2018 Individual and Family

2018 Individual & Family Renewal Information
Four Insurance Carriers are leaving the Central Puget Sound Area market –Bridgespan, Kaiser PPO (Kaiser HMO is still available), LifeWise and Regence.

Four Insurance Carriers remain – AmBetter (CoordinatedCare), Kaiser HMO, Molina and Premera.

Enrolling for a 2018 medical insurance plan – You will most likely need to set up an account on the WA Exchange. And the plans that are available will also be a different product then what you may have had in the past – There are no PPO plans remaining in WA.

10 Things you need to know about your 2018 medical insurance options.

  1. Bridgespan, Kaiser PPO, LifeWise or Regence plan – will not be available in 2018 for residents of King, Pierce and Snohomish Counties.
  2. All remaining plans have a limited – Narrow provider Network – either a Health Maintenance Organization (HMO) or an Accountable Care Organization (ACO). Only emergency care out of area will be covered (Except for Kaiser who has a limited multistate HMO network).
  3. Health Savings Account (HSA) qualified plans are only available from one medical insurance carrier – Kaiser HMO, both ON Exchange and Off Exchange.
  4. I have created a ‘2018 Map of the Market’ that is posted on my website. On a single page you will be able to see all the Silver plans available in King, Pierce and Snohomish counties. It shows very basic information as well as premiums in 10 year increments. This information will save you some time instead of scrolling page after page on the WA Exchange to get an initial view of your many options. You will still need to view your options on the WA Exchange to find your specific age, tobacco use and zip code based premium.
  5. You will most likely need to set up an account at the WA Exchange and select a plan from one of the four remaining medical Insurance Carriers. If you want to enroll with Kaiser HMO they have different options ON Exchange and OFF Exchange (Direct). Kaiser HMO is the only remaining medical Insurance Carrier that offers a direct application – OFF Exchange.
  6. Enrollment deadlines – December 15 for a January 1st start date. January 15th for a February 1st start date. The last day of Open Enrollment for 2018 is January 15th. This is much shorter time period than prior years.
  7. Go to wahealthplanfinder.org to view all your ON Exchange options at the ‘Shop for Plans’ link – and then when you are ready to move forward Set up an account using the ‘Sign In’ link or ‘Create Account’ link. If you or a family member has set up an account at the WA Exchange in the past do not set up a new account (contact me).
  8. If you know that your household income is above the amount to be eligible for a Premium Tax Credit you can answer NO to the question – Do you want to apply for Apple Health or a Premium Tax Credit? If you answer NO then you will not need to provide income information on your application. Taking this step will simplify your application. You may still be eligible for a Premium Tax Credit at the end of the year if you answer NO. Now you can go shopping and enroll in a plan, anytime up to the open enrollment deadlines, after you set up an account.
    You must go through checkout to finalize you choice.

    Please name me as your Broker

    After you set up your application and before you log out please go to your home page. Or if you open your WAHPF Account at a later date:

    1. On the Right side of your Home Page under Quick Links select Request Help From a Broker.
    2. Look for me with two items – Last Name Johnson in zip code 98092. I am not listing an Organization name.
    3. You will then see my contact information if the search was correct – email (Jeff @JBJInsurance.com) and phone number (253.249.7846)
    4. Then agree to the next two or three prompts to name me as your Broker. There is no charge for my services.
  9. I can help you with selecting a plan and assist you with looking up providers in the limited networks. I’m available for a telephone and computer screen sharing appointment most Mondays, Wednesdays and Fridays 8AM to 8PM on the hour. Please send me an email noting if you are or are not a current client. And if you are or are not losing your insurance carrier. Then provide me with a few dates and times that will work with your schedule and I will email you back with an appointment time.
  10. The 2018 Rates are increasing from 20% to 60% over 2017. I know that this may be painful for you if you are not eligible for a Premium Tax Credit. Our household rates are increasing 57% over last year. By Federal Law and Regulations if the insurance carrier you select over charges their individual medical insurance pool, then members of the pool will be issued a rebate the following year. There were 4.8 million people who received ACA rebates in 2016.

Remember I’m here to help. The next 45 days are going to be very busy. I will return your email or phone call, but it may take several days. I generally get caught up by the end of the weekend. So please be patient.

I help anyone at any age with

Individual Medical and Dental Insurance

as well as Medicare

Map of the Market - Network

King, Pierce, and Snohomish County

Apple HealthON ExchangeOFF Exchange (Direct)
MedicaidQualified Health PlanQualified Health Plan
No cost if income eligiblePremium Tax Credit may reduce premiumPremium Tax Credit not available
All Narrow Network PlansAll Narrow Network PlansAll Narrow Network Plans
Amerigroup
Community Health
Coordinated CareAmBetter - HMO
Kaiser - HMO, HSAKaiser - HMO, HSA
MolinaMolina Marketplace - HMO
Premera - ACO
United Healthcare
2018 Map of the Market – Networks

  • AmBetter – HMO
    • CHI Franciscan (Pierce County locations only), Evergreen, Providence and Swedish
  • Kaiser Permanente – HMO
    • HMO Clinics and Community Providers in outlying areas
  • Molina – HMO
    • Multicare, CHI Franciscan, UW, Overlake, Swedish and Providence
  • Premera – ACO – Accountable Care Organization – Premera Personal Care Plan
    • Select one Hospital/Clinic System after application
      • Everett Clinic
      • Evergreen Health Partners
      • Multicare
      • Northwest Physicians Network
      • UW Medicine
      • Virginia Mason plus Poly Clinic

I listed the major clinics for the four remaining insurance carriers. There are many independent providers that will be contracted IN Network.

EPO (Exclusive Provider Organization): Similar to an HMO, with an EPO you must use network providers – doctors, hospitals and other health care providers – that participate in the plan. The only exception is for emergency care. Unlike an HMO, you do not need to select a Primary Care Physician, nor do you need to contact your PCP for referrals to specialists.

HMO (Health Maintenance Organization): If you are in an HMO, you must use network providers – doctors, hospitals and other health care providers – that participate in the plan. The only exception is for emergency care. An HMO generally requires the selection of a Primary Care Physician (PCP) to manage your care. Referrals are usually needed from your PCP to see a specialist, who must also be in the network.

Accountable Care Organization/ Accountable Care Network: An ACO/ACN is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients. In our area the ACO/ACN is organized by Hospital and Clinic Systems. Such as Swedish, Virginia Mason, University of Washington, Multicare or Evergreen. Similar to an HMO, with an ACO/ACN you must use network providers – doctors, hospitals and other health care providers – that participate in the plan. Your network is limited to the Hospital and Clinic System you elect. The only exception is for emergency care.

These are general terms and the plan you select may be organized differently. Read the Insurance Carriers’ summary of benefits for plan specifics.

Map of the Market - 2018 Rates - Area 1 King
Map of the Market - 2018 Rates - Area 2 Kitsap, Mason, Pierce, Snohomish, Thurston
Income Eligibility Chart - Apple Health/Premium Tax Credit
Family size2017 household income less than2017 household income less then2017 household income greater then
1$16,643$48,240$48,240
2$22,412$64,960$64,960
3$28,180$81,680$81,680
4$33,948$98,400$98,400
5$39,717$115,120$115,120
6$45,485$131,840$131,840
You may qualify for…Apple Health for AdultsMarketplaceMarketplace
MedicaidQualified Health PlanQualified Health Plan
Premium Tax Credits and
possible cost sharing reductions
to reduce your monthly
premiums and out of
pocket expenses
You will pay the full
premium without any
Premium Tax Credit
reductions
Federal Poverty LevelUnder 138%Between 138% and 400%Above 400%