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.
New 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.
Well, there they go again. Presidential candidates Scott Walker and Marco Rubio have now outlined their plans to replace the ACA, repeating tired myths like the law has increased costs for consumers. While both candidate statements omit critical details, it’s clear that either proposal would be a disaster for consumers. And their rhetoric can deter consumers from exploring the new options for affordable coverage that are available.
Both proposals would repeal a law that has enrolled over two million New Yorkers, lowered costs by an average of 50% in the individual market, set higher standards for health plan quality, and reduced the chances that consumers will be stuck with massive medical bills. According to the Roosevelt Institute’s Richard Kirsch, this would have grave impacts at the national level. The country would “return to the days when insurance companies could deny coverage or charge higher premiums because of a pre-existing condition, charge women more for health insurance than men, and stop paying claims when people have high-cost illnesses.”
Both plans would force millions of people off Medicaid immediately and take away coverage from millions of young people who are on their parents’ plans, according to the Kirsch post. And the Walker plan would allow health insurance to be sold across state lines, threatening a “race to the bottom” in which states compete with each other to attract insurers by loosening consumer protections. New Yorkers could lose the hard-won consumer protections that our State has put in place over many years.
While attacks on the ACA have been less frequent in the past few months, the Walker and Rubio initiatives and continuing proposals in Congress to repeal or cut back the ACA make it clear that the law is not politically out of the woods yet. As New York State begins its third Open Enrollment period, health advocates need to practice how to explain the many benefits of the ACA in New York, and how to debunk the myths that continue to circulate. Thankfully, as the latest Kaiser tracking poll data indicates, the law is now finally supported by a clear majority of Americans, as more and more get covered or know someone who did.
In its second Open Enrollment report, the New York State of Health Marketplace (NYSOH) identified trends in plan selection. One stand-out trend is the high uptake of out-of-network products in the areas in which they are offered.
An “out-of-network” product provides insurance coverage for services delivered by providers that do not belong to the carrier’s network. During the 2015 Open Enrollment period, carriers offered Qualified Health Plans (QHPs) through NYSOH with out-of-network coverage in 11 counties of the state: Albany, Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Rensselaer, Saratoga, and Wyoming counties.
In these 11 counties, a whopping 21 percent of QHP enrollees selected plans with an out-of-network benefit. QHPs with an out-of-network benefit are more expensive than plans that only cover in-network providers – costing 7% to 40% more in monthly premiums – but a significant share of consumers clearly value this option when it is offered.
HCFANY will continue to advocate that carriers should offer out-of-network options in all counties. New York is one of only three states where out-of-network coverage is not widely available in the individual market. As insurers have moved to narrower networks and more limited networks, it has been especially hard for people with serious illnesses and disabilities who are receiving care from many providers to find a network that includes all of their providers. Even with improved network adequacy and external review appeal processes, many consumers would prefer to purchase a more expensive plan with out-of-network coverage than a cheaper plan that requires them to say in-network. People paying for vital treatments with trusted providers – HIV and cancer specialists, for example – should retain the right to see these providers without having to pay out-of-network rates and cover the cost entirely out-of-pocket.
Eleven New York counties (shown in green) offer out-of-network plans in the Marketplace
This is the fifth in a series of blog posts about the NYSOH 2015 Open Enrollment Report.
As we discussed in the first blog post of this series, 2.1 million New Yorkers have enrolled in health coverage through the NY State of Health Marketplace (NYSOH) as of the end of the marketplace’s second open enrollment period. NYSOH’s second annual open enrollment report shows one of the key reasons why: the strong program the State has established to provide one-on-one in-person assistance to consumers and small businesses to compare and enroll in health plans.
Two-thirds (67%) of total marketplace enrollees used in-person assistors – Navigators, certified application counselors (CACs) and brokers – in the marketplace’s second year, a significant increase from the first year, when 49% got one-on-one help. All three kinds of in-person assistors are trained and certified by the State. Navigator agencies are funded by NYSOH.
The State’s investment in Navigators and other in-person assistors has really paid off. In the second year, New York made significant progress in enrolling hard-to-reach populations – exactly the New Yorkers that Navigators and CACs are intended to reach. Eighty-nine percent of consumers in the second year didn’t have insurance at the time they enrolled, versus 81% in the first year. Thirteen percent said their preferred language was Spanish, versus 10% in the first year. The state’s Navigators know the communities they serve and are trusted by community members to provide accurate and unbiased information. When you’ve never had health insurance before, or you have limited English proficiency, you’re much more likely to prefer getting help from a community group in your neighborhood than to call a toll-free number. Navigators work evenings and weekends, which is particularly attractive for those with more than one job, irregular work hours, or child care obligations.
The in-person assistance program also expanded in 2015: there were 11,388 trained assistors (Navigators, CACs, and brokers) as of the end of February of 2015, versus 8,960 in 2014, according to the state report. In-person assistance will continue to be a key to the success of NYSOH in 2016, as more and more people hear from their friends, co-workers, relatives and neighbors about the value of assistors in navigating the complexities of health insurance enrollment.
This is the second in a series of blog posts about the NYSOH 2015 Open Enrollment Report.