HCFANY Rate Review Letters Available!

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Last month, we told you about the rate review process, which happens every year when health insurance companies submit requests for rate increase or decreases to the state Department of Financial Services (DFS). New York’s carriers were asking for some pretty big increases this year – about 18 percent on average across the individual and small group market. But as we explained, those are just requests. DFS has final say, and will release its decisions in the next few weeks.

The rate review process requires a tricky balancing act. Sometimes a rate increase is needed to make sure that the insurance company can stay in business. But consumers have to be able to afford coverage. In New York, consumers contribute to this process by telling DFS how premium costs affect their lives (you can look at all the comments people sent in on the DFS website).

HCFANY participates each year by reviewing all the applications and drafting formal comments. We will post the results as soon as they are released by DFS. But in the meantime, you can look through our letters, all of which are below.

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Guest blog by Max Hadler, Health Advocacy Specialist at The New York Immigration Coalition

Despite the major health care coverage gains achieved under the Affordable Care Act, more than 450,000 New Yorkers remain uninsured because their immigration status makes them ineligible for affordable coverage. As a result of the continued failure to approve federal immigration reform or lift health coverage restrictions on many groups of immigrants, it continues to fall to state and local governments to pick up the slack. Health Care For All New York has responded to the dire lack of coverage options for immigrants by launching the Coverage 4 All campaign under the leadership of two of the coalition’s member organizations, Make the Road New York and the New York Immigration Coalition.

The campaign’s mission is to obtain affordable coverage options for all New Yorkers, regardless of immigration status. A shorter-term goal is to expand coverage to a smaller group of immigrants who are “permanently residing under color of law” (PRUCOL). These are people whose presence in the U.S. is known and may be unauthorized, and who have received confirmation from the federal government that it has no intention of deporting them. In New York, immigrants who are PRUCOL are eligible for state-funded Medicaid when they meet the income requirements (less than $16,242 annual income for a single person). However, the same people are not currently eligible for the Essential Plan, New York’s low-cost, comprehensive coverage program for low-income residents whose incomes are too high for Medicaid (up to $23,540 annually for a single person). This restriction runs counter to New York’s history of providing coverage to many immigrants who are excluded from federally-funded programs.

Most immigrants who are PRUCOL are young adults who grew up in the U.S. and have Deferred Action for Childhood Arrivals (DACA) as a result of President Obama’s 2012 executive order providing them two-year work authorizations and a reprieve from deportation. These young people are encouraged to work as a result of their DACA status but are then faced with a dearth of affordable coverage options when their incomes increase beyond the Medicaid threshold because they are ineligible for the Essential Plan and prohibited from accessing tax credits through the New York State of Health insurance marketplace.

To begin to remedy these coverage gaps, the New York State Assembly is working to expand Essential Plan eligibility to include immigrants who are PRUCOL. The Assembly included $10.3 million in its 2016-17 budget to provide this coverage, but the funding was ultimately cut in budget negotiations. Assemblymembers Richard Gottfried and Marcos Crespo have since introduced legislation that would expand Essential Plan eligibility to include immigrants who are PRUCOL. Bill A10054 was successfully voted out of the Assembly Health Committee on May 17 and is now awaiting a vote by the Ways and Means Committee. HCFANY has submitted a memorandum of support for the bill. Others are encouraged to submit their own memorandums and to borrow language from the HCFANY memo as needed. Please contact me at the New York Immigration Coalition if interested in registering your support (mhadler@nyic.org).

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)

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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!