TRENDING: "I was told I would get a grandfather."

No grandpa for you!

There is an article out in the Associated Press that seems to be raising a lot of eyebrows across the internet this morning.  Titled, “Like your insurance? You may be losing it,” it explains how a lot of folks who currently have limited benefit health coverage may have to upgrade this coming fall.

This information may seem to fly in the face of what many folks have been told about Obamacare: “If you like your coverage, you can keep it.”  While this may still hold true for a lot of folks, the devil – as always - is in the details.

Most health plans that existed before the ACA was signed in March of 2010 were eligible for grandfathered status.  This means that they are exempt from having to provide most (but not all) of the comprehensive benefits and consumer protections that the ACA requires.  But, if in the past three years or so, the insurer or the employer have made significant changes to a plan’s benefits or how much members have to pay, then the plan would have lost its grandfathered status.

So, there you go.

This should not be cause for panic. Chances are, if your current health plan is a good one, then it probably meets the requirements set forth in the ACA (or has already changed to do so), in which case you are fine. Those who may have to get a new health plan are the folks with non-grandfathered plans that have not changed to meet the new requirements.

This is not a bad thing. Yes, folks might be confused about it at first. Yes, some folks will end up having to pay more. But the new benefits and consumer protections will mean better health insurance and greater financial protections for you when you get sick.  And you will get sick.*

The important thing to keep in mind here is that people need to be vigilant of their health insurance. Talk to your HR department and find out if your plan is changing (which may or may not be due to Obamacare). If you buy coverage on your own, just keep an eye out in the mailbox for a notice from your insurer or the Department of Financial Services. If your insurance is being discontinued, and you need help figuring out your options, you can always get free help from Community Health Advocates by calling (888) 614-5400.

 

*I use the term “sick” catch-all term for any illness or injury (even good ones like childbirth) - physical, mental or dental - or even just plain growing old. 

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!

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.”

 

 

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.