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New York health insurance exchange

new-york guide to health insurance

New York health insurance exchange

By
healthinsurance.org contributor
July 24, 2014

New York State of Health has been one of the most successful exchanges in the country ever since open enrollment began in October.  As of April 16, 435,479 New Yorkers enrolled in private health plans through New York State of Health, and another 525,293 enrolled in Medicaid or CHIP, bringing total enrollment to 960,762 (enrollment has continued to increase since mid-April, but NY State of Health isn’t going to release official totals again until November).  This was a significant increase from the 812,000 people who had enrolled as of early in the day on March 31.  Of the people who selected private plans, 74% received subsidies – lower than the national average of 85%.  New York’s enrollment included a slightly higher percentage of “young invincibles” (people between the ages of 18 and 34), at 31%, than the national average of 28%.

Open enrollment ended on March 31, but the enrollment total through April 15 includes people who were enrolling because of a qualifying life event and those who had started their applications by the end of March but were unable to complete them by the deadline (NY granted an extension to April 15 for those individuals).  Among all enrollees, roughly 70% were uninsured prior to enrolling in coverage, so NY is certainly making a huge dent in its uninsured population.

Carriers that wish to participate in the 2015 open enrollment were required to have notified the exchange by May 9.   In late-April, officials decided that carriers would not be required to cover out-of-network care in order to sell plans for 2015.  This has been a contentious issue during the first open enrollment, as none of the 16 carriers offering plans in the NY exchange cover out-of-network care unless it’s an emergency.  Consumer advocates had pushed to require plans to cover out-of-network care, citing the narrow networks as a barrier to care for some residents.  But insurers pushed back, noting that plans would be more expensive if they covered services provided outside of the established networks – ultimately, the exchange agreed.

State-run exchanges across the country are scrambling to figure out how to obtain funding going forward, as they are all expected to be financially self-sustaining by 2015.  New York State of Health is planning to rely solely on state funds to pay for the exchange next year (as opposed to user fees).

New York Governor Andrew Cuomo included the ACA’s Basic Health Program in his budget proposal released in late January.  If approved by the NY legislature, the BHP could be providing health insurance for people with incomes between 133% and 200% of poverty by 2016.  Although provisions for the BHP were included in the ACA, only a handful of states have thus far expressed interested in pursuing the BHP as a way to provide health insurance for low income residents who don’t qualify for Medicaid.  That NY is among them is no surprise, given how dedicated the state has been to implementing and supporting the ACA.

Given the success of the exchange, officials in New York declined President Obama’s offer to allow health insurance plans scheduled for year-end termination to be extended into 2014.  Roughly 100,000 NY residents received cancellation notices, but that figure is dwarfed by the number of people who enrolled in exchange plans with January 1 effective dates, so it’s likely that most of the cancelled plans were replaced with new ACA-compliant plans.

New York launched its consumer-facing website for its health insurance marketplace, NY State of Mind, on Aug. 20, 2013. The website included FAQs, an interactive map showing which health plans are available by county, and a calculator to help consumers learn if they are eligible for tax credits and how much they will pay for health insurance.

Gov.  Cuomo established New York’s marketplace, or health insurance exchange, through an executive order. Cuomo issued the order in April 2012 after New York’s legislature failed to approve an exchange law in both the 2011 and 2012 sessions.

Cuomo cited numerous reasons in his executive order for starting an exchange. According to the governor’s office, state and local governments pay more than $600 million every year to cover the health care costs of uninsured individuals. Uninsured individuals, the order read, “frequently forego preventive care and other needed treatment, putting them at risk of being sicker throughout their lives and dying sooner than those who have health insurance, which diverts funds from other public uses …”

New York enacted ACA-style reforms in the individual market two decades ago; policies there have been guaranteed issue and community rated ever since.  This meant that premiums in New York were far higher than in other states where medical underwriting was utilized.  There was no individual mandate, and few insurers participated in the pre-ACA individual market in New York.  The ACA’s individual mandate has increased the number of carriers offering policies in New York, and premiums in 2014 will be lower than they were in 2013.  Combined with the ACA’s premium subsidies, these changes make individual health insurance far more affordable in New York than it used to be.

Sixteen insurers – double the national average – are participating in the state’s marketplace:

  • Affinity Health Plan, Inc.
  • American Progressive Life & Health Insurance Company of New York (Today’s Options of NY, Inc.)
  • Capital District Physicians Health Plan, Inc.
  • Health Insurance Plan of Greater New York (EmblemHealth)
  • Empire BlueCross and Empire Blue Cross Blue Shield
  • Excellus (Excellus Blue Cross Blue Shield in Central NY and Univera in Western NY)
  • Fidelis Care
  • Freelancers Co-Op (Health Republic Insurance)
  • Healthfirst New York
  • HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)
  • Independent Health
  • MetroPlus Health Plan (Market Plus)
  • MVP Health Plan, Inc.
  • North Shore LIJ
  • Oscar Insurance Corporation
  • United Healthcare of New York, Inc. (United, Oxford)

Aetna had originally planned to sell policies in the New York exchange, but pulled out in late August.

Carriers are also allowed to offer plans outside the exchange in NY, but they are required to offer the same policies in the exchange that they offer outside the exchange, which means there aren’t many reasons for consumers to shop off-exchange in NY.

About 2.7 million people in New York — about 16 percent of the population — did not have health insurance in 2013, according to the Urban Institute. About 1.1 million are expected to buy insurance through the new marketplace.

Contact the New York exchange

NY State of Health
855-355-5777

More New York health insurance exchange links

State Exchange Profile: New York
The Henry J. Kaiser Family Foundation overview of New York’s progress toward creating a state health insurance exchange.

Health Care For All New York (HCFANY)

Health Insurance Exchange – Federal Health Care Reform Implementation in New York State