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!

The third open enrollment period for the New York State of Health begins on November 1, 2015, and the Healthcare Education Project and HCFANY member organizations are already busy preparing.

Building on two successful years of enrollment summits, this year’s 8 regional summits will continue to bring together stakeholders and community leaders to develop coordinated plans for outreach and open enrollment in 2015.

Navigators, health advocacy groups, health insurance plans, community groups, healthcare facilities, Certified Application Counselors, unions and small business representatives will come together to examine best practices, and share strategies, resources and partnerships to maximize enrollment in New York State of Health, the state’s insurance marketplace, taking into account the introduction of the Essential Plan in 2016.  Participants will be able to volunteer for a number of enrollment and outreach tasks, and get their organizations involved.

Over 2.1 million New Yorkers enrolled in a health plan through Feb 28, 2015. This surpassed the New York State of Health goal to enroll 1.1 million New Yorkers in the first three years, and we’re continuing to work towards coverage for all New Yorkers!

Below is a list of all 8 summits. Local groups should come to the summit that covers their region. Statewide groups are urged to send their local affiliates. Contact local coordinators listed below with questions and to RSVP.



Thursday, Sept. 17, 2015 • 9:00 am – 12:00 noon

Ramada Inn Conference Center, 542 Route 9, Fishkill (exit 13 off I-84), NY 12524

To register: Visit



Friday, Sept. 25, 2015 • 12:00 noon – 3:00 pm

1199SEIU Auditorium, 310 W. 43rd St., NY, NY 10036

To register: Visit



Monday, Oct. 5, 2015 • 10:00 am – 1:00 pm

1199SEIU, 100 Duffy Avenue, Suite 300W, Hicksville, NY 11801

To register: Email Luis Valenzuela at


CENTRAL NEW YORK (Binghamton, Syracuse)

Tuesday, Oct. 6, 2015 • 1:00 – 4:00 pm

Southern Tier Independence Center, 135 E. Frederick St, Binghamton, NY 13904

To register: Contact Mary Clark at 607-723-0110 or by email at



Tuesday, Oct. 6, 2015 • 10:00 am – 1:00 pm

Staten Island Mental Health Society, Safir Auditorium, 669 Castleton Ave, Staten Island, NY 10301

To register: Email Nicole O’Loughlin at Nicole.O’ or call (917)543-3200.



Thursday, Oct. 8, 2015 • 12:30 pm – 4:00 pm

SEIU Albany, 155 Washington Ave., Albany, NY 12210

To register: Visit or email Sara Couch at or call 518-222-1711.


WESTERN NEW YORK (Buffalo, Rochester)

Thursday, Oct. 8, 2015 • 9:00 am – 12 noon

1199SEIU Conference Room, 2421 Main Street, Buffalo, NY 14214

To register: Contact Bill Covington by phone at 716.995.3705 or by email at



Wednesday, Oct. 21, 2015 • 10:00 am – 1:00 pm

Bedford Stuyvesant Restoration Plaza, 1368 Fulton St, Brooklyn, NY 11216

To register: Email Marcelle Dinnall at or Jennifer Clarke-Craig at    


This event series is being held in cooperation with New York State of Health,



Citizen Action of New York • Community Health Care Association of New York State (CHCANYS) • Community Service Society of New York • Healthcare Education Project (1199SEIU/GNYHA) • Health Care For All New York • Make the Road NY • Raising Women’s Voices-NY

By Heidi Siegfried, Esq., Project Director of New Yorkers for Accessible Health Coverage and Health Policy Director for Center for Independence of the Disabled, NY


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.



NYS counties

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.