Out-of-Network Coverage Proves Popular in New York State of Health Enrollment Statistics

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.

 

By Bob Cohen, Esq., Policy Director of Citizen Action of New York and the Public Policy and Education Fund

 

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. 2015 Infographics - Where

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.

The New York State Department of Financial Services (DFS) released its final decisions on the rate review process (Don’t remember what that is? Check out our blog post about it here). The 17 carriers on the individual insurance exchange were approved for a weighted average premium increase of 7.1%, which is 3.3% lower than requested by the plans. IndivMarkActions2016These figures mask considerable variation among plans; Health Republic, Empire HMO, Emblem HIP, and MVP Health Plan were all approved for double digit rate increases, while United and Oxford OHP had their requests cut by 20.4% and 17.6%, respectively. New York’s individual market has more choices than most other states, so it behooves consumers to shop around to get the best deal for themselves and their families in this upcoming open enrollment period, beginning November 1, 2015.

While the New York State Health Plan Association condemned DFS’s approved rates as too low, their customers can’t help but compare their 7.1% increase to the much lower 4% rate increase California allowed for 2016. As HCFANY described in its rate comments, New York’s proposed and now adopted rate increases exceed the national rate of medical cost inflation predicted by independent analyses; considerably exceed growth in wages, according to the most recent Employment Cost Index released by the Bureau of Labor Statistics; and they are significantly higher than the average rate increase of 5.7% approved by DFS last year.

We recognize that some plans had seriously underpriced premiums in the past and are facing financial difficulties.  DFS has a challenging balancing act to perform.  DFS correctly notes that its rate reductions will still keep premiums 50% lower than they were before the launch of the New York State of Health marketplace. All told, the prior approval process will save New York consumers $430 million in premiums for 2016.  Unfortunately, the price hikes will still hurt.

 

Already more than two million New Yorkers have gained affordable health coverage through the NY State of Health marketplace, but there are still some people (namely women!) who may find themselves left behind. First-in-the-nation legislation providing special insurance enrollment options for pregnant women passed both the State Assembly and State Senate a few weeks ago and awaits the Governor’s signature.baby talking 2

In the past, moderate- and higher-income uninsured women who become pregnant had to wait to enroll in private health insurance. Low-income women can enroll in Medicaid at any time, but their higher-income counterparts can be left without affordable prenatal and maternity care. Lack of coverage can lead poor health outcomes for mom and baby. Improved maternal and child health outcomes support the New York State Prevention Agenda, and it’s the right thing to do.

Senate Bill 5972/Assembly Bill 6780-B creates a special enrollment period (SEP) for uninsured women who become pregnant and seek coverage outside of the open enrollment period. HCFANY urges Governor Cuomo to sign it into law. You can send a message here or call 518-474-8390 to ask him to sign S.5972/A.6780-B today!