new-york guide to health insurance

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New York health insurance exchange / marketplace

2.1 million enrollees in NY exchange, including Medicaid; 88% prev. uninsured; open enrollment extended + special enrollment period

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  • March 23, 2015

2015 enrollment progress

By the end of open enrollment on February 15, NY State of Health announced that their total enrollment, including private plans and Medicaid/CHIP, had exceeded 2.1 million people, and that 88 percent of them had been uninsured prior to obtaining coverage through the exchange.

564,315 of those enrollees have private plans (although the private plan enrollment total includes 156,827 Child Health Plus enrollees; the remaining 407,488 enrollees have QHPs).  And total Medicaid enrollment through the exchange stood at 1,545,319 people as of February 15.

The majority of the current enrollees obtained coverage through the exchange in 2014 and renewed it for this year.  But 552,993 enrollees are new to the exchange for 2015.  Of those, about a third are enrolled in private plans (including Child Health Plus), and the rest are enrolled in New York’s expanded Medicaid program.

By February 21, HHS reported that NY State of Health’s private plan enrollment (not counting CHP) stood at 408,841, and that 35 percent of those enrollees are new to the exchange for 2015.

Open enrollment extension

Open enrollment was scheduled to end on February 15, in New York and across the country.  But on February 13, NY State of Health announced that anyone who has “taken steps to apply” on or before February 15 would have until February 28 to complete the enrollment. Applications that were completed from February 16 to February 28 will have a coverage effective date of April 1.

tax season special enrollment period

On February 20, NY State of Health announced a special enrollment period (March 1 to April 30), for people who didn’t previously know about the ACA’s individual mandate penalty, and only found out about it when they filed their taxes and were subject to a penalty for 2014.  By taking advantage of this special enrollment period, people who are subject to the penalty for 2014 can avoid – or partially avoid – the penalty for 2015.  Enrollments submitted by March 15 will have coverage effective April 1, which means they won’t be subject to a penalty for 2015 (you’re allowed one short gap in coverage, up to three months long)

Aiming high

The second round of open enrollment began on November 15, and navigators and brokers are impressed with the improvements that the exchange has made since last year, with one navigator organization pointing out that for most of the people they’re helping, the enrollment process takes half the time it did during the 2014 open enrollment period.

In November, soon after open enrollment began, NY State of Health executive director, Donna Frescatore, was predicting 350,000 new private plan enrollments for the exchange by February 15 (they had 132,549 as of February 4), in addition to retaining their 370,000 2014 enrollees.

That would put their target at 720,000 total private plan enrollees by the end of open enrollment, and clearly they fell short of that goal.  But ACAsignups’ Charles Gaba – who is usually very accurate in his predictions – had a lower projection for NY State of Health (573,000 by February 15), and the exchange came very close to reaching that mark.  Once the totals are in for the tax season special enrollment period, it’s likely that they could exceed 573,000 private plan enrollees.

Officials believe that after three years, there will be 615,000 people enrolled in private plans through the exchange (although far more than that will likely enroll over the course of three years, the individual health insurance market has always been volatile, and attrition is to be expected as time goes by).

The exchange allowed 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 your plan was automatically renewed, it’s still worth your while to compare the 2015 plans before the end of open enrollment (February 15) to see if there’s a different plan that offers a better value this year.  NY State of Health created a video that explains what you need to do if you already purchased a plan in 2014.

You can make a change to your plan anytime until February 15, and your new coverage will be effective March 1.  After February 15, you’ll only be able to switch plans for 2015 (including outside the exchange) if you have a qualifying event.

NY State of Health has added a feature to their website that allows users to browse plans, including estimated premium subsidies, by entering some very basic information about their age, location, and income.  Last year this wasn’t available – people had to enter identifying data in order to see prices that included subsidies.  The improvement – similar to one that made for people in states with federally facilitated marketplaces – makes the website more user friendly.

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.

NY State of Health was working well early in October 2013, at a time when and many of the state-run exchanges were still struggling.  And just before the second open enrollment began, the New York State Health Association released the results of a survey that found 92 percent of the 2014 NY State of Health enrollees are satisfied with their coverage, and three quarters of the exchange’s enrollees would recommend NY  State of Health to other people.

2015 rates and changing benchmark plans

Has the law delivered affordable health insurance to the state? Rates for 2015 were approved in New York in early September.  In the individual market (both on and off-exchange), 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.

But as of November 11, PricewaterhouseCooper’s weighted average rate increase across 21 carriers in New York was just half a percent for 2015, ranging from a decrease of 15.3 percent to an increase of 13 percent.  Any way you look at it, rates in New York look pretty good.

Within the exchange, the second-lowest cost Silver plan (the benchmark plan) in New York City averaged $365/month (pre-subsidy) for a 40 year-old enrollee in 2014.  That’s gone up to $372/month for 2015 – an average increase of just 1.8 percent.   But that’s assuming that the applicant again selects the second-lowest-cost Silver plan in 2015, which often means switching plans.

The Upshot from the NY Times released a map that shows each state broken into rating areas and the average price changes that enrollees in the 2014 benchmark plan can expect if they stay with their plan from 2014, versus switching to the new benchmark plan for 2015.  In some areas of New York, it makes a dramatic difference in premium.  Regardless of where you live, it’s in your best interest to take a few minutes to shop around again before settling on a plan for 2015.

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 (carriers’ phone numbers and provider network links are available here).

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 has joined the exchange for 2015.

NY State of Health is also offering stand-alone dental plans from ten different carriers for 2015.  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

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).

But in early February 2015, Governor Andrew Cuomo unveiled his 2015-2016 executive budget, which includes a new tax on health insurance premiums (roughly $25 per person) for private plans sold on and off the exchange.  The tax is projected to raise about $69 million, but health insurance carriers are opposed to the tax, as they say it will make health insurance less affordable for NY residents.

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.

Single-payer in NY?

New York lawmaker Richard Gottfried (D-Manhattan) is working on a plan for single-payer healthcare in the state, co-sponsoring – with Senator Bill Perkins – legislation that would create a universal coverage program known as “New York Health” and hosting a series of public hearings about the proposed plan.

Gottfried and Perkins introduced their bill nearly two years ago, in March 2013, and 83 other lawmakers signed on to co-sponsor it.  Gottfried says the switch to single-payer would save $20 billion a year.  If the New York Health program were to be approved, it would take a few years to get everything up an running, and would make New York the second state to enact a single-payer program.  Vermont’s Green Mountain Care is scheduled to go into effect in 2017.

2014 enrollment

New York State of Health has been one of the most successful exchanges in the country.  As of April 15, 2014, 370,604 New Yorkers had enrolled in private health plans through NY State of Health, and another 590,158 had enrolled in Medicaid or CHIP, bringing total enrollment to 960,762.

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.

Enrollment data – current as of September – is available based on zip codes (impressive considering the state has 2,200 zip codes!) in an interactive map created in November by Capital New York.  And it’s broken down into QHP, Medicaid and CHIP totals to give a very accurate picture of where the exchange has had the most impact.

Among the 2014 enrollees, more than 80 percent were uninsured prior to enrolling in coverage, so NY is certainly making a huge dent in its uninsured population.

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

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