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Exchange board approves 2027 standard plan designs amid warnings of higher premiums
Summary
The Washington Health Benefits Exchange board voted to approve the 2027 standard plan designs after staff outlined trade-offs across metal levels: a recommended bronze with a $7,000 deductible, silver plans with lower mental-health co-pays to preserve tax-credit value, and two gold options. The motion passed by roll call.
The Washington Health Benefits Exchange board approved standard plan designs for plan year 2027 during its Dec. 11 meeting after staff presented recommended benefit structures and actuarial trade-offs.
Leah (staff) and Kristin (senior policy analyst) guided the board through the design principles. Staff explained they modeled options under the planning assumption that enhanced federal premium tax credits would expire and that CMS's final actuarial value calculator was still pending. For the bronze plan staff recommended a design with a $7,000 deductible and $45 office visit co-pay to minimize further cost-sharing increases for customers likely to buy down into bronze.
For silver, staff said they aimed to remain at the top of the actuarial-value range to maximize customers' tax-credit value and proposed lowering the mental-health outpatient co-pay to $20, matching mental-health office visits. The staff recommended two gold options: a low-AV gold intended to be competitive with employer-type offerings and a "complete" gold designed for high utilizers, where the out-of-pocket maximum would be kept stable though the deductible may rise modestly.
Board member Hiroshi moved to approve the 2027 standard plans; the motion was seconded by April Lynn and passed on a roll-call vote with the members present recorded as approving during the vote call. Chair Dr. Monica McLemore announced the plans approved.
Staff emphasized that the designs reflect an incremental approach in a year of market disruption and that some features (for example, actuarial values and AV calculator inputs) could be revised if federal rules change or if CMS releases the final AV calculator. Carriers had submitted premium-impact estimates during the public comment process; staff said there were no major premium differences between the options presented for public comment.
The board's approval sets these standard designs as the required baseline plans carriers must offer on the Exchange for plan year 2027; carriers may still offer nonstandard plans under existing state law. Staff will proceed with implementation steps, stakeholder communication and coordination with carriers and regulators ahead of carrier filings.
