Washington residents who buy their health insurance on the state health-care exchange got both kinds of news Thursday.
The good: After five years of sharp increases, premiums for most health insurance offered through Washington Healthplanfinder will fall by an average of 3.27% in 2020, according to the state insurance commissioner’s office.
It’s a modest but welcome break after premium hikes that have averaged 13.7% a year since exchange coverage began in 2014 under the federal Affordable Care Act, also known as Obamacare. In 2018 alone, exchange premiums increased 34.99%.
But that good news comes with a caveat: Even if exchange users are paying lower premiums in 2020, their out-of-pocket expenses will likely keep climbing, said Stephanie Marquis, spokeswoman or the office. “What we did see with a number of the [exchange] plans is that their deductibles again are going up,” Marquis said.
Next year’s premium decrease is mainly the result of better data. After five years, the eight insurers that sell through Healthplanfinder are simply better at anticipating the actual costs of insuring the roughly 241,000 state residents who buy individual health coverage, most of them through the state exchange.
Insurers “have a more predictable market,” Marquis said. “They know who is signing up and they understand what the costs are going to be.” for paying claims and administering the policies.
Falling premiums won’t translate into lower overall costs for exchange consumers, however.
To the contrary, because health-care costs in Washington and elsewhere are still rising, the federal government will once again lift the cap for total out-of-pocket costs for consumers covered under the ACA, Marquis said.
In 2020, the cap on out-of-pocket costs, which includes deductibles and co-payments among other costs, can be as high as $8,200 per person, Marquis said. In 2015, the out-of-pocket cap was $6,600.
Already, Marquis said, several insurance companies have raised the 2020 deductibles on some of the plans they offer on the exchange.
There may be some relief on the horizon. In May, the state Legislature enacted a “public option” insurance plan that could help reduce total out-of-pocket costs by, among other things, capping how much doctors and other providers are reimbursed by government. But the public option won’t go into effect until 2021.
In the meantime, Washington residents who buy health insurance on the state exchange can expect to see higher deductibles.
Although many exchange users qualify for federal “cost-sharing” assistance on those out-of-pocket expenses (in 2017, it was 73,865 residents, or nearly 40 percent, in Washington state, Marquis said), those who don’t face “a very high out of pocket cost,” she said. “They have health insurance they can’t afford to use.”