In Snohomish County, new year brings changes to health insurance

EVERETT — Local and federal changes to health insurance that went into effect at the start of 2026 have the potential to impact many Snohomish County residents.

Locals covered by Humana Medicare Advantage plans got word in November that the company's contracts with Optum Care Washington, one of the largest health care providers in the region, would expire on Jan. 1.

Also on Jan. 1, enhanced premium tax credits introduced as part of pandemic-era relief for Affordable Care Act recipients expired after Congress failed to renew the spending last year, following a lengthy government shutdown. The expiration of those credits will lead to some individuals — though not all — who receive Affordable Care Act coverage, also known as Obamacare, seeing increased premiums.

Optum and Humana

Neal Jacobson got word in November that Optum care facilities would no longer be covered by his Humana Medicare Advantage plan as of Jan. 1. Jacobson, a former aerospace worker, lives on Camano Island and had gone to an Optum clinic in Stanwood since 2010 for his medical care.

"I find it quite irritating," Jacobson said in a November interview. "There's no explanation. It's just, 'We're doing this.'"

Healthcare Dive, a health industry news outlet, previously reported on the contract dispute between Optum and Humana.

Medicare Advantage plans, offered by private companies, include the base coverage of Medicare — provided by the federal government — and usually include some additional benefits. But those with Medicare Advantage plans can only use doctors within the provider's network.

Of the nearly 150,000 people who are Medicare beneficiaries in Snohomish County, almost 90,000 utilize a Medicare Advantage Plan and other health plans, according to federal Medicare data.

The news that Jacobson would no longer be able to use Optum providers led to a sort of scramble to find coverage he could access close to his home. The main Medicare open enrollment period is from Oct. 15 to Dec. 7. Those already in a Medicare Advantage plan can switch to another before March 31.

"Insurance, by itself, is already a different language," said Kristin Johnson, an Everett-based health insurance broker. "Medicare is probably the hardest language of them."

Humana, however, eventually referred Jacobson to Skagit Regional Health, a medical organization with a clinic in Stanwood, he said Friday, keeping his commute similar.

In a statement, an Optum spokesperson wrote that the company was "disappointed we could not reach an agreement with Humana."

"We remain fully committed to supporting our Washington patients through this transition by helping them maintain continuity of care with the providers they know and trust – whether by selecting a different health plan or provider," the spokesperson wrote Friday. "Our clinicians show up every day to deliver high-quality, coordinated care and we will continue advocating for fair reimbursement that sustains access, quality and long-term stability for the patients who depend on us."

Humana wrote in a statement that negotiations with Optum are ongoing.

"We continue to engage in good-faith discussions and have put forward proposals that would place Optum at rates that are fair, reasonable and market-based," the company wrote in a statement Friday. "Medicare beneficiaries deserve choice and a fair, competitive market. We are committed to advocating for these values. For our members, we have provided clear guidance and assistance to help them continue receiving the care needed."

As of 2023, Optum controlled 45% of the primary care market in Snohomish County, according to a 2025 research article published in Health Affairs Scholar.

In the Seattle metropolitan area — including King, Pierce and Snohomish counties — UnitedHealth Group, Optum's parent company, controlled 42% of the Medicare Advantage market share as of 2024, an American Medical Association report found. Humana was the second largest Medicare Advantage insurer in that area, with 17% of the market share.

UnitedHealth Group is the largest health insurer in the country, according to the American Medical Association. It is also the largest Medicare Advantage insurer in the country, followed by Humana.

"I would say the big rub in all of this was just the reality that Optum dominates the medical care marketplace here in Snohomish County," said Neil Angst, an Everett-based insurance broker.

The contract dispute between Optum and Humana followed one of a few Optum has had with other insurance providers over the years. In 2023, Optum terminated its contract with another Medicare Advantage provider, Regence.

"This year, one could make the argument it was Humana's turn," Angst said.

Now, Optum — whose parent company, UnitedHealth Group, bought The Everett Clinic in 2017 — accepts three providers for Medicare Advantage plans, according to the organization's website. But one of those, Aetna, is restricted to only Boeing retirees. Another provider, Kaiser Permanente, is available, but those plans can exclude primary care services at a number of locations across Snohomish County.

The only Medicare Advantage provider available to the general population, where beneficiaries would be covered at Optum's locations across the county, is UnitedHealthcare, according to Optum's website. UnitedHealthcare and Optum are owned by the same parent company, UnitedHealth Group.

Johnson said her hope was that in the future, insurance companies could come to agreements sooner, to give grace to individuals looking to ensure they remain covered by health insurance.

"It can be scary, this kind of thing. It hurts my heart for them, and it's really frustrating," Johnson said. "… I understand doctor's groups and insurance companies need to negotiate, they need to figure out their terms. I think in a perfect world, every year they go through their negotiations, or every three or five years, that they have this done long before open enrollment, so we all know what we're dealing with."

Affordable Care Act

Another Jan. 1 change came in the form of the expiration of enhanced premium tax credits for individuals with Affordable Care Act coverage.

To be eligible for those credits, individuals had to meet several criteria related to income, citizenship and other coverage options, wrote Ilene Stohl, a spokesperson at the Washington Health Benefit Exchange. The Health Benefit Exchange operates a state marketplace that allows people to enroll in Affordable Care Act coverage or Medicaid.

About 75% of people using the exchange benefited from the expanded tax credits, Stohl wrote.

The expanded tax credits expired after Congress approved a federal spending bill in November, ending a 43-day government shutdown, that didn't include an extension of the subsidy.

State and federal officials warned of potential ramifications of the tax credits expiring, including the potential for skyrocketing premiums and people losing coverage.

The Washington Health Benefit Exchange estimated that the loss of the enhanced tax credits could lead to 80,000 people in the state forgoing health coverage due to increased premiums, and would amount to a $285 million loss in federal funding. The Congressional Budget Office estimated last year that about 2 million Americans nationwide would eventually lose health insurance if the enhanced tax credits lapsed.

But Washington state officials took some steps to try and minimize the impacts of the expiring tax credits.

Affordable Care Act coverage is separated into bronze, silver, gold and platinum plans — which denote the percentage of costs the insurer pays compared to the person enrolled in the plan.

Under the law, tax credits are calculated based on the second-lowest silver plan in the marketplace. But by increasing the premiums for those plans — to the point where they become more expensive than even the gold plans — the amount of tax credits customers can receive will increase significantly. The practice even has a name: "Silver loading."

Now, Angst said, the increased silver premiums gave significantly more tax credits to individuals enrolled in other plans. He said many of his customers actually saw a decrease in their monthly premium costs thanks to the move from the state's Office of the Insurance Commissioner.

"It very well could be that in many other states, lots of people got whacked, and it was because their states didn't do what Washington state did," Angst said.

The "silver loading" will bring in $100 million of extra premium tax credits available to those who qualify, helping at least 64% of the Health Benefit Exchange's customers, Stohl wrote.

"While fewer people qualify for federal tax credits this year, actions made by Washington state have protected many of our customers from the doubling and tripling of premiums seen nationwide," wrote Ingrid Ulrey, the CEO of the Washington Health Benefit Exchange, in a press release Thursday.

There will still be severe impacts to people most vulnerable to the expiration of the enhanced tax credits. It particularly affects people with incomes either below the federal poverty level or more than four times the poverty level, the income range for individuals who qualify for the original premium tax credit.

"Many of these people are older adults who are not yet eligible for Medicare and have little additional earning power to make up the difference in the loss of tax credits," Stohl wrote.

Congress is in talks over a potential extension of the lapsed Affordable Care Act tax credits, though a compromise remains a "long shot," The New York Times reported.

As of Thursday, 278,000 people had signed up for dental and health insurance for 2026 through the Health Benefit Exchange. The deadline for open enrollment on the Washington Health Benefit Exchange is Jan. 15 for coverage that starts on Feb. 1.