Tag: Marketplace

CMS Issues Final Marketplace Stabilization Rule

Last week, The Centers for Medicare and Medicaid Services issued the final Marketplace Stabilization rule to “help lower premiums and stabilize individual and small group markets and increase choices for Americans.” While the rule is designed to help lower premiums and increase the choices consumers will have, some of the policy changes in the rule may potentially impact consumers in a negative way. Below are the key components of the final rule:

2018 Open Enrollment Period: The final rule shortens the annual open enrollment period to November 1, 2017, until December 15, 2017. This is half the duration of open enrollment periods in the past. This shortened window to enroll will result in many consumers potentially missing the opportunity to enroll in coverage and will overwhelm the already limited capacity of organizations providing in-person enrollment assistance. During the 2016 Open Enrollment period for the New York State of Health Marketplace (November 1, 2015 – January 31, 2016), about 74% of consumers enrolled or renewed their coverage with the help of an assistor. Consumers that do not enroll during the open enrollment period will only be able to enroll if they are eligible for a Special Enrollment Period (those eligible for Medicaid, Child Health Plus or the Essential Plan can enroll at any time during the year.)

Special Enrollment Period: Individuals applying outside of open enrollment will be required to provide proof of eligibility for a special enrollment period by submitting supporting documents. This rule aims to reduce fraud and abuse by ensuring that only those who are eligible are able to enroll. Consumers are not currently required to submit proof and this additional documentation burden could result in consumers experiencing delays in their coverage.

Continuous Coverage: The final rule allows insurers to require individuals to pay back past due premiums before enrolling in a plan with the same insurer the following year. Consumers who fell behind in premium payments will have to pay the balance due or they will not be able to enroll in the same coverage, forcing consumers to choose between overcoming a financial burden or being locked out of coverage for the entire year.

Ensuring Additional Choices for Consumers: the final rule allows insurers additional flexibility with the actuarial value of plans so they can offer more plan choices with lower premium options. While at first glance it does seem beneficial to offer greater consumer choice, actuarial value flexibility will allow insurers to offer cheaper plans by removing benefits or increasing out of pocket costs. Consumers may not realize what benefits are not being offered with their plan or what out-of-pocket costs they will be responsible for.

While overall these policy changes may be aimed at increasing choices and lowering costs, a robust education and outreach component should also be included to ensure that consumers understand how these changes may impact their coverage.

State-run marketplaces, like the New York State of Health, do often have more flexibility in establishing some of these policies so it is not entirely clear at this time how this final rule will impact consumers currently enrolled or enrolling in coverage through the New York State of Health Marketplace. HWCLI will continue to follow these changes and provide further updates when additional information is provided by the state.

Census Data Shows Drop in Uninsured

According to a new federal survey released this week by the U.S. Census Bureau, number of uninsured Americans declined from 13.3 percent of the population in 2013 to 9.1 percent in 2015. Uninsured rates declined across all age groups with adults ages 19-25 experiencing the biggest one-year drop. The uninsured rate among adults ages 19-25 dropped by 2.6 percentage points in 2015. Young adults ages 19 and 26 have a higher uninsured rate than other ages in the group likely due to Child Health Plus ending at age 19 and children losing coverage through their parents at 26. Among racial/ethnic groups, Latinos experienced the largest coverage gains although they continue to be the most likely to lack insurance.

Data from the American Community Survey shows higher uninsured rates in states that have not expanded Medicaid. In 2013, 19 states had uninsured rates of more than 14 percent. In 2015, only Alaska and Texas have uninsured rates that high and at the time data was collected neither had expanded Medicaid (Alaska’s Medicaid expansion went into effect September 2015).

Despite tremendous gains in the number of people covered by insurance, 29 millions Americans remain uninsured. States that have not expanded Medicaid should accept the federal dollars available to them to expand coverage for low-income residents of their states. For more details check out this report from the Commonwealth Fund.

New York State Announces 2017 Marketplace Insurance Rates

The New York State Department of Financial Services announced Friday the 2017 health insurance rates for Individual and Small Business plans through the New York State of Health Marketplace. Plans on the individual marketplace will increase by an average 16.6% – the largest increase since the Marketplace opened in 2014. The new rates will go into January 1, 2017. Seven plans offered in Nassau and Suffolk counties were approved for double digit premium increases and 3 of those plans (Affinity, NSLIJ-Care Connect, and United) will increase premiums by more than 20%.

Despite the double-digit increase for many plans, the Cuomo administration touted its vigilance, saying the department reduced insurers’ requested 2017 rate increases by more than 28 percent overall, which will save policyholders more than $302 million. While many consumers qualify for tax credits to assist with the cost of health insurance premiums, consumers should shop around during their re-certification process to determine which plan fits their needs best.

Click here for the full press release.

House Republicans Unveil Healthcare Plan

House Republicans recently released their long awaited 37 page white paper entitled “A Better Way,” laying out the initial framework for their plan to repeal and replace the federal health law. The proposal lacks crucial details and almost any mention of costs and the effect it will have on the estimated 20 million people who have signed up for insurance since the start of the ACA.

The plan starts with the repeal of the ACA and its requirements and taxes, but also would likley eliminate tax credits for small businesses, bring back the Medicare donut hole, bring back cost sharing for preventive care and decrease funding for community health centers. It would then put back some of its most popular elements: Allowing young adults to stay on their parents’ health plan to age 26; banning insurers from charging people with pre-existing health problems higher premiums; and forbidding insurers from dropping coverage if a policyholder gets sick. The plan only provides protections for consumers with pre-existing conditions if they maintain continuous coverage, putting many consumers at risk for high medical costs. The Republican plan offers a compensation: high-risk pools that sell insurance only to people with very expensive medical needs. Such pools already exist, and they work extremely badly, in large part because providing insurance to people with very high medical expenses is, well, expensive

The plan also repeals all health insurance exchanges and marketplaces where consumers currently buy insurance and receive government tax credits to assist with premium costs. Instead, everyone buying policies in the individual market would receive tax credits. Older people could be charged as much as 5 times more than younger adults for insurance.

The plan would also get rid of most of the coverage requirements and the coverage expansion under the Medicaid program for the poor, so states could make them more or less generous than they are currently. It would also limit funding and states could opt for either a per-person cap or a block grant. This would likely only increase the already stark differences in coverage from state to state.

It also includes long-held Republican proposals such as allowing consumers to buy health insurance across state lines, expanding health savings accounts, reforming medical liability rules; capping medical malpractice lawsuit awards; and raising premiums for older consumers to reduce rates for younger adults.


Open Enrollment Begins November 1st!

Open Enrollment for the New York State of Health Marketplace begins this Sunday, November 1, 2015 and runs through January 31, 2016. During Open Enrollment, consumers can switch plans or enroll for the first time.

New this year is the Essential Plan, a low or no cost health insurance option available to those who are over the income limit for Medicaid but still struggling with healthcare costs, despite subsidies. Depending on income, Essential Plan premiums range from $0 to $20 per month.

Consumers enrolled in Qualified Health Plans will renew their coverage between November 16, 2015 and December 15, 2016. At renewal, consumers will have the opportunity to compare plan options for 2016 coverage.

Applications and renewals can be completed online at https://nystateofhealth.ny.gov/ or by calling 1-855-355-5777

NY State of Health Announces 2016 Health and Dental Plans

The New York State of Health Marketplace has announced the insurers that will offer health and dental plans to individuals and small businesses in 2016. This list also includes the insurers that will offer the new Essential Plan.

Health Republic, which was offered in 2014 and 2015, will not be offered in 2016. Consumers with Health Republic will be instructed to choose a new plan during their re-certification.

The full list of available plans for 2016 can be found here