Helping you get enrolled

clayton & candra got you covered

The health insurance enrollment process can be overwhelming. Take a look at these entertaining videos on health insurance literacy for navigators, assistors, and consumers brought to you by Cover Missouri, a project of the Missouri Foundation for Health (MFH). They touch upon major issues and questions that you may encounter during the application process such as what questions to ask when you are on the phone with your carrier, common misconceptions of the Affordable Care Act, and how to find a primary care provider.

Check them out on YouTube:

Helping consumers talk with their insurance company

Myths and misconceptions of the ACA

Helping consumers find a primary care provider

Helping consumers understand the importance of preventive care

How to calculate Modified Adjusted Gross Income (MAGI)

uncle sam

The time to enroll or renew your coverage on the NY State of Health (NYSOH) Marketplace is just a few days away! Nearly 2.6 million people have enrolled in the Marketplace since its launch in 2013. We can continue to make progress by making sure more New Yorkers get enrolled and those who are covered maintain their coverage.

How it works and what you can do:

  • Visit the Marketplace and look at available options – even if you are satisfied with your current coverage. The Marketplace continues to change, and this year you may find a plan that better suits your needs.
  • See if you qualify for the new Essential plan for low- and moderate- income New Yorkers. You could get comprehensive coverage for yourself and your family for $0 or $20 per person per month!
  • There are options to make the process of enrollment or renewal easier. You may go online and search through the Marketplace, call the Community Health Advocates helpline at 1-888-614-5400, or visit an in-person assistor in your community.

A few important dates for new enrollees:

  • The Third Open Enrollment Period begins on November 1, 2015, and continues through January 31, 2016.
  • To get coverage that begins January 1, 2015 you must enroll by December 15, 2015.
  • For coverage starting February 1, 2016 you must enroll between December 16, 2015 and January 15, 2016.
  • For coverage starting March 1, 2016 you must enroll between January 16, 2016 and January 31, 2016.

For returning consumers, the re-certification period begins on November 15, 2015:

  • To make sure you do not have a gap in coverage, you must renew your coverage between November 15, 2015 and December 15, 2015 for coverage that begins on January 1, 2016.

If you miss the re-certification deadline, your coverage stop after December 31, 2015 and you will not be insured for a certain time period:

  • For coverage that begins on February 1, 2016 you must renew your coverage between December 16, 2015 and January 15, 2015 (coverage gap is 1 month).
  • If you renew your coverage between January 15, 2016 and January 31, 2016, your coverage will begin on March 1, 2016 (coverage gap is 2 months).

Make sure to get coverage to stay healthy and avoid the increasing tax penalty. Remember, the penalty for not being covered is rising to the greater of $695 per person ($347.50 per child under 18) or 2.5% of your family yearly taxable income in 2016!

Guest post: Lois Uttley, Director, Raising Women’s Voices – NY


The NYS Department of Financial Services issued a Circular Letter in December 2014 requiring private health insurance plans in our state to cover all medically-necessary care for treatment of gender dysphoria. With the one-year anniversary of this policy approaching, the LGBT Task Force of Health Care for All New York (HCFANY) is determining whether private health insurance plans are complying with this policy.

LGBT healthThe LGBT Task Force is inviting transgender individuals, as well as their clinicians and advocates, to share their experiences with us and with state officials at “listening sessions” to be held this fall in three locations: New York City, Albany and Rochester. The goal of these sessions is to identify systemic problems with insurer compliance with the transgender coverage policy, so that we can work with state officials and insurers to address the problems. The sessions will be invitation-only and will not be open to the public or media for confidentiality purposes. We are taking special steps to ensure the comfort of transgender individuals who are willing to testify.

The listening sessions are planned to highlight the wide range of challenges transgender individuals experience when trying to use their private health coverage to obtain needed care. For example, such problems might include difficultly obtaining pre-certification approval, denials of coverage for surgical procedures and lengthy appeal processes.

If you have a recent story about how you, your client or your patient has had difficulty obtaining approvals for private health insurance coverage of transgender care, please fill out the form at, and a Task Force member will get in touch shortly.  Please note that these experiences must have taken place since December 2014, when the new policy was issued, and must concern private insurance coverage, not Medicaid coverage (which we will analyze in a later stage of this process). Please direct all Medicaid stories to the email, and Task Force members will reach out to you in the next phase of this project.

The ACA makes insurance more affordable for people through a cost-sharing reduction (CSR) benefit. CSRs are available to consumers with incomes between 138% and 250% of the Federal Poverty Line ($27,311 to $49,475, for a family of three) who purchase Silver level plans. CSRs are sliding scale discounts on cost sharing, including deductibles, co-pays, and co-insurance. New analysis from Washington D.C.-based Avalere Health of nationwide Marketplace enrollment for 2015 shows that only 73% of enrollees eligible for cost-sharing reductions chose Silver level plans. Thus 2.2 million consumers forfeited this benefit.

According to Avalere’s analysis, “consumers may not be aware that CSRs are available and the benefits they offer. ‘Additional consumer education and more sophisticated decision support tools are likely needed to ensure that all patients are accessing the benefits available under the Affordable Care Act,’ said Elizabeth Carpenter, vice president at Avalere. ‘Specifically, consumers need tools that highlight the tradeoff between monthly premiums and out-of-pocket costs and demonstrate the benefits of cost-sharing reductions.’”

In New York, however, 78% of eligible enrollees chose plans that came with CSRs – 5% better than the national average. New York also saw a steep curve between the three CSR tiers: 97% of those eligible for the highest level of CSR subsidy – 94% actuarial value – enrolled in Silver plans; but only 62% of people eligible for the lowest level of CSR subsidy – 73% actuarial value – enrolled in Silver plans (see graph below). This suggests that New York consumers are making strategic enrollment decisions. New York’s 11,000 assistors, who disproportionately serve consumers with lower incomes, are likely a part of our success story.

CSR levels graph 2New York’s data also suggest that consumers eligible for the lowest level CSRs (CSR-III) – with a $1200 deductible – may still face affordability problems. These consumers may be choosing Bronze level plans to save money on premiums, or they may forgo CSRs altogether and “buy up” to Gold level plans.

Come 2016, consumers in the CSR-I and CSR-II bands will qualify for the Essential Plan (EP), which will have very low cost or no cost premiums and minimal cost sharing. This may underscore the affordability issues facing consumers eligible for the CSR-III subsidies, earning between $39,581 and $49,475, for a family of three.