an HMO, it was a non-starter for 2014.
Of the 13 other companies that filed, offerings from Molina and Time Insurance (Assurant) have likewise been “Not Approved” by the OIC. I would think that these plans possibly could be amended and refiled if the carriers chose to do so.
The 11 other plans are offered by the following companies and their affiliates; Regence Blue Shield, Premera, Group Health Co-operative, Kaiser Foundation, Community Health and Time Insurance.
Before I expand on the carriers and their filed plans, I would like to take a moment to explain in very simple terms the concept of the Health Insurance Exchanges as envisioned by the government.
Insurance companies will be free to offer plans either within the Exchange or outside of the Exchange. However, and this point is very important, ONLY plans purchased through the Exchange will be eligible for subsidies or premium support if you qualify based upon income levels.
The Health Insurance Exchange will be an online marketplace where people can review plans benefits and premiums and then apply for coverage directly from the company on one central website.
The income levels to be eligible for premium subsidies are quite generously capped at 400 percent of the federal poverty level. This equates to $45,000 for a single person to over $94,000 for a family of four.
Needless to say, the lower your income level, the lower the premium you will have to pay.
The Washington Health Benefit Exchange website can be found at www.waplanfinder.org and it includes a great tool to help estimate premiums and subsidies. I would strongly urge everyone to take a few minutes to explore this site.
While it does not include plan details at this point as they have not yet been approved, it does provide a wealth of information. When the site is live with real information I shall keep you informed.
At this point my thought is that everyone should consider a plan through the Exchange if they would receive a subsidy and only look outside of the Exchange if they were not eligible for a subsidy.
Now back to plans filed but not yet approved by the OIC.
Regence BlueShield and affiliates have filed four plans. Regence BlueCross BlueShield of Oregon will offer plans in the Vancouver, Wash., area; Regence BlueShield or Asuris is available in most counties throughout the state. Bridgespan Health is a new Regence company and is the company through which all the Regence Exchange policies will be offered.
Regence announced that it only will be offering Exchange plans in six counties in Western Washington and one county in Eastern Washington. These are as follows: Skagit, Snohomish, King, Pierce, Thurston and Kitsap in Western Washington and Spokane County in Eastern Washington.
Group Health Co-operative only will be offering Exchange plans in the current counties where they offer their HMO plans and Clallam is not in that category. GHC’s reasoning for this was that in those areas it already had built a network of preferred providers and those counties accounted for 70 percent of its subscribers.
Kaiser Foundation only will be offering its plans in Southwest Washington from Vancouver up to the Kelso/Longview area.
Premera and Lifewise have filed for both Exchange plans and non-Exchange plans in all counties.
Community Health will be offering plans only within the Exchange, but its OIC filing did not include Clallam County as one of the counties it will serve.
Time Insurance has filed to only offer its individual products outside of the Exchange.
So, there you have it folks. In Clallam County we will have plans available from the Exchange and they will be offered by both Premera BlueCross and Lifewise. When I spoke with Premera officials, they told me plan benefits and premiums will be basically the same for both companies.
When I asked why they would use both companies, the answer I received was that many current clients are familiar with the name Lifewise, whereas non-clients probably would be more familiar with a Blue Cross-branded product.
If you would like more information, please shoot me an e-mail at firstname.lastname@example.org or call 683-9284.
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