A Westchester Family Gets Covered


The first open enrollment period for NY State of Health has come to a close, and as of April 16, 960,762 New Yorkers were able to get health care plans through the state marketplace. That means there are nearly one million stories of New Yorkers getting affordable, quality health coverage because of the NY State of Health and the ACA.

Here’s one, from Maryanne Tomazic of Raising Women’s Voices – New York:

For Dustin* and Abigail*, NY State of Health meant their family didn’t have to go without coverage before Dustin starts his new job. Dustin and Abigail live with their family of five in a small town in Westchester County. Dustin was hired by a new company, but the transition meant that his family would experience a gap in health care coverage. “COBRA wasn’t a realistic option for us,” Abigail said. “It was too expensive.”

Fortunately, Dustin was able to get health insurance through NY State of Health. He and his daughter Elizabeth* initially filled out the application online, but had trouble reporting his income due to his job transition. They went to a Navigator, who helped correct the problem. “We also wanted to make sure we could still go to the doctors we’ve been going to for years and also to our local hospital, Westchester Medical Center,” said Dustin. “We called our doctor to confirm that the plan we picked included them in their network.” The family’s previous health care plan had been grandfathered by the ACA, so many preventive services still required copays. “I had to pay $86 a month for my birth control pills,” said Elizabeth. “With this new plan, I can now get the contraception I need at no additional cost.”

The family’s new health care plan took effect on April 1, so thanks to the Affordable Care Act and NY State of Health, their family did not experience a gap in coverage. Like the 960,762 New Yorkers, and the over 8 million Americans, who enrolled during this first open enrollment period, they now have an affordable, quality health insurance plan to help them get the care they need!


Jessica K., 27, enrolled in health insurance through NY State of Health in February
with the help of a Navigator from Community Service Society

As strange as it seems, the 1st open enrollment period under the ACA has come to an end. The final count of enrollees from NY State of Health is stunning: more than 865,000 New Yorkers enrolled in private and public plans between October 1 and April 1. While some New Yorkers will not have the opportunity to enroll in NY State of Health Coverage until the next open enrollment period on November 15 of this year, hundreds of thousands will still be able to enroll in private and public health insurance plans in the coming months.

This is due to a series of extensions and special enrollment periods, as well as different enrollment rules for public programs such as Medicaid and CHIP. A short guide to these post-open-enrollment opportunities is below.

New Yorkers who are unable to enroll in NY State of Health due to technical glitches will be allowed to complete their applications after March 31.

The Obama administration announced Tuesday, March 25 that individuals who have started their applications before the March 31 deadline but were not able to complete the process before the deadline will have more time to enroll. Shortly after, New York agreed to do the same for those who had made a “good faith” effort to complete their application. These New Yorkers will have until April 15 to finish up.

Domestic violence victims will have until May 31 to apply.

A little known provision in the ACA prevents married couples who file separately from being eligible for premium subsidies. This causes problems for individuals with a barrier to filing for divorce or legal separation, such as domestic violence victims. Last week, the Treasury department announced it would issue guidance that married individuals living apart from their spouse and unable to file a joint return as a result of domestic abuse, will be able to file separately from their spouse and still claim a subsidy. Domestic violence victims will have an extension through May 31 to apply.

New Yorkers may qualify for a special enrollment period to enroll after the deadline.

As with any insurance, there are special circumstances that qualify people to enroll in NY State of Health after the open enrollment deadline has passed. These circumstances are called “qualifying life events,” and they include:

  • Getting married
  • Having, adopting, or placement of a child
  • Permanently moving to a new area that offers different health plan options
  • Losing other health coverage (e.g. due to a job loss, divorce, loss of eligibility for Medicaid/CHIP, expiration of COBRA coverage, a health plan being decertified, aging out of the ACA provision allowing young adults to stay on their parents’ insurance until age 26)
  • For those enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.

There are also more complex cases, which you can learn about here.

New Yorkers eligible for Medicaid and Child Health Plus (CHP) can enroll at anytime of the year.

New York’s Medicaid and CHP programs operate under a policy called “continuous enrollment,” meaning people can enroll at anytime of the year. You can learn more about New York’s Medicaid program here and the CHP program here.

So, while open enrollment has ended, there are still plenty of opportunities for New Yorkers to apply for affordable health coverage through NY State of Health.

Engracia_GCNY_Homeless2Get Covered New York volunteer Engracia Jamieson

Guest post by Maryanne Tomazic, Raising Women’s Voices – New York (RWV-NY)

We’re in the final week of 2014 open enrollment, and people across the State are working around-the-clock to make sure those who still need affordable, quality health insurance have a chance to apply through NY State of Health. HCFANY partner Get Covered New York has been doing targeted outreach in hard-to-reach communities, including among low-income individuals and members of the homeless community.

As part of this work, I recently presented to staff members at the Coalition for the Homeless, an organization that provides support to homeless men, women and children. Their services include housing, job training, emergency food, crisis intervention, and youth programs. The presentation helped staff members get the resources they need to identify clients who may be eligible for expanded Medicaid or financial aid to buy health care coverage.

Additionally, RWV-NY outreach intern Engracia Jamieson has joined the Coalition for the Homeless on some of their van routes throughout New York City. Here is what she had to say when asked about her experiences:

What kind of outreach have you done with the homeless community?

I do outreach alongside the Coalition for the Homeless. They go on routes throughout Manhattan and the Bronx and when they make stops, I talk to people about the new health care options while they are waiting on line. I also meet many people who are homeless at the soup kitchens I visit.

Many of the navigators require you to call and set up an appointment beforehand. How does this work for people who don’t have a phone?

If I meet someone who doesn’t have a phone but wants to get covered, I give them a flyer with information about walk-in hours at a nearby navigator’s office. We try to include walking directions on the flyer, too. This is important, because often it means that the next day they can go and begin to apply.

Are people excited to talk to you about the new health care options?

Yes, a lot of people are interested and very thankful. Many of the people I’ve met have had poor experiences at hospitals in the past, and in some cases emergency room visits are how they have ended up in financial trouble.  Having a plan to protect themselves is very important to them.

What kinds of questions do people ask?

Very often people ask me if they will be able to get health insurance since they already have some kind of illness. I am always happy to tell them that the Affordable Care Act has made it illegal for people to be turned down for coverage because of pre-existing conditions.

What message do you hope they walk away knowing?

I want them to know that we care and that this is real. This is a chance for them to get the care they need.

Alongside this outreach, RWV-NY’s Community Organizer Liza Lederer-Plaskett has organized “days of service” where volunteers talk with local soup kitchen attendees. Volunteers distribute flyers about the new health care coverage options available through NY State of Health. Since many New Yorkers speak Spanish, volunteers also distribute Spanish-translated flyers. Bi-lingual volunteers are always on hand to better explain the new marketplace.

As Engracia mentioned, volunteers talk with people who do not have a phone or internet access. They may find themselves unable to call and schedule appointments with navigators. To address this issue, Get Covered New York has developed flyers with walking directions to navigators who have “open, walk-in hours.” Sample flyers can be found here in English and in Spanish.

To contact Liza Lederer-Plaskett about this outreach effort or to get more involved, e-mail liza@raisingwomensvoices.net

Last week, we got great news from NY State of Health. As of February 25, over half a million New Yorkers had enrolled in insurance plans through NY State of Health. To put that in perspective, New York’s three year goal is to enroll 1 million New Yorkers in health plans. So, we’re already over halfway there, and we still have one-month to go in the first year of enrollment.

Even more exciting is the fact that 70 percent of enrollees were uninsured when they applied. That’s 350,844 New Yorkers that now have health insurance, thanks to the Affordable Care Act. Big numbers are always hard to picture, so let’s break this down:

Let’s say all of those newly insured wanted to go see the Mets play at Citi Field. Big stadium, right? The capacity is 45,000. The over 350,000 newly insured New Yorkers would fill Citi Field. About 8 times.

Citi field Citi field Citi field Citi field Citi field Citi field Citi field Citi field

That many uninsured New Yorkers finally getting health care is something to celebrate! And, we still have nearly a month to go until the end of open enrollment on March 31.