washington health benefit exchange...full price until moop $45 30% x-rays and diagnostic imaging $60...

Washington Health Benefit Exchange

Environmental Scan: Cascade CareBackground Slides

2021 Individual Market and Public Option Plan Filings – Key Dates

Milestone Date

OIC Plan Filing Date for 2021 Individual Market Plans May 21, 2020

HCA Due Date for Public Option Bidders’ Phase 2 Responses May 22, 2020

HCA Announcement of Public Option Apparently Successful Bidders

July 2, 2020

OIC Approval of 2021 Individual Market Plan Filings September 2020*

HBE Board Certification of 2021 Exchange Plans September 16, 2020*

Public Option Contracts Executed by HCA September 25-30, 2020*

Open Enrollment 2021 Begins November 1, 2020

2

* Future dates subject to change

2021 Exchange Plans & Rates

4

13 QHP Issuers | 122 QHPs

2021 Exchange QHPs - Metal Level Overview

Gold

76%-82% AV

• 13 Issuers

• 30 Plans

Silver

66%-72% AV

CSRs available

• 13 Issuers

• 37 Plans

Bronze

56%-65% AV

• 13 Issuers

• 53 Plans

CatastrophicOnly through the Exchange

Under age 30 or hardship

No tax credits

• 2 Issuers

• 2 Plans

Carrier Participation On Exchange

CarrierAverage rate

increase/decreaseRange of

increase/decrease

Kaiser Foundation Health Plan of Washington

-5.48% -3.12% to -10.18%

Coordinated Care Corporation .8% -2.97% to 3.64%

Molina Healthcare of Washington -.39% -3.77% to 2.34%

LifeWise Health Plan of Washington 3.49% .58% to 5.14%

Premera BlueCross -9.29% -6.66% to -11.36%

Kaiser Foundation Health Plan of the Northwest

-3.45% -6.39% to -2.57%

PacificSource Health Plans 3.31% -3.59% to 9.83%

BridgeSpan Health Company -1.57% -4.47% to .16%

Providence Health Plan N/A N/A

Proposed 2021 Exchange Rate Changes

Source data: 2021 Individual rate filing, WA OIC

Averages are not weighted for enrollment; cross mapping increases/decreases are not included. Top 4 carriers listed have 83% of total Exchange enrollment.

Average Percent Decrease/Increase Across

All Counties^

Range of Percent Decrease/Increase Across All

Counties^

Gold -3% -10% to 4%

Silver -1% -13% to 8%

Bronze -11% -26% to -1%

7

^Average percentages are not weighted for enrollment.

Note: Exchange consumers under 400% FPL receive federal premium tax credits, which shield them premium increases.

Percent Decrease/Increase toLowest Priced Plan in 2021

King County: 2021 Landscape▪ 8 carriers, 76 plans on the Exchange

▪ 49 Non-standard, 24 standard, 3 public option

▪ 1 Catastrophic plan, 34 Bronze, 24 Silver, 17 Gold

▪ Two new carriers to the county: Regence BlueShield, United Healthcare

▪ 2020 Landscape: 6 carriers, 34 plans

$289

$372 $413

$278

$358

$409

$-

$50

$100

$150

$200

$250

$300

$350

$400

$450

Bronze Silver Gold

2020 lowest rate 2021 lowest rate

Spokane County: Landscape

▪ 8 carriers, 66 plans on the Exchange


▪ 2 Catastrophic plans, 27 Bronze, 21 Silver, 16 Gold

▪ Two new carriers to the county: CHNW, BridgeSpan


$285

$342

$401

$255

$348

$389

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

Bronze Silver Gold


Chelan County: Landscape▪ 3 carriers, 31 plans on the Exchange


▪ 12 Bronze, 11 Silver, 8 Gold

▪ One new carrier to the county: CHNW


$329

$394

$462

$311

$421 $450

$-

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

Bronze Silver Gold


Wahkiakum County: Landscape▪ 2 carriers, 14 plans on the Exchange


▪ 7 Bronze, 4 Silver, 3 Gold

▪ One new carrier to the county: Regence BlueShield

▪ 2020 Landscape: 1 carrier (Premera), 4 plans

$416

$533

$608

$329

$496 $549

$-

$100

$200

$300

$400

$500

$600

$700

Bronze Silver Gold


2019 2020 2021

GOLD

Deductible Range $0 - $2,925 $0 - $2,925 $0- $2,925

Median Deductible $1,175 $1,200 $500

SILVER

Deductible Range $2,000 - $7,150 $2,000 - $7,500 $800- $6,900

Median Deductible $4,500 $3,750 $2,450

BRONZE

Deductible Range $4,750 - $6,500 $5,000 - $8,150 $3,000- $8,550

Median Deductible $5,600 $6,750 $6,100

12

Proposed Deductibles for 2021

Silver deductibles presented in this graph are for a standard silver plan (no cost sharing reductions).

Deductibles shown are for an individual.

Standard Plans

Final 2021 Standard Plans

2021 Standard Plans – Cost Sharing Reduction Silver Variants

Proposed 2021 Bronze Rates, King County

Graph features lowest priced 2021 standard plan and nonstandard plan of carrier; 2020 average is the average of all bronze plans in King County

Rates for 40-year-old non-smoker

$296 $289

$301

$311 $313 $324

$358

$369

$278 $284

$291

$305

$284 $294

$356

$150

$200

$250

$300

$350

$400

Standard Nonstandard 2020 average

Cost-Sharing Compare: 2021 Standard Silver2021 Standard

Silver

Coordinated

Care Balanced

Care (2021)

Molina Constant

Care (2021)

Kaiser Virtual

Care* (2021)

Integrated Yes Yes No Yes

Deductible ($)$2,000 $6,900

$0 medical/ $800

drug$3,000

MOOP ($) $7,800 $6,900 $8,500 $8,100

Emergency Room Services$800

Full price until MOOP

$750 30%

Urgent Care $60 $60 $30 $10

All Inpatient Hospital Services$800 copay per day


$1,200 copay per

day30%

Primary Care Visit to Treat an Injury or Illness(exc. Preventive, and X-rays) $25 $30 $30 $10

Specialist Visit $60 $60 $60 $25

Laboratory Outpatient and Professional Services$35


$45 30%

X-rays and Diagnostic Imaging$60


$80 30%

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$600Full price until

MOOP$500 30%

Generics $20 $15 $20 $15

Preferred Brand Drugs $70 $50 $60 50%

Non-Preferred Brand Drugs$250


40% 50%

Specialty Drugs (i.e. high-cost)$250


40% 50%

All Other Benefits 30% 0% 40% 30%Federal AV from AVC 72.06% 71.35% 71.39% -Adjusted AV 71.21% 70.82% 71.39% 71.30%

* Multiple in network tiers are applicable; information in chart is for Tier 1

Public Option Plans & Rates

CHNWCountyCarrier's Public

Option (PO) Silver

Lowest-Cost Standard Silver in County

Lowest-Cost Silver in County

Average 2020 Silver

% Difference Between Public Option & 2020

Average

Cowlitz $451 $451 $451 $474 -5%

Kitsap $451 $415 $371 $436 3%

Lewis $451 $415 $371 $436 3%

Spokane $392 $374 $348 $393 -0.2%

Pierce $394 $393 $387 $413 -5%

Kittitas $400 $400 $369 $420 -5%

Yakima $400 $400 $369 $420 -5%

Chelan $421 $421 $421 $442 -5%

Douglas $421 $421 $421 $442 -5%

Grant $421 $421 $421 $442 -5%

Okanagon $421 $421 $421 $442 -5%

Offering Public Option plans only• CHNW PO is -3% less on average than 2020

average plans• In 9 of 11 counties, CHNW PO has lower

premium than 2020 average plan• Lowest-cost standard silver in 7 counties• Lowest-cost silver in 5 counties

LifeWise

Offering Standard, Non-standard, and Public Option• PO is their lowest cost offering (7%

lower than their standard plan, and 2% lower than non-standard)

• PO is the lowest-cost standard silver in Adams

• PO is 12% higher on average than 2020 average plans

CountyCarrier's Public

Option (PO) Silver

Carrier's Lowest Non-Standard

Silver

% Difference Between PO & Carrier’s Non-

Standard

Carrier's Standard

Silver

% Difference Between PO

& Carrier’ Standard

Lowest Cost Standard Silver in County

Lowest Cost Silver in County

Average 2020 Silver

% Difference Between PO & 2020 Average

Klickitat $508 $520 -2% $544 -7% $428 $428 $449 13%

Benton$438 $449 -2% $469 -7%

$413 $369 $401 9%

Adams $453 $464 -2% $485 -7% $453 $424 $415 9%

UnitedCounty

Carrier's Public Option (PO) Silver

Lowest-Cost Standard Silver

in County

% Difference Between PO &

Lowest Standard Silver

Lowest-Cost Silver Plan in

County


& Lowest Silver

Average 2020 Silver Plan


& 2020 Average

Adams $465 $453 3% $424 10% $415 12%

Clallam $445 $445 0% $445 0% $467 -5%

Jefferson $445 $415 7% $371 20% $436 2%

King $476 $386 23% $358 33% $405 17%

Kittitas $439 $400 10% $369 19% $420 5%

Lincoln $414 $374 11% $348 19% $393 5%

Mason $457 $393 16% $387 18% $413 11%

Pierce $457 $393 16% $387 18% $413 11%

Whitman $418 $418 0% $383 9% $439 -5%

Yakima $439 $400 10% $383 15% $420 5%

Offering Public Option plans only• PO is 6% higher on average than 2020

average plans • Only PO offered in King County

• PO is 23% higher ($100/month more) than lowest-cost standard silver

• PO is 33% more than lowest-cost silver• PO is lowest silver in Clallam and lowest

standard silver in Whitman

Coordinated Care

CountyCarrier's

Public Option (PO) Silver

Carrier's Lowest Non-

Standard Silver

% Difference Between PO & Carrier’s Non-

Standard

Carrier's Standard

Silver

% Difference Between PO & Carrier’s Standard

Silver

Lowest Cost Standard

Silver Plan in County

% Difference Between PO & Lowest Silver in

County

Average 2020 Silver

Plan


& 2020 Average

Asotin $436 $383 14% $429 2% $429 14% $450 -3%

Garfield $436 $383 14% $429 2% $429 14% $450 -3%

Whitman $436 $383 14% $429 2% $418 14% $439 -1%

Offering Standard, Non-standard and Public Option• PO is their most expensive offering• PO is 14% higher than their non-

standard offering (also lowest silver in county)

• PO is 2% higher than their standard silver plan

• PO is 2% lower on average than 2020 average plans

BridgeSpan

Offering Standard and Public Option• PO is 21% higher on average than

2020 average plans• PO is 29% higher ($100+/month

more) on average than lowest-cost silver plan in county

• PO is 21% higher on average than lowest-cost standard silver plan in county

CountyCarrier's Public

Option (PO) Silver

Lowest-Cost Standard Silver

in County

% Difference Between PO &

Lowest Standard Silver in County

Lowest Cost Silver in County

% Difference Between PO & Lowest Silver in

County

Average 2020 Silver Plan

% Difference Between PO & 2020 Average

Kittitas $491 $374 31% $369 33% $393 25%

Adams $530 $453 17% $424 25% $415 28%

Garfield $496 $429 16% $383 30% $450 10%

washington health benefit exchange...full price until moop $45 30% x-rays and diagnostic imaging $60...

Documents