A Westchester Family Gets Covered

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The first open enrollment period for NY State of Health has come to a close, and as of April 16, 960,762 New Yorkers were able to get health care plans through the state marketplace. That means there are nearly one million stories of New Yorkers getting affordable, quality health coverage because of the NY State of Health and the ACA.

Here’s one, from Maryanne Tomazic of Raising Women’s Voices – New York:

For Dustin* and Abigail*, NY State of Health meant their family didn’t have to go without coverage before Dustin starts his new job. Dustin and Abigail live with their family of five in a small town in Westchester County. Dustin was hired by a new company, but the transition meant that his family would experience a gap in health care coverage. “COBRA wasn’t a realistic option for us,” Abigail said. “It was too expensive.”

Fortunately, Dustin was able to get health insurance through NY State of Health. He and his daughter Elizabeth* initially filled out the application online, but had trouble reporting his income due to his job transition. They went to a Navigator, who helped correct the problem. “We also wanted to make sure we could still go to the doctors we’ve been going to for years and also to our local hospital, Westchester Medical Center,” said Dustin. “We called our doctor to confirm that the plan we picked included them in their network.” The family’s previous health care plan had been grandfathered by the ACA, so many preventive services still required copays. “I had to pay $86 a month for my birth control pills,” said Elizabeth. “With this new plan, I can now get the contraception I need at no additional cost.”

The family’s new health care plan took effect on April 1, so thanks to the Affordable Care Act and NY State of Health, their family did not experience a gap in coverage. Like the 960,762 New Yorkers, and the over 8 million Americans, who enrolled during this first open enrollment period, they now have an affordable, quality health insurance plan to help them get the care they need!

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Jessica K., 27, enrolled in health insurance through NY State of Health in February
with the help of a Navigator from Community Service Society

As strange as it seems, the 1st open enrollment period under the ACA has come to an end. The final count of enrollees from NY State of Health is stunning: more than 865,000 New Yorkers enrolled in private and public plans between October 1 and April 1. While some New Yorkers will not have the opportunity to enroll in NY State of Health Coverage until the next open enrollment period on November 15 of this year, hundreds of thousands will still be able to enroll in private and public health insurance plans in the coming months.

This is due to a series of extensions and special enrollment periods, as well as different enrollment rules for public programs such as Medicaid and CHIP. A short guide to these post-open-enrollment opportunities is below.

New Yorkers who are unable to enroll in NY State of Health due to technical glitches will be allowed to complete their applications after March 31.

The Obama administration announced Tuesday, March 25 that individuals who have started their applications before the March 31 deadline but were not able to complete the process before the deadline will have more time to enroll. Shortly after, New York agreed to do the same for those who had made a “good faith” effort to complete their application. These New Yorkers will have until April 15 to finish up.

Domestic violence victims will have until May 31 to apply.

A little known provision in the ACA prevents married couples who file separately from being eligible for premium subsidies. This causes problems for individuals with a barrier to filing for divorce or legal separation, such as domestic violence victims. Last week, the Treasury department announced it would issue guidance that married individuals living apart from their spouse and unable to file a joint return as a result of domestic abuse, will be able to file separately from their spouse and still claim a subsidy. Domestic violence victims will have an extension through May 31 to apply.

New Yorkers may qualify for a special enrollment period to enroll after the deadline.

As with any insurance, there are special circumstances that qualify people to enroll in NY State of Health after the open enrollment deadline has passed. These circumstances are called “qualifying life events,” and they include:

  • Getting married
  • Having, adopting, or placement of a child
  • Permanently moving to a new area that offers different health plan options
  • Losing other health coverage (e.g. due to a job loss, divorce, loss of eligibility for Medicaid/CHIP, expiration of COBRA coverage, a health plan being decertified, aging out of the ACA provision allowing young adults to stay on their parents’ insurance until age 26)
  • For those enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.

There are also more complex cases, which you can learn about here.

New Yorkers eligible for Medicaid and Child Health Plus (CHP) can enroll at anytime of the year.

New York’s Medicaid and CHP programs operate under a policy called “continuous enrollment,” meaning people can enroll at anytime of the year. You can learn more about New York’s Medicaid program here and the CHP program here.

So, while open enrollment has ended, there are still plenty of opportunities for New Yorkers to apply for affordable health coverage through NY State of Health.

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This Saturday is National Youth Enrollment Day, a day of action to educate young adults on the importance of having health insurance. Celebrities like Amy Poehler (above), are helping to get the word out and the Young Invincibles campaign is encouraging people to share the message to friends and networks. Young adults between 19 and 34 have disproportionately high uninsured rates – those 19-29 have the highest rate in the country, representing over a third of the uninsured population. They also tend to be healthier than older adults. (Which doesn’t mean they (we) don’t want and need health insurance!)

Because this group tends to be healthy, there has been a lot of talk about so-called “Young Invincibles” and the way enrollment rates among these young adults may impact the overall success of the Health Insurance Marketplaces. The logic goes that if more healthy, young adults enroll in Marketplace plans, this will subsidize the older and sicker population that enrolls. With too many sick enrollees, experts expect to see higher insurance rates. As of the end of December, about 1/4 of enrollees around the nation were young adults – 26% in New York. Some have questioned whether these numbers are high enough to protect the risk pools, while others have pointed out that many young adults are likely to wait until later in the enrollment period to sign up. There is also controversy about whether “young adults” should really be the focus – in fact, the Commonwealth Fund just released a new report on the subject, arguing that it is the health status of the insured pool, not age, that really makes the difference.

We do know that thousands of New Yorkers between 19 and 35 have already signed up and are benefiting from the new, more affordable options available to them. Take Tamika G., a 26-year-old from Brooklyn who will now pay $135/month for insurance that gives her peace of mind and access to the services she needs. Tamika was eligible for financial assistance in the form of tax credits and cost-saving reductions – these reduced her monthly premium and lowered her other out-of-pocket costs. For many young adults who have struggled to afford insurance in the past, this financial assistance will make the dream of being covered a reality.

Now that she’s insured, Tamika is ready to share the love:

“I’m going to tell my friends as soon as I get home that this is the way to go.  You don’t want to break your arm and worry about how you’re going to pay for it.”

Out of all of the attention on young adult enrollment, this is the message that should stand out:  Health insurance is for all of us, young adults included. Now that we have our chance to finally have the affordable, quality coverage we deserve, let’s take it – and make sure our friends do, too.

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Left: Adora Campis (red hat) with parade participants at the annual Three King’s Day parade in Harlem; Right: Adora and Maryanne Tomazic of Raising Women’s Voices – NY at HCFANY’s Annual Meeting Thursday, January 9.

Guest post: Lois Uttley, Director, MergerWatch Project/Raising Women’s Voices-NY

Adora Campis is a part-time bilingual (English and Spanish) outreach worker for Raising Women’s Voices-NY. She will go pretty much anywhere to find uninsured women and families and tell them about the new health coverage options available through NY State of Health, New York’s Marketplace!

Last Monday, she joined the annual Three King’s Day parade through East Harlem to talk to uninsured people along the route in this neighborhood with many low-income, Spanish-speaking people.  (She’s in the red hat in the photo left, above). Later in the week , she spoke at HCFANY’s annual meeting in Albany about why she is so passionate about her work.

Here is her story:

I’m sure you want to know about the faces of the uninsured that I have met in New York City. This much I know. From a homeless person at a soup kitchen starving for medical care, to a degree-holding woman facing loss of coverage and having to pay too much for COBRA – they want and are eager for affordable health care.

The timing is right. The uninsured are diverse and come from all walks of life. Some of them are people in between jobs, others are at jobs that have no health benefits. Some are recent college graduates, others are new citizens. Some have young kids, others are still kids themselves.

Sometimes they are people like me. I am a single mother and raised two children on my own. My son unexpectedly needed health care while he was in college. Luckily he had health insurance. It wasn’t the best, so we still got a $1,000 bill. But there was peace of mind knowing that he was able to get the care he needed.

I didn’t have health insurance though. Last year, I had worked for a couple organizations part-time, but still couldn’t afford to buy health care coverage on my own. Because New York decided to expand Medicaid eligibility this year, I was able to enroll in health insurance through NY State of Health and now am covered.

That’s what I love about going into the community to talk about these new changes. I know it works. It can be scary approaching strangers at community events to talk about health reform, but I’ve found that everyone is very passionate about this. They have personal, sometimes painful stories. But they all end in the fact that this change couldn’t be any more timely. People welcome it!