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Do YOU understand the new coverage choices under the ACA?

Posted on February 25, 2013 by Arianne Slagle

Coverage choices

Thanks to the Affordable Care Act (ACA), more than 1 million uninsured  New Yorkers will newly have access to affordable health insurance options starting this fall.  That’s a lot of folks who will need to wade through a lot of new information in the coming months.

HCFANY will be holding a briefing in New York City on Thursday, March 7th at the Interchurch Center from 9:00 am – 11:30 am to go over the necessary public outreach and enrollment efforts that will need to happen in order to ensure that the greatest number of New Yorkers benefit from the ACA.  Specifically, we will be going over the following questions:

  • How will New Yorkers learn about new health coverage options?
  • How is New York State going to reach out to and sign up the uninsured?
  • What will individuals, families, and small employers in New York l need to know?
  • What’s to be gained if we do it all right  (…and at risk if we don’t)?
  • What can our elected officials do to help make it go smoothly?
  • How can groups across New York contribute and participate?

This meeting is open to all New York members, allies, colleagues and new friends in the NYC area.

For more information, or to RSVP, click here!

 

Filed under: ACA, Comprehensive Coverage, Employer Sponsored Health Insurance, Insurance reform, Medicaid, New York Health Benefit Exchange, New York Health Reform, Underinsured, Uninsured, young adult | Tagged: , , | Comments Off

Prior approval law saves New Yorkers $500 million

Posted on January 7, 2013 by Arianne Slagle

Yes folks, it's the Hoover Dam!

A press release issued by Governor Cuomo’s office yesterday announced that New Yorkers will save over $500 million on health insurance premiums this year thanks to the Department of Financial Services’ (DFS) utilization of the State’s prior approval law.  As you may remember, New York’s 2010 prior approval law allows DFS officials to review insurance rate increases before they go into effect and scale them back if they are too high.

Health insurers had requested overall increases averaging around 12.4%, which were then cut down to an average of 7.5% by DFS.  Rate increases for small group plans will increase an average of 9.5%, down from the average 15.7% increase requested by the insurance plans.  Prior to passage of the prior approval law, annual premium rate increases averaged 14%. 

These modest increases stand out at a time when many states are experiencing double-digit increases in premiums.  For example, an article in Saturday’s New York Times notes that states like Florida and Ohio have seen rates rise by as much as 20%, with similar rate increases proposed in California.

The Affordable Care Act requires states to review any proposed rate increases above 10%, however New York is one of 37 states which allows state officials to deny excessive rate increases (an issue that is explored further in the Times article). 

So, thanks again to our Senate Democrats who really championed this issue back in 2010 and made savings like this possible today.  We appreciate the work you do!!!

 See below for a breakdown of the average requested rate increase and what the DFS ended up actually approving.  For the full list of increases by insurance plans, see the Governor’s press release.

 

Health Insurance Market Segment
Total Number
of Members Affected
Requested Annual Rate Increase (Weighted Average)
Approved Annual Rate Increase (Weighted Average)
Reduction by DFS
Individual, direct-pay
52,383
+9.54%
+4.48%
-5.06%
Small Group
1,280,649
+15.77%
+9.59%
-6.18%
Large Group
611,780
+7.84%
+5.20%
-2.64%
HealthyNY
117,859
+24.84%
+11.81%
-13.03%
Medicare Supplement
319,722
+3.27%
+2.59%
-0.68%
Overall
2,382,393
+12.37%
+7.52%
-4.85%

Click here to read the Governor’s press release.

Click here to read the NYTimes article, titled “Health Insurers Raise Some Rates by Double Digits.”

 

 

Filed under: ACA, Accountability, Affordable, Employer Sponsored Health Insurance, Federal health reform, Governor Cuomo, Governor Paterson, HealthyNY, New York Health Reform, Premiums, Small Business | Tagged: , , , , , | Comments Off

Blindsided by Bills

Posted on November 20, 2012 by Arianne Slagle

Connor is a 68-year-old Westchester resident with heart problems, insured in a preferred provider organization (PPO). He had a stent put in last year, and when he was experiencing extreme shortness of breath he rushed to his local in-network hospital. The heart problem was too severe to be treated there, so he was transferred to a major academic medical center nearby, also in-network. After observation and testing, his treatment team decided that he needed emergency open heart surgery to implant a special pump. Though he was at an in-network hospital, neither the surgeon nor his assistant was in-network. The surgeon billed $71,000, out of which Connor’s insurer’s out-of-network benefit paid $29,000. The assistant billed $35,000, out of which Connor’s insurer paid $6,737. In total, Connor was left owing more than $70,000 for his surgery, even though he had “good insurance” and went to in-network facilities for his emergency treatment.

Connor is one of many New Yorkers who have been blindsided by balance billing, when patients are charged the difference of what an insurer agrees to pay a provider.

The problem of “surprise” out-of network medical billing has recently gained attention in the press, including an article in today’s New York Times. Earlier this year, the New York State Department of Financial Services released a report, An Unwelcome Surprise: How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers. 

This year, Health Care For All New York made a statement on out-of network billing, including recommendations: New York should protect insured consumers from “Surprise” out-of-network billing, require all insurers to have adequate networks and offer a reasonable mechanism to go out-of-network when medically appropriate, and ensure transparency about billing from health providers and plans.

Visit Community Health Advocates  for the Out-of-Network DIY Appeals Packet if you think your plan is not reimbursing you enough for out-of-network care.

Filed under: Affordable, Balance billing, Employer Sponsored Health Insurance, Insurance reform | Comments Off

ACA takes the mystery out of shopping for insurance

Posted on October 9, 2012 by Arianne Slagle

Consumers seeking health coverage are often in the dark about how different plans work, what they cover, and what out-of-pocket costs will be incurred.  Current plan members may find themselves in a similar situation, resulting in surprise bills due to a lack of understanding of their plan’s benefits. A new Affordable Care Act (ACA) provision, which went into effect September 23, aims to alleviate this problem.

As of September 23, 2012, health insurance plans must provide consumers with a Summary of Benefits and Coverage (SBC) and a Uniform Glossary. These documents must be provided at the time of application, at the time of renewal of coverage, and upon request.  The documents are consumer-friendly, and are meant to assist consumers in making informed decisions when seeking and using coverage.

The SBC is standardized; each plan uses the same template, so that consumers can compare and contrast options when shopping for coverage.  The template is a chart that informs consumers of covered benefits, what costs apply when services are received in-network or out-of-network, and any limitations or exceptions to coverage.  The template includes examples to illustrate how the plan’s coverage functions.  It also contains some basic information on rights to continued coverage, appeal rights, and language access.

The Uniform Glossary educates consumers about health plan jargon. It defines and explains terms such as “deductible,” “balance billing,” and “appeal.”  It uses a diagram to illustrate how the consumer will share costs with the plan in light of the deductible, coinsurance, and out-of-pocket limit.

An SBC and Uniform Glossary must be issued for both employer-based and individual plans. Non-English speakers can request the SBC and the Uniform Glossary in languages other then English.

You can find links to a sample SBC and the Uniform Glossary here.

You can find SBC templates and the glossary in languages other than English here.

Some carriers post the SBC online. Here’s an example.

Filed under: ACA, Comprehensive Coverage, Consumer Assistance, Employer Sponsored Health Insurance, Federal health reform | Comments Off

New York Selected EHB Benchmark – Oxford EPO

Posted on October 4, 2012 by Arianne Slagle

On Monday, October 1, New York State selected the benefits of the State’s largest small group plan, Oxford EPO, as the Essential Health Benefits (EHB) benchmark plan.

The state also outlined the coverage areas in which the Oxford plan’s benefits will be supplemented to meet ACA requirements:

  • Pediatric dental/vision coverage – NYS will supplement the Oxford plan’s benefits with the current pediatric dental/vision benefits offered through NY’s CHIP coverage.
  • Habilitative services – will have parity with rehabilitative services.
  • Mental health/substance abuse parity – benefit limits in the Oxford plan will be removed.
  • Annual/lifetime dollar limits – quantitative limits will be substituted when further federal guidance is available.

As we explained in our August 13 post, the selected benchmark EHB will apply to all non-grandfathered plans both inside and outside the State Health Insurance Exchange (the Exchange), as well as the benefits included in a Basic Health Plan, if New York implements such a plan.

In our written comments to the State, HCFANY urged the State to select the New York State Employee Plans’ Empire Plan, which has more comprehensive benefits than the Oxford plan. Among other differences, the Empire Plan covers adult dental care, and covers some services (like physical therapy and speech therapy) according to medical necessity rather than limiting those services to a set number of visits.

The State balanced value to consumers and small business employees of the more comprehensive benefits with the predicted additional cost these benefits would add to premiums. According to Milliman, the consultant that studied the EHB benchmark options for the State, selecting the Empire Plan would add $15 more to monthly premiums than selecting the Oxford plan would. The complete report by Milliman on EHB is available here.

The State received extensive feedback, including 60 written comments from the public.  Some of the comments, like this comment from the Hemophilia Association of New York, urged the State to select the Empire Plan because consumers need comprehensive coverage. Others, including this comment from the New York State Conference of Blue Cross and Blue Shield Plans urged the State to select an Oxford plan to keep premiums lower.

Input at the Regional Advisory Committees was similarly mixed, with stakeholders including carriers and small business advocates urging the State to keep premiums low, and stakeholders including consumer advocates urging the State to choose a more comprehensive benefit package.

While consumer advocates are disappointed in the State’s decision, there are some consolations for consumers:

  • The EHB will serve as a floor, not a ceiling, for benefits offered by individual and small group plans in New York.
  • The EHB will raise the floor for many New York consumers, including consumers who currently have coverage through Healthy NY plans.
  • Benefits that are not covered by the EHB, like adult dental, will be available through more comprehensive plans or coverage riders.
  • The EHB decision may be revisited for 2016.

HHS will offer the public one more opportunity to comment on this decision through a Notice of Proposed Rulemaking. We will keep you posted about opportunities to comment at that time.

Filed under: ACA, Comprehensive Coverage, Employer Sponsored Health Insurance, Federal health reform, HealthyNY, Insurance Exchange, Premiums, Small Business, State Department of Health | Comments Off

Thanks to the ACA, Premium Increases Are Slowing Down

Posted on September 11, 2012 by Arianne Slagle

Today, the Kaiser Family Foundation and Health Research & Educational Trust (HRET) released the 2012 Employer Health Benefits Survey. Thanks to the Affordable Care Act (ACA), in 2012, premium increases are at an all time low and workers are getting more affordable benefits from their employers. The survey found that employer-sponsored family health coverage reached $15,745, an increase of 4 percent from last year. Workers pay, on average, $4,316 toward the cost of their coverage.

Fewer plans are considered grandfathered in 2012 than in 2011 (48% down from 56%), resulting in more workers benefiting from preventive care with no co-pays and access to an external appeals process, keys provisions of the ACA that have been implemented for non-grandfathered plans.  For plans to remain grandfathered, employers must not make significant changes to their plans to reduce benefits or increase employee costs.

According to the survey, 2.9 million young adults are currently enrolled on their parent’s coverage because of the dependent coverage for children up to age 26 provision in the ACA. This provision has largely contributed to the decline in the percentage of uninsured adults ages 19-25 over the past year, from 33.9% to 27.9%.

Unfortunately, the survey showed that workers with coverage at lower-wage firms (where at least 35 percent of workers earn $24,000 or less a year) may fare worse with some employer-sponsored health benefits than workers at higher-wage firms (where at least 35 percent of their workers earn $55,000 or more a year).

  • Workers at lower-wage firms on average pay $1,000 more each year for family coverage than workers at higher-wage firms.
  • Workers at lower-wage firms are more likely to face high deductibles than those at higher-wage firms.
  • Large employers are more likely than small ones to allow workers to pay their share of premiums with pre-tax income (91 percent, compared to 41 percent) and to contribute pre-tax dollars to Flexible Spending Accounts (76 percent, compared to 17 percent).

As states and the feds continue to implement the provisions of the ACA, workers will reap the benefits through their employer-sponsored coverage. We look forward to the 2014 survey, when many more substantial provisions of the ACA will be in effect. For the impatient in the audience, tomorrow the U.S. Census Bureau will release its Report on Health Insurance Coverage on 2011.

Filed under: ACA, Employer Sponsored Health Insurance, Premiums, young adult | Comments Off

THE AFFORDABLE CARE ACT IS UPHELD!!!

Posted on June 28, 2012 by Arianne Slagle

It’s true! The decision was just handed down just a little bit ago.  The verdict? The entire law is upheld – including the individual mandate! 

It looks like there will only be one small change to the Medicaid expansion.  The ACA had originally stated that states could expand Medicaid eligibility to people up to 133% of the Federal Poverty Level, and that the federal government would basically pick up the entire cost for it, but that if they didn’t expand they could risk losing their existing funds.  The Supreme Court changed this so that states who don’t choose to expand their Medicaid eligibility won’t risk losing funding. 

Overall, this is a HUGE win for Americans, and a HUGE win for New Yorkers! And who do we have to thank? Justice Roberts! Who miraculously took a big one for the team by siding with the left-leaning justices on this.  That is one man who will be heavily toasted to (and cursed) by millions tonight.

So, what should we do with this information? Why, let’s celebrate of course!!!  Join HCFANY around this great State of New York TODAY at a series of public events for folks to speak up and celebrate this big victory!!! 

  • Albany: 3:00 PM at the Capital (State Street side). Contact Bob Cohen at bcohen@citizenactionny.org or (518) 465-4600 x104 for more info.
  • Binghamton: 4:00 PM at the Federal Building, 15 Henry Street. Contact Mary Clark at cabing@citizenactionny.org or (607) 723-0110 for more info.
  • Buffalo: 3:00 PM in the lobby of Congressman Higgins’ office, 726 Exchange Street. Contact Natalie Luczkowiak at nluczkowiak@citizenactionny.org or (716) 855-1522 x2 for more info.
  • Cortland: 5:00 PM at the U.S. Post Office, 88 Main Street. Contact Janet Steck at jsteck@twcny.rr.com or (607) 749-7016 for more info.
  • New York City: New Location! 5:30 PM (assemble at 5:15 pm) in Foley Square in lower Manhattan, across from the Federal Courthouse at the African American Burial Ground Monument (Take 4, 5, 6, J, M, N, or R trains to City Hall-Brooklyn Bridge stations). Contact Mark Hannay at metrohealth@igc.org or (917) 318-5008 for more info.
  • Syracuse: 4:00 PM at the Federal Building, 100 Clinton Street. Contact Lanika Mabrey at lmabrey@citizenactionny.org or (315) 435-2480.

We hope to see you there!!!

 

Filed under: ACA, Accountability, Affordable, Consumer Assistance, Employer Sponsored Health Insurance, Federal health reform, Insurance Exchange, Insurance reform, New York Health Reform, Premiums, Underinsured, Uninsured, Women, young adult | Tagged: , , , , | Comments Off

Your ACA Money-Back Guarantee

Posted on June 21, 2012 by Arianne Slagle

This summer, insurance companies are sending money back, thanks to the ACA’s “medical loss ratio” rule. The Department of Health and Human Services (HHS) announced today that insurance companies will be sending out $1.1 billion in rebates to 12.8 million consumers around the country. In New York, over 1 million consumers will receive more than $86.5 million in rebates, or an average of $138 per family. The average rebate for a New York family with small group coverage is $632.

Why the rebates? The ACA requires insurance companies to spend at least 80 percent of every premium dollar (85 percent for plans in the large group market) on medical care and quality. HHS calls it the “80/20 rule.” If a plan spends less than 80 percent of premiums on medical care, it has to give back the extra money. Here in New York, of course, we raised the bar a little. Insurance plans for individuals and small groups have to spend 82 percent of every premium dollar on medical care.

So what can you expect from your insurance company? First, you can expect to get a letter explaining the rule and whether the plan met the 80 (or 82 or 85) percent minimum spending on medical care. If not, the letter should explain how far off they were, and how much is owed in rebates.

If your insurance company owes a rebate you might receive:

  • a rebate check in the mail;
  • a lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card;
  • a direct reduction in your future premiums; or
  • a rebate from your employer using one of the above rebate methods, or a rebate “in a manner that benefits its employees.”

Filed under: ACA, Affordable, Employer Sponsored Health Insurance, Federal health reform, Insurance reform, Premiums, Prior Approval | Comments Off

I am broke, and therefore…invincible?

Posted on June 20, 2012 by Arianne Slagle

The whole argument that young people don’t buy insurance because they don’t think they need it (i.e. the “young invincibles” stereotype) has bugged me for some time.

Having somewhat recently emerged from the 19 -29 age bracket, I can say firsthand that it never occurred to me at any point during my free-wheeling years that I didn’t need health insurance.  Any gaps in my coverage were purely due to the fact that I was between jobs and didn’t have the income to pay for COBRA coverage.  The same went for most of my friends too.  Not having health insurance when you are financially on your own is stressful.

Now, that’s not to say that there aren’t some young, extreme sport Mountain Dew enthusiasts out there who really do revel in taking risks, or independently wealthy young folks who can afford to pay for any health care out-of-pocket.  But, those really do represent the minority among young people.

I’ve long been a believer that the term “young invincible” was one coined by the insurance industry as a way of convincing the public that what young people really want is cheap, crappy insurance products with huge deductibles that won’t do us a lick of good when we actually need it, or plans that won’t help us at all if we develop an itchy eye infection from sleeping in our contact lenses, but might cover a few days on a ventilator if we get hit by a Mack truck.

And sure, young adults are as a whole healthier than older adults, but most of us know someone our own age – if not ourselves - who have gotten sick.  Like, really sick.  A good friend of mine got skin cancer on his face when he was 23.  Another guy I know got testicular cancer at 26.  A girl I waited tables with in college struggled with uterine fibroids for years.  Another girlfriend fell playing basketball and knocked out her two front teeth!  Trust me – we just want what everyone else wants: good,  affordable coverage that we can rely on when we need it.

That’s why I found a new report issued by the Commonwealth Fund recently to be a breath of fresh air.  The report surveyed young adults aged 19-29 on health insurance.  It found that of young adults who are offered health insurance through their jobs, 64% end up taking it up.  Of those 36% that don’t take it up, only 6% said it was because they didn’t need it.  The other 30% were either already covered elsewhere, or simply couldn’t afford it.  In fact, 36% of all young adults said they had problems paying medical bills or were paying off medical debts over time.  For those who had no insurance, 51% said they had problems with medical bills.  

Doesn’t really sound like a population that is touting their own invincibility, does it? I mean, remember, these are the same people who rushed out by the millions to get on their parents’ insurance plans once the ACA gave them the green light to do so. 

Anyways, it’s a good report to check out.  If anything, it confirms what most of us youngins (and former youngins) already knew.

Click here to read the Commonwealth Fund report, titled, “Young, Uninsured, and in Debt: Why Young Adults Lack Health Insurance and How the Affordable Care Act is Helping.”

And, here’s a related article from Kaiser Health News, titled “Survey: Young Adults Don’t Necessarily Fit ‘Young Invincible’ Stereotype.”

 

Filed under: ACA, Affordable, Children, Comprehensive Coverage, Employer Sponsored Health Insurance, Federal health reform, Uninsured, young adult | Tagged: , , , , | Comments Off

Health reform law gets approval from Main Street

Posted on June 14, 2012 by Arianne Slagle

With the Supreme Court ruling on the ACA now just around the corner, the Small Business Majority has released the results of a new poll that asked New York’s small business owners just what they think about all of this.

They found that the majority of small business owners in New York – 59% – want to see the ACA upheld with little or no changes.  After hearing more about the provisions of the new law, this number went up to 64%.

The hottest point of contention around health reform proved to be the individual mandate that requires everyone to have health insurance starting in 2014.  However, even this still pulled a 52% approval rate.

Slightly more than half of small business owners polled (52%) said that they are currently taking advantage of the new tax credits available to small businesses to help them pay for the cost of their employee health insurance.  Of those who said they were not claiming these credits, a whopping 70% said it was because they didn’t know they were available.  [You can find more info on the small business tax credits by clicking here].

In terms of the new health insurance exchange currently underway in New York, 73% of small business owners said they planned on buying insurance on the exchange, or at least would consider doing so.

The New York poll was part of a larger nationwide survey of small businesses.  To learn more about this effort and the results found, visit the Small Business Majority polling webpage at: http://www.smallbusinessmajority.org/small-business-research/healthcare/small-business-owners-views-on-aca.php

 

 

Filed under: ACA, Employer Sponsored Health Insurance, Federal health reform, Insurance Exchange, Insurance reform, Small Business | Tagged: , , , , | Comments Off

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