If you need health insurance through Washington’s Health Benefit Exchange, it’s time to get busy and start comparing plans now.
Enrollment time is shorter than in previous years.
▪ Open enrollment started Wednesday and runs until Dec. 15, if you want coverage by Jan. 1. This is the deadline you want to meet.
▪ The full enrollment period lasts until Jan. 15, but if you wait between Dec. 16 and the last day, your coverage won’t begin until Feb. 1.
Don’t ignore those deadlines, because if you don’t sign up for insurance, you’ll owe a fine — unless you qualify for an exemption.
Also, the plan you signed up for in the past might not be what you want in 2018, given the changes to rates and cost subsidies.
HOW IT WORKS
In general, the exchange, in operation since October 2013, serves Washington residents who need insurance because they don’t get it through their employers.
“More than 300,000 people in Washington — or about 5 percent of our state population — do not get health insurance from their employer and must buy a plan through the individual health insurance market,” according to the state Office of the Insurance Commissioner.
(The state-run exchange also is where you can check to see whether you qualify for free coverage in Apple Health, Washington’s Medicaid program.)
The exchange has four levels of coverage: bronze, silver, gold and platinum plans.
Under the plans, as with employer-based insurance, if your monthly premium payment is low, your cost of getting care when you go to the doctor will be higher.
Conversely, higher premiums up front mean paying less out of your own pocket when you receive care or medication.
The bronze plan has the lowest monthly premiums, but the highest out-of-pocket expense, paying 60 percent of the costs.
Silver pays 70 percent of the costs in the plan, while gold pays 80 percent of costs. Platinum has the highest monthly premiums, but pays 90 percent of costs.
If you qualify financially, the exchange offers help with premiums and lower co-payments and deductibles.
Bottom line: It pays to compare plans.
You don’t necessarily have to buy through the exchange, but it can save you money. Coverage is the same if you buy directly from an insurer, but you have to buy your health plan through the exchange to gain financial help with your premium and lower cost-sharing.
The exchange’s website offers this rough outline for picking a plan:
▪ If you are relatively healthy and don’t need or haven’t needed a lot of care now or in the past, the bronze plan might be for you. It costs you less each month, but pays less of your costs when you visit a doctor.
▪ If you expect to see your doctor frequently and qualify for financial aid, you might want to pick a silver plan to avoid so much sticker shock for an office visit.
▪ If you expect a lot of doctor visits or use prescription medication, you might want to go platinum or gold. These plans often have higher monthly premiums but pay more of your costs for care.
THE SUBSIDY ISSUE
In October, President Donald Trump announced an end to subsidy payments to insurers, known as cost-sharing reductions.
That caused an average premium increase of 36.4 percent in Washington for next year, according to the office of the state’s insurance commissioner.
As The News Tribune reported in October, silver plans are the only ones required under the Affordable Care Act to offer the cost-sharing discounts to people who are eligible.
Also because of the president’s action, those who pick a silver plan through the exchange will see an additional rate increase in 2018.
However, people who financially qualify still can receive cost-sharing assistance and possibly a tax credit, according to the state.
And, the state office also points out: “Silver plans sold only outside the exchange, as well as bronze and gold plans, have rate changes, but are not impacted by the president’s action.”
More details on plan comparisons following the end of subsidy payments are available at kaiserf.am/2zJo8wZ.
Ultimately, you need to go online to see what effect the changes will have on your plan. When you go through the online application process, you can find out whether you are eligible for tax credits that could help offset premium rate hikes.
You also can reach the toll-free customer support center at 855-923-4633 for answers to questions or for help using the online process.
The center’s hours are 7:30 a.m. to 8 p.m. weekdays and 10 a.m. to 2 p.m. Saturdays. Extended hours will be offered leading up to the sign-up deadlines.
Thirteen statewide locations will offer in-person assistance to those seeking help with the exchange. The full list is at bit.ly/2A3JJ4g or call your own insurance agent, who could refer you to a broker who specializes in the state exchange.
▪ There’s an app for the exchange: Go to bit.ly/2xIjy1p to download for your smartphone or tablet. As a customer, you can keep track of your plan, upload documents and view your coverage status. You also can opt for push notifications through the app to keep track of deadlines. (Works for Apple and Android/Google-based phones).
▪ Don’t make a choice based solely on monthly premiums: Figure out your out-of-pocket expenses, so that when a surprise hospitalization or diagnosis occurs, you won’t face a financial meltdown.
In general, your premiums should be close to 5 percent of your annual gross income. Ultimately, your personal rates will vary on several factors: where you live, your age, lifestyle (smokers vs. nonsmokers) and which plan and benefits you choose.
▪ Generally, you cannot switch plans outside the enrollment period: The exchange’s website includes a list of what events do and do not qualify for allowable changes in between enrollment periods.
▪ If you are on medication, make sure it’s still covered: Drugs, like doctors, also drop off coverage lists.
The News Tribune archives and news services contributed to this report
Plans’ essential requirements
All plans in the Washington Health Benefits Exchange are required to cover 10 “essential health benefits,” according to its website. They are:
▪ Doctor visits and hospital stays.
▪ Trips to the emergency room.
▪ Care before and after your baby is born.
▪ Mental health and substance use treatment.
▪ Prescription drugs.
▪ Services and devices to help you recover if you are hurt or if you have a disability or chronic condition.
▪ Lab tests.
▪ Preventive services, including counseling, screenings and vaccinations.
▪ Management of a chronic disease, such as diabetes or asthma.
▪ Pediatric care.
Most plans also offer free preventive services, such as screenings, counseling and vaccinations.