Washington Health Benefit Exchange 2019 Plan Certification Update

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1 Washington Health Benefit Exchange 2019 Plan Certification Update Policy Committee June 12, 2018 Molly Voris, Policy Director Christine Gibert, Associate Policy Director

2 Themes of 2019 Individual Market Health Plan Filings Plans submitted in all counties no bare counties Rate increases range from 6% for Premera to 29% for Kaiser Washington significant variability in proposed rate changes Several counties will have only one choice of carrier Five counties have no bronze offering making it difficult for unsubsidized consumers to find affordable coverage 2

3 Summary of 2019 Exchange Health Plan Filings Exchange Individual Market 7 issuers submitted QHPs Same issuers as proposed QHPs 41 QHPs in counties with one issuer Asotin, Chelan, Clallam, Douglas, Ferry, Garfield, Grays Harbor, Island, Okanogan, Pacific, Pend Oreille, San Juan, Skagit, Wahkiakum 9 counties with one issuer in 2018 Single-issuer counties include Coordinated Care, Kaiser WA, LifeWise, Molina, and Premera coverage 3

4 Number of Exchange Issuers by County 4

5 2019 Exchange QHPs - Metal Level Overview 7 QHP Issuers 40 QHPs Gold Silver Bronze Catastrophic Federal Range: 76%-82% AV WAHBE: 77.10%-81.97% AV Federal Range: 66%-72% AV WAHBE: 67.13%-71.91% AV CSRs available Federal Range: 56%-65% AV WAHBE: 60.75%-63.25% AV Only through the Exchange Under age 30 or hardship No tax credits 7 Issuers 10 Plans 7 Issuers 17 Plans 5 Issuers 11 Plans 2 Issuers 2 Plans 5

6 Exchange Service Area and Plan Changes Service area changes for one holding company in 2019 Premera expanding into Skamania and Stevens counties Premera/LifeWise present in 26 counties in 2019 (vs. 24 in 2018) Premera and LifeWise products will not be offered in the same county Plan Offering Changes Two counties will have bronze plans in 2019 that did not in 2018 Skamania and Stevens Five counties will not have bronze plans in 2019 Chelan, Douglas, Ferry, Lincoln, Pend Oreille Kaiser WA and Kaiser NW s Bronze plans are Expanded Bronze AVs above 62% and must either be HSA compatible or cover and pay for one major service (other than preventive care) before deductible 6

7 Inside vs. Outside Exchange Offerings 7 carriers in the outside market 3 are both inside and outside the Exchange BridgeSpan, Kaiser WA, Kaiser NW Kaiser WA is offering two silver options off Exchange that are not offered on Exchange No changes to off-exchange service areas 10 counties with on-exchange coverage only no off-exchange plans Clallam, Ferry, Grays Harbor, Jefferson, Lincoln, Pacific, Pend Oreille, Skamania, Stevens, Wahkiakum Same as

8 Percent Increase to Lowest Priced Plan Offering by Metal Level Average Percent Increase Across All Counties* Range of Percent Increase Across All Counties* Gold 15% 0% 33% Silver 15% 3% 35% Bronze 24% 1% 37% *Average percentages are not weighted for enrollment. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 8

9 Carrier BridgeSpan* 2019 Silver Plan Rates^ (40 y/o Individual) 2017 Approved Rate 2018 Approved Rate 2019 Proposed Rate Percent Increase of 2019 Rate over 2018 Rate $327 $492 $ % Coordinated Care Corp. $230 $328 $ % Kaiser Foundation Health Plan of WA $276 $404 $ % Kaiser Foundation Health Plan of the NW* $324 $435 $ % LifeWise Health Plan of WA* $333 $451 $ % Molina Healthcare of WA $253 $385 $ % Premera Blue Cross $406 $517 $ % ^ Lowest rate for a household of one 40-year-old non-smoker in King Co. (if available) * Indicates carrier that is not offering plans in King County; plan rates reflect lowest silver premium in other rating area Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 9

10 2019 Silver Plans by Age: Spokane County $1,200 $1,100 $1,000 $900 $800 $700 $600 $500 $400 $300 $200 $100 $- $1,111 $940 $834 $728 $523 $443 $343 $393 $397 $336 $298 $260 Coordinated Care Molina LifeWise Kaiser Washington 20 y/0 40 y/o 60 y/o ^ Proposed rates depicted in this graph are for the lowest silver plan offering for each carrier Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 10

11 2019 Silver Plans by Age: King County $1,200 $1,100 $1,000 $900 $800 $700 $600 $500 $400 $300 $200 $100 $0 $1,140 $1,020 $888 $781 $537 $480 $418 $368 $408 $365 $317 $279 Coordinated Care Molina Kaiser Washington Premera Blue Cross 20 y/o 40 y/o 60 y/o ^ Proposed rates depicted in this graph are for the lowest silver plan offering for each carrier. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 11

12 $1,200 $1,100 $1,000 $900 $800 $700 $600 $500 $400 $300 $200 $100 $ Silver Plans by Age: Walla Walla County $369 $784 $280 $454 $344 $964 $1,173 $552 $419 Coordinated Care LifeWise Kaiser Washington 20 y/0 40 y/o 60 y/o ^ Proposed rates depicted in this graph are for the lowest silver plan offering for each carrier. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 12

13 Rates for a Household of Three (40, 14, 12 y/o) Carrier Lowest Bronze Lowest Bronze BridgeSpan* $716 $732 Kaiser Foundation Health Plan of WA $581 $766 Kaiser Foundation Health Plan of the NW* $589 $686 LifeWise Health Plan of WA* $763 $828 Premera Blue Cross $904 $948 Rates reflect the rate for a 3-person family consisting of a 40 year-old, 14-year-old, and 12-year-old living in King County. *Indicates carrier that is not offering plans in King County; plan rates in rating area 3. 13

14 Rates for a Household of Two (60, 62 y/o) Carrier Lowest Silver Lowest Silver BridgeSpan* $ 2,152 $ 2,087 Coordinated Care Corp. $ 1,433 $ 1,608 Kaiser Foundation Health Plan of WA $ 1,765 $ 2,100 Kaiser Foundation Health Plan of the NW* LifeWise Health Plan of WA* Molina Healthcare of WA Premera Blue Cross $ 1,811 $ 2,002 $ 2,029 $ 2,177 $ 1,684 $ 1,827 $ 2,258 $ 2,347 Rates reflect the rate for a 3-person family consisting of a 60 year-old and 62 year-old living in King County. *Indicates carrier that is not offering plans in King County; plan rates in rating area 3. 14

15 Rates for a Household of Two (35, 36 y/o) Carrier Lowest Gold Lowest Gold BridgeSpan* $ 994 $ 1,037 Coordinated Care Corp. $ 789 $ 835 Kaiser Foundation Health Plan of WA $ 779 $ 997 Kaiser Foundation Health Plan of the NW* LifeWise Health Plan of WA* Molina Healthcare of WA Premera Blue Cross $ 780 $ 906 $ 1,014 $ 1,050 $ 896 $ 1,155 $ 1,163 $ 1,214 Rates reflect the rate for a 2-person family consisting of a 35 year-old and 36 year-old in King County. *Indicates carrier that is not offering plans in King County; plan rates in rating area 3. 15

16 Proposed Deductibles for 2019 Gold Deductible Range $0 - $3,800 $0 - $2,925 Median Deductible $1,250 $1,175 Silver Deductible Range $1,750 - $7,150 $2,500- $7,150 Median Deductible $4,500 $4,500 Bronze Deductible Range $5,000 - $7,150 $4,750 - $6,500 Median Deductible $6,350 $5,700 16

17 Proposed Average Rate Changes for Washington's 2019 Individual Health Insurance Market Health Carrier Asuris Northwest Health BridgeSpan Health Company Coordinated Care Corporation Health Alliance Kaiser Foundation Health Plan of the Northwest Kaiser Foundation Health Plan of Washington LifeWise Health Plan of Washington Molina Healthcare of Washington Premera Blue Cross Regence BlueCross BlueShield of Oregon Regence BlueShield Total proposed average change Proposed Average* Rate Change Sold Inside/Outside Exchange Number of Counties 5.73% Outside % Both % Inside % Outside % Both % Both % Inside % Inside % Inside % Outside % Outside % * Premium will depend on where you live, your age, whether you smoke, and which health plan you select. Source: Office of the Insurance Commissioner, Washington State 17

18 2019 Proposed Dental Market Summary 5 Issuers Statewide coverage with generally same issuers and service areas as 2018 Premera and LifeWise no longer offering in the same county 2 Family Plans 1 Low - Dentegra 1 High Delta Dental 4 Pediatric-only Plans Delta Dental, Kaiser NW, LifeWise, Premera 2 Low 2 High High= Plan Value of ~85% Low= Plan Value of ~75% 18

19 Next Steps OIC is currently reviewing the proposed rates Exchange is continuing to analyze consumer impacts of the proposed rates and plans Exchange Board is discussing affordability at upcoming Board Retreat Ongoing stakeholder discussions regarding options for improving affordability Exchange Board will certify plans in September

20 Appendix 20

21 Proposed Individual QHP Submissions Carrier Gold Silver Bronze Catastrophic Coordinated Care BridgeSpan Kaiser NW Kaiser of WA LifeWise Molina Premera Total

22 2019 Silver Plans: Thurston County $1,200 $1,100 $1,159 $1,000 $900 $959 $1,025 $800 $786 $700 $600 $500 $451 $483 $546 $400 $370 $414 $300 $200 $281 $343 $366 $100 $- Coordinated Care Molina LifeWise Kaiser Washington 20 y/0 40 y/o 60 y/o ^ Proposed rates depicted in this graph are for the lowest silver plan offering for each carrier. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 22

23 King County: Two-Person Household (61, 62 y/o) Carrier Metal Level Proposed Rate Kaiser Foundation Health Plan of Washington Bronze $1,551 Coordinated Care Corporation Silver $1,635 Molina Healthcare of Washington, Inc. Silver $1,858 Premera Blue Cross Bronze $1,919 Coordinated Care Corporation Gold $1,936 Kaiser Foundation Health Plan of Washington Gold $2,310 The offerings above are a sample of coverage offerings available in King County. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 23

24 Clark County: Two-Person Household (32, 33 y/o) Carrier Metal Level Proposed Rate Kaiser Foundation Health Plan of the Northwest Bronze $582 Lifewise Health Plan of Washington Bronze $702 Molina Healthcare of Washington, Inc. Silver $841 Lifewise Health Plan of Washington Silver $952 Molina Healthcare of Washington, Inc. Gold $1,211 The offerings above are a sample of coverage offerings available in Clark County. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 24

25 Thurston County: Three-Person Household (45, 14, 12 y/o) Carrier Metal Level Proposed Rate Kaiser Foundation Health Plan of Washington Bronze $925 Premera Blue Cross Bronze $1,032 Molina Healthcare of Washington, Inc. Silver $1,050 Kaiser Foundation Health Plan of Washington Gold $1,373 Molina Healthcare of Washington, Inc. Gold $1,513 The offerings above are a sample of coverage offerings available in Thurston County. Note: Exchange consumers under 400% FPL may be eligible for federal premium tax credits, which can help shield them from premium increases 25

26 Rates for a Household of 3 (40, 14, 12 y/o) Carrier Lowest Silver Lowest Silver BridgeSpan* $1,082 $1,049 Coordinated Care Corp. $720 $808 Kaiser Foundation Health Plan of WA $887 $1,056 Kaiser Foundation Health Plan of the NW* LifeWise Health Plan of WA* Molina Healthcare of WA Premera Blue Cross $910 $1,006 $991 $1,094 $846 $918 $1,135 $1,180 Rates reflect the rate for a 3-person family consisting of a 40 year-old, 14-year-old, and 12-year-old living in King County. *Indicates carrier that is not offering plans in King County; plan rates in rating area 3. 26

27 Timeline for 2019 Plan Certification Process Feb May 24 Aug Aug/Sept Nov Guidance for Participation issued Plans submitted to OIC for review Initial rates available 10 business days after submission Carriers sign participation agreement Plans approved by OIC Rates are final Exchange Board certifies plans (9/13) Open enrollment begins 27

28 OIC QHP and QDP* Approval Criteria Issuer 1. Be licensed and good standing * 2. Comply with risk adjustment program 3. Comply with market rules (e.g., offer at gold and silver level) 4. Comply with non-discrimination rules* Product 4. Meet network adequacy requirements* 5. Use hospital patient safety contracts 6. If offered, integrate Direct Primary Care Medical Home into QHP Plan 8. Comply with essential health benefits*, limits on cost sharing*, metal levels 9. Comply with service area standards for a QHP (e.g., county, zip code) and submit rates for a plan year* 10. Submit and post justifications for premium increases 28

29 WAHBE QHP and QDP* Certification Criteria Issuer 1. Pay assessed user fees* 2. Achieve accreditation with a national organization Product 3. Meet marketing requirements* 4. Submit healthcare provider directory data* 5. Implement a quality improvement strategy 6. Submit health plan data for presentation to consumers in standard format* 7. Report quality and health performance data; participate in quality programs 8. Use the Exchange enrollment application Plan 9. Submit health plan benefits, cost-sharing, and premium rates data to display on web pages for consumer shopping* 29

30 Terminology The Board certifies plans Products are a suite of plans Consumers know issuers and plans 30

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