When Langley resident Kymy Johnson received a letter from her health insurance provider saying she would lose her individual coverage in 2018, suffice to say she was frustrated.
Losing her coverage with the company, Regence Blue Shield, sparked her to research her options next year. Already having a solid grasp of the individual plan options in Island County, she was worried about what she’d find.
Her research confirmed her fears.
“The only four individual plan options in 2017 for Island County are Kaiser (Permanente), Regence, Premera and LifeWise,” Johnson said. “When I looked at my options after receiving the letter saying I lost my coverage, I found out the only individual plan offered in Island County next year is an HMO plan through Kaiser.”
“Even if families qualify for some tax credit to make their premiums lower, all of the PPO &EPO options are gone.”
Regence Blue Shield, Premera and LifeWise, three of the four providers in Island County in 2017, are pulling out of the individual market starting Jan. 1, 2018. This isn’t the case for health insurance coverage offered through employers, as all but LifeWise will still be available. However, Johnson said the single option of going through Kaiser Permanente, formerly GroupHealth, for an in-network (HMO) plan poses a problem to small business owners in Island County such as herself, who don’t qualify for small group insurance.
Johnson says she has had private individual health insurance for “eight or nine years,” prior to the passing of the Affordable Care Act (ACA). She says her experience navigating the system over the years has made her well-versed on the subject, better than most. Knowing what people like her will face next year and the lack of understanding many have of the health care system, she’s urging those with individual plans to prepare themselves when they enroll for 2018 in November.
“A lot of my friends with individual coverage said they’d wait to see what their options are in November, but I think people will be shocked at the single option they have,” Johnson said. “It makes it really hard for someone to have an in-network plan if they have a child that has a health condition. Plus, it’s not very cheap.”
Nicolas Jensen (not related to the reporter), a navigator program manager for Whatcom Alliance for Health Advancement, confirmed that the only individual coverage option next year will be through Kaiser. Through his organization, Jensen helps people in the five-county area in the north Sound navigate their health care insurance options.
Jensen said although there is a single insurer offering an in-network plan, there are different levels to choose from that offer different levels of care. This gives people options for how much coverage they want to pay for. Still, having a single in-network option limits where Whidbey Islanders can receive care.
“I know the Office of the Insurance Commissioner is still working on getting more plans,” Jensen said. “Regardless of whatever happens, we’re going to have very high premiums and carriers will likely leave the market because they know it won’t be a viable business plan to stay in the market. That’s kind of the spot we’re in, and we just have to wait and see what happens at the federal level.”
Johnson says only having the option to get individual coverage from Kaiser Permanente poses a problem for many on South Whidbey. Although a number of primary care clinics on the South End accept the Kaiser HMO plan, she says The Everett Clinic has told her and others in her position the clinic’s locations won’t accept Kaiser’s individual HMO plan.
“The Everett Clinic is not in the Kaiser network, which is hard because a lot of South End residents use them for primary care, specialists and for their walk-in and urgent care to avoid going to the ER on the weekends,” Johnson said.
Johnson, who owns and operates an online business by herself, said she could theoretically apply for small group insurance in order to gain access to more plan options. However, she would have to hire a few employees for her business in order to qualify for small group insurance.
Although neither Johnson nor Jensen could confirm the number, Johnson says she imagines there is a “decent chunk” of people on Whidbey Island who are self-employed and in a similar position to her.
“While for some families it’s not as big of a deal, for many others, especially if they have any regular medical needs, it is,” Johnson said. “I just don’t want people to be shocked when they enroll in November.”
On top of decreasing coverage options in the individual market, insurance providers through the state exchange have proposed significant rate increases for 2018. According to information from the Office of the Insurance Commissioner website, Kaiser Permanente proposed a 12.9 percent rate increase for its individual plan.
For small group insurance in Island County, Regence proposed an 11.3 percent increase; Premera requested a 2.2 percent increase and Kaiser Permanente proposed a 6.6 percent increase. The proposed increases haven’t been approved yet.
For information on options and proposed rate increases for 2018, visit https://fortress.wa.gov/oic/consumertoolkitrt/Search.aspx.