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New York health insurance exchange

NY exchange very successful; 435K enrolled in private plans

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  • By
  • healthinsurance.org contributor
  • October 17, 2014

How successful is NY State of Health?

Very.  NY State of Health has long been considered one of the most successful state-run exchanges in the country.  Including Medicaid and private plans, the exchange enrolled nearly a million people during the first open enrollment period, most of whom were previously uninsured.  NY State of Health was working well early in October last year, at a time when HealthCare.gov and many of the state-run exchanges were still struggling.

2015 renewals and rates

Open enrollment begins on November 15, and NY State of Health is gearing up for a strong round of enrollments and renewals.  The exchange is allowing automatic renewal for people who, during their 2014 enrollment, granted the exchange permission to access their tax returns in subsequent years to verify subsidy eligibility.  But even if you’re among the people who have access to automatic renewal, it will be worth your while to compare the 2015 plans during open enrollment to see if there’s a different plan that offers a better value next year.

Rates for 2015 were approved in New York in early September.  In the individual market, the average approved rate increase is just 5.7 percent – a significant decrease from the 12.5 percent that carriers had originally filed with the state.  This chart shows each carrier by market share, and hovering over a carrier’s segment of the chart allows you to see their approved rate increase for 2015.

Two New York navigator organizations  – Niagara Falls Memorial Medical Center and The Dale Association – will be hosting insurance fairs on November 1 from 10am to 1pm.  Navigators from Public Policy Education Fund and Neighborhood Legal Services will also be there, as well as tax advisers and representatives from four health insurance carriers.  The events are called “The Affordable Care Act, Year Two: Now What?” and will focus on answering consumers’ questions and getting everyone up to speed so that they can head into the upcoming open enrollment fully educated about what they need to do to renew existing coverage, select a new plan, or enroll for the first time.

Carriers offering 2015 policies

NY State of Health announced on September 22 that sixteen carriers would be offering coverage in the individual market for 2015, and nine carriers would offer small business coverage through the SHOP exchange.  American Progressive Life and Health Insurance Company of NY will no longer be selling policies after gaining a very small market share in 2014.  But WellCare will be joining the exchange for 2015.  NY State of Health will also offer stand-alone dental plans from ten different carriers during the upcoming open enrollment period.  Across all three types of coverage – individual, small group, and dental – there are a total of four new insurers on the NY exchange for 2015.

Sixteen insurers – double the national average – are participating in the state’s individual marketplace for 2015:

  • Affinity Health Plan, 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)
  • WellCare

Enrollment data

New York State of Health has been one of the most successful exchanges in the country.  As of April 16, 435,479 New Yorkers enrolled in private health plans through NY 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, due to qualifying events). 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 percent received subsidies – lower than the national average of 85 percent. New York’s enrollment included a slightly higher percentage of “young invincibles” (people between the ages of 18 and 34), at 31 percent , than the national average of 28 percent.

The exchange released county-by-county enrollment data in July (you can view it with this interactive map), but it’s still based on their mid-April enrollment totals.  NY State of Health is following the lead of HHS on this issue, and will not be releasing enrollment totals during the “off season” outside of open enrollment.  They will announce updated enrollment numbers in November, but Charles Gaba of ACAsignups fame is predicting that they’ve been averaging 360 – 460 enrollments per day during the summer (of course, we also have to account for attrition, since people can drop their coverage outside of open enrollment).

Among all enrollees, more than 80 percent were uninsured prior to enrolling in coverage, so NY is certainly making a huge dent in its uninsured population.

Regulations, funding, and legislation

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 percent and 200 percent 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.

NY State of Health History

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 were more than 50% lower than they were in 2013, and that will continue to be the case in 2015. Combined with the ACA’s premium subsidies, these changes make individual health insurance far more affordable in New York than it used to be.

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