Washington's health insurance marketplace opens Tuesday

By Marissa Harshman, Columbian health reporter

Published:

 

Opening day is finally here.

Washington Healthplanfinder, the state-based insurance marketplace created under the Affordable Care Act, opens for business Tuesday. The online marketplace where uninsured individuals will purchase health coverage for themselves and their families is scheduled to open at 7:30 a.m.

State officials said they hope as many as 130,000 residents will enroll in health plans through the online marketplace by the end of the year. By 2017, the state expects marketplace enrollment to be up to nearly half a million people.

Here's what you need to know about the insurance exchange and who you can turn to for assistance:

Clark County options

Through the insurance exchange, http://www.wahealthplanfinder.org, consumers can compare benefits and prices and enroll in health plans.

Clark County residents can choose from 18 plans offered by three insurers — Kaiser Foundation Health Plan of the Northwest, Community Health Plan of Washington and LifeWise Health Plan of Washington.

The insurers offer three plan options: bronze, silver and gold. The options are based on how much of the medical costs are paid by the health plan and how much is the member's responsibility through co-pays and co-insurance.

For bronze-level plans, the health plan pays 60 percent of costs. Silver plans cover 70 percent of costs and gold plans cover 80 percent.

Most individuals and families making less than 400 percent of the federal poverty level will qualify for a federal tax credit to help pay for their health coverage. The Healthplanfinder website computes the subsidy amount for consumers.

In Clark County, about 46 percent of households are potentially eligible for a tax credit to help pay for health insurance, according to the Health Benefit Exchange, the public-private partnership tasked with implementing Healthplanfinder.

The website will also determine whether an individual or family qualifies for expanded Medicaid coverage, under which people ages 19 to 65 who earn up to 138 percent of the federal poverty level will be eligible for benefits.

In Clark County, an estimated 28,600 people will be added to the Medicaid program.

Assistance programs

On Sept. 1, the Washington Health Benefit Exchange opened a call center. The Spokane-based center has about 60 representatives who can answer questions about health plans, the enrollment process and eligibility for tax credits. Representatives can also help walk callers through the enrollment process and educate them about available plan options.

Phone lines are open weekdays from 7:30 a.m. to 8 p.m. Call 855-WAFINDER (855-923-4633) for assistance.

In addition, Washington Health Benefit Exchange is partnering with Clark County Public Health to provide in-person assistance. The health department is working with numerous Clark County organizations, including the Free Clinic of Southwest Washington, PeaceHealth Southwest Medical Center and Lifeline Connections (see box for complete list of local partner organizations).

Licensed brokers

Call center representatives and in-person assisters will not be able to offer advice or recommendations on which health plans to choose. Only insurance brokers who are registered with the exchange are permitted to offer recommendations based on an individual's needs and budget.

The Washington Health Benefit Exchange has trained more than 1,000 registered insurance brokers to help residents enroll in health plans. In addition to completing the training, licensed brokers must be appointed by respective health insurance carriers to sell plan products.

Individuals, families and small businesses can locate registered brokers by name or ZIP code on the Healthplanfinder website.

Deadlines

Washington residents have until March 31 to purchase coverage through the exchange. In most cases, those who miss the open enrollment period will have to wait until the next open enrollment — which begins Oct. 15, 2014 — to purchase coverage.

Insurance coverage begins Jan. 1.

Beginning Jan. 1, most U.S. residents are required to have health insurance or face fines. The penalty for being uninsured in 2014 is $95 per adult or 1 percent of the family income, whichever is greater. The fine increases in following years.

There are some exceptions to the individual mandate.