Two health insurers approved to sell plans on Exchange in Adams County for 2020

Washington Insurance Commissioner Mike Kreidler approved eight health insurers to sell health plans in Washington state's 2020 Exchange-including two in Adams County-it was announced on Sept. 12.

The approved plans-which were certified by the Washington Health Benefit Exchange Board later that day-have an average rate decrease of -3.27%, a record low since the Exchange was created in 2011 as a public-private partnership.

Two health insurers, Coordinated Care Corporation and Lifewise Health Plan, will be offering plans in Adams County through the Exchange. The Exchange exists for the roughly 241,000 people in the state who don't get coverage from their employer and must go through the individual market to purchase health insurance.

"I'm pleased to see the average rate change go down and that many will see lower premiums next year," said Kreidler in a news release. "This comes in the face of continuing efforts by the Trump administration to dismantle the Affordable Care Act with no replacement plan. We still have work to do to lower the underlying cost of health care and to help lower out-of-pocket costs, but these new rates are welcome news."

Lifewise and Asuris Northwest Health will also be offering plans in the county outside of the Exchange. Their plans, according to the Office of the Insurance Commissioner, are still under review.

According to May 2019 data from the Washington Health Benefit Exchange, Adams County is one of five counties in the state where 40% or more of their population is covered by Washington Healthplanfinder, the Exchange's online marketplace. Washington Healthplanfinder covers 49% of Adams County residents, the highest rate of any county in the state.

Coordinated Care Corporation

In June, Coordinated Care had requested an average rate increase of 10.16%, easily the highest of the eight health insurers offering plans inside the state Exchange. However, Kreidler approved Coordinated Care Corporation for an average rate increase of just 0.31%.

Coordinated Care will be offering two gold plans in Adams County, the highest coverage level being offered in 2020. Both plans are Health Maintenance Organization plans, which are only covered if you see a provider within that HMO's network.

The first gold plan, Ambetter Secure Care 1, allows three free primary care physician visits. It has a $1,000 medical and $500 drug deductible and an out-of-pocket maximum of $6,350. For primary care and specialist visits, there is a 20% coinsurance after deductible. There is a $250 copay for emergency room services after deductible, and a $10 copay for generic drugs. The premium ranges from $401 to $462 per month.

The second gold plan, Ambetter Secure Care 5, does not allow any free primary care physician visits. It has a $1,250 deductible with an out-of-pocket maximum of $5,900. There is a $15 copay for primary care visits and generic drugs and a $35 copay for specialist visits. For emergency room services, there is a 20% coinsurance after deductible. The premium ranges from $402 to $462 per month.

Coordinated Care is also offering seven silver plans inside the Exchange in Adams County, all of which have HMO plan types. On those plans, the deductible ranges from $3,350 to $7,050, the out-of-pocket maximum ranges from $6,500 to $7,450, and the premium ranges from $342 to $417 per month. Three of the plans also offer vision.

Lifewise Health Plan

In the summer, Lifewise requested an average rate decrease of -5.89%, the third lowest of the health insurers offering plans inside the Exchange. Kreidler approved them for an average rate decrease of -4.01%, still the third lowest of the health insurers.

Lifewise will be offering one gold level plan in Adams County for 2020, Lifewise Essential Gold. It is an Exclusive Provider Organization plan, which offers a local network of hospitals and doctors for people to choose from.

The plan has a $1,000 deductible and an out-of-pocket maximum of $6,600. There is a $10 copay for generic drugs, a $30 copay for primary care visits and a $60 copay for specialist visits. For emergency room services, there is a $250 copay with deductible and a 30% coinsurance after deductible. The premium ranges from $456 to $524 per month.

Lifewise offers two silver plans, both EPO plans. The first plan, Lifewise Essential Silver High Deductible, has a deductible of $4,000, an out-of-pocket maximum of $7,500 and a $10 generic drugs copay. The second plan, Lifewise Essential Silver Low Deductible, has a deductible of $2,500, an out-of-pocket maximum of $8,150 and $20 generic drugs copay.

Both plans have a $30 copay for primary care visits, a $60 copay for specialist visits and a $250 copay with deductible and 30% coinsurance after deductible for emergency room services. The premium of the first plan ranges from $412 to $495 per month, and the premium of the second plan ranges from $414 to $498.

Lifewise also offers two bronze plans and one catastrophic plans. The premium for the bronze plans range from $307 to $373 per month, and the premium for the catastrophic plan ranges from $257 to $309.

Lifewise also offers a family dental plan and a pediatric dental plan. For the family dental plan, the premium for a child is $28.77 per month and the premium for an adult is $35.66 per month. For the pediatric dental plan, the premium for a child is $28.35 per month.