Affordable Care Act Plans Approved

ACA Plans Approved

As I mentioned briefly in last week’s column, the State Office of the Insurance Commissioner (OIC) has just approved the insurance plans for sale inside the exchange. The OIC is still reviewing plans that will be available outside of the exchange.

To recap, it is only plans that are purchased through the exchange that will be eligible for premium support or subsidies. This is an important factor as many folks will enjoy some level of assistance, especially families.

The only plans that have been approved for sale inside the exchange in Clallam County are the plans offered by Premera Blue Cross and its subsidiary Lifewise. The company has decided to use both names primarily for marketing reasons.

After an exhaustive review fueled by numerous cups of coffee and based upon a hypothetical 52 year old nonsmoker (yes, that’s my demographic) I came to the following conclusion: The plans as well as the premiums are 100% identical between the two companies.

Now as they say in England, let’s get down to brass tacks and talk money. Once again, all the premiums are based upon my demographic of being a 52 year old nonsmoker.  If you are younger your premiums would be lower, and if older the rates would be higher.

As I mentioned before, the rates for both Premera and Lifewise are the same, however the premiums do vary slightly when you look either inside or outside of the exchange.  The plans within the exchange are approximately 1% lower cost than those outside the exchange. I believe this has something to do with the pediatric dentistry benefit.

My current non ACA plan has a $5,000 deductible, no prescription drug coverage and a monthly premium of $274.

Under the ACA options my premium choices would range from a high of $559 down to a low of $354. The $354 is for a Bronze level Health Savings Account (HAS) $5,250plan.  So, the lowest priced plan will be 23% more costly that my current plan.

That is a large increase, but I thought it was going to be far worse. However, I know my benefits will be far superior regardless of which plan I finally decide upon. Currently once I have met my $5,000 deductible I still have a maximum out of pocket of $12,500, whereas I believe the new plans can only have a maximum out of pocket of $6,350 and that includes the deductible. So, you can hear a massive “PHEW!” from me.

In previous columns, I had mentioned the sample premium calculator on the www.waplanfinder.org web-site.  I am pleased to let you know that they have been recalibrated with premiums that are more reflective of the premiums approved by the OIC.  That is good as the actual premiums will be lower than we had been thinking.

I am pleased to see that HSA plans will still be available.  This had been a gray area and I’m glad it’s been clarified.

In closing, the new plans will have lower premiums than I had anticipated.  That is before we even take into account the income based premium support many individuals and families will receive.

It is nice to be able to give some concrete information about plans and premiums after so many months of guesstimates and assumptions.  If you would like to check out the details I have outlined here, I would suggest you arm yourself with a caffeinated beverage to keep yourself awake and check out the OIC web-site at www.insurance.wa.gov or sign up for one of our free community educational seminars starting in September.  As the tag line of the X-Files says “The truth is out there”.