By Hayley Day
Contributor
Individual health plans by Premera Blue Cross will not be available for San Juan County residents through the Washington Health Benefit Exchange in 2017.
That leaves only one health insurance provider for individual Affordable Care Act plans for about 16,000 island residents, Group Health. Premera eliminated coverage in 12 rural Washington counties where they say they cannot offer affordable insurance.
“Insurance companies are pulling towards urban areas, where their preferred clinics are located,” said Gigi Zakula, agent and owner of Islanders Insurance in Friday Harbor. “Out here, it’s a little more expensive.”
Zakula said Premera is moving toward a health maintenance organization model, where it only allow customers to choose from clinics in its specific network to control costs.
The lack of competition in rural areas like San Juan County makes price negotiations between insurance companies and health care providers more difficult. According to the Washington state Department of Health, northwest Washington has 47 percent of the state’s physicians, and San Juan County has the fewest physicians of any county in the region with just .1 percent.
Premera received almost $412 million in premiums in 2015 and paid almost $457 million in claims, said Premera public relations representative Melanie Coon. Premera’s rates have risen 10 percent since last year.
The ACA does not allow insurance companies to refuse service to the sick. Some insurance companies have charged higher premiums to compensate for higher claim rates since the provision took effect in 2014.
Coon said 925 Premera individual health customers living in San Juan County will be affected by the loss. Of those, 240 bought insurance through Premera’s subsidiary, LifeWise of Washington.
Employer-sponsored plans through Premera will not be affected, nor will individual plans purchased through LifeWise before the ACA was enacted in 2010. ACA plans bought through the exchange or directly through Premera or LifeWise will not be available for renewal in 2017.
Outside the exchange in 2017, San Juan County residents can choose individual and group coverage from Group Health and Regence Blue Shield.
San Juan County auto and life insurance brokers like Michele Wiley of Madrona Point Insurance recommend Harald Schot of LifePlan Financial in Stanwood to clients.
Schot said San Juan County residents had three health insurance providers through the exchange in 2016: Premera, Group Health and UnitedHealth Group. UnitedHealth announced last spring that they would drop coverage for the entire state in 2017.
In 2016, UnitedHealth was the least popular of the three insurance companies in its first year in the state exchange, said Schot, due to pricing and familiarity. Premera was a preferred provider organization, with a large network of doctors, and was equally as popular as Group Health.
“You’re picking from Group Health or Group Health if you want to buy from the exchange in 2017,” said Schot, who is a member of the “Healthplanfinder” committee for brokers, which advises the state insurance exchange board.
Premera made the announcement in a press release in May. Letters to individual coverage holders were sent in late September. That’s when Wiley decided to create a health forum for the county.
“It’s very concerning and very disappointing,” said Wiley. “As a person, I’m affected too.”
Wiley and Schot will hold hour-long informational sessions on Group Health at 10 a.m., 2 p.m. and 4 p.m. on Thursday, Nov. 3 at the coworking space 376 Group, LLC at 596 Main Street in Eastsound.
Attendees will receive informational packets, and there will be time for private questions with brokers afterwards. Call Madrona Point Insurance at 376-5707 to reserve a seat in the 15-person room or an individual meeting with a broker on a different day. Advice from the insurance brokers is free, as they are paid by insurance companies.
Premera will also not offer ACA health plans in Chelan, Douglas, Ferry, Kittitas, Lewis, Lincoln, Mason, Pend Oreille, Skagit, Stevens and Yakima counties – which means the company now offers individual exchange plans in just 27 Washington counties, down from 39.
Premera’s subsidiary, LifeWise Health Plan of Oregon, will also leave Oregon at the end of 2017.
Open enrollment through state health care exchanges runs from Nov. 1 through Jan. 1. Washington ACA plans can be purchased at www.wahbexchange.org.
