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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

August 28, 2014 at 4:09 PM

More health insurance options increase choice — and possibly confusion

Home page for Washington Healthplanfinder.

Home page for Washington Healthplanfinder.

The board overseeing the Washington’s health insurance marketplace Thursday certified more than 100 health and dental plans to be sold this fall.

Washington residents will have roughly twice as many health insurance plans to choose from in the individual market for coverage beginning in 2015, including for the first time plans at the “platinum” level, which denotes those with the highest amount of benefits. Additionally, small employers statewide will have their first opportunity to buy coverage through the exchange; this option is currently available in only two counties.

The Office of the Insurance Commission has compiled information online about the plans and providers that should be helpful for those shopping for coverage.

But while members of the Washington Health Benefit Exchange board were pleased that the public will have more options to choose from, they were concerned about helping people sort through their choices. Plans vary in terms of how much people must pay before their insurance kicks in, which drugs are covered and which doctors are included in their network.

The board worried that people automatically will opt for one the cheapest “bronze” level plans — which can include deductibles of more than $6,000 — without realizing that it might cost less in the long run to buy a slightly more expensive plan with better coverage. And only the “silver” level plans, a step up from bronze, qualify for cost-sharing benefits that reduce out-of-pocket costs for patients, a fact that’s easily overlooked.

When it comes to educating the public, “I want to make sure we are doing something a little more proactive this next year,” said board member Teresa Mosqueda. “I want to make sure people are making an informed decision.”

It appears unlikely that the state will be able to make significant changes to the Washington Healthplanfinder website where people enroll in insurance plans to help with decision making. But exchange staff said they will work on outreach efforts to better educate people in their health-care choices.

Next steps

The board certified 82 individual health plans Thursday and an additional eight plans are offered in multiple states so they await federal approval. Not all plans are sold everywhere in the state, with fewer options typically available in more rural counties. Plus, individual insurance plans from two companies have not yet been approved for sale by the state’s Office of the Insurance Commissioner, but still could be.

On Wednesday, Insurance Commissioner Mike Kreidler announced that he had approved the 90 plans and an increase in individual insurance premiums for exchange plans of 1.9 percent on average. Before passage of the Affordable Care Act and last year’s launch of the health insurance exchange, individual rates increased each year on average between 8 and 18 percent going back to 2007. (The 1.9 percent increase does not include individual plans sold outside of the exchange; those rates are still being finalized.)

The sign up for individual coverage begins Nov. 15 and runs until Feb 15, 2015. The enrollment period includes the sale of plans inside the exchange sold through the website, and outside from brokers or insurance companies. Only plans sold inside the exchange are eligible for federal tax benefits based on one’s income that reduce the cost of premiums.

By Oct. 1, insurance companies must inform people if their plan was not renewed. By mid to late October, the exchange will send customers renewal notices, which will include an estimate of insurance premium costs and tax benefit estimates.

New options for small employers

Small employers interested in providing health insurance for their workers through the exchange, called Healthplanfinder Business, will be able to purchase coverage from Moda Health Plan anywhere in the state. In Clark and Cowlitz counties they can also choose coverage from Kaiser Permanente, which has been selling exchange plans there since last year. The board Thursday certified 23 plans for sale on the small employer exchange.

But only 10 businesses in Clark and Cowlitz currently are enrolled in the business exchange, formerly called the Small Business Health Options Program, or SHOP. Most small employers buy coverage from associations that typically offer discounted rates, and many experts expect that will remain the preferred option.

The Affordable Care Act includes a tax benefit to encourage small employers to insure their workers. The perk applies to businesses that paid at least half the cost of their workers’ premiums, and employed fewer than 25 people making on average $50,000 a year. The benefit applies only to the government-run marketplaces, though in Washington it temporarily was extended to insurance bought outside of the exchange because of the limited marketplace. However, people have complained that it’s difficult to figure out the amount of the tax benefit and to apply for it, making the incentive less effective.

Even with exchange plans available statewide, “it’s hard for me to be wildly enthusiastic about the likelihood of sustainable success with the program,” said Bainbridge Island attorney Jeff Gingold, who represents some of the associations selling insurance.

“Whether small business owners are receptive to Moda’s new plan selection will depend largely on cost — premiums, deductibles and out-of-pocket costs,” added Patrick Connor, state director of the National Federation of Independent Business, in an email. “Small employers want to offer health coverage to their workers and the families they support. But it has to be a value to the workers and a price employers and workers can both afford.”

Comments | Topics: Affordable Care Act, health insurance, Healthplanfinder

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