Premiums in New York will increase this year for people buying plans in the individual and small group markets. But thanks to our public rate review process, the increases are smaller than what carriers requested. Carriers asked the Department of Financial Services (DFS) to approve an average 18 percent increase (learn more about rate review here). After reviewing their requests and public comments (including ten letters submitted by HCFANY), DFS approved an increase of 16.6 percent for the individual market and 8.3 percent for the small group market. DFS estimates that this will save consumers $302 million in 2017.
While any premium increase is difficult for consumers to bear, rate review limits increases to those that are necessary because of legitimate cost trends in the health insurance market. Other states also have a rate review process, but New York’s is special because it allows public participation. Carriers who want to sell insurance in our marketplace have to publicly justify their requests for premium increases. And the public can tell the decision-makers at DFS exactly how premium costs impact their lives. Rate review can’t eliminate all premium increases, but for the third year in a row, it has reduced them (we blogged about previous results in 2015 and 2014).
Consumers who are concerned about high premiums should remember that these average increases will not necessarily result in large increases for individuals, because most individuals who purchase marketplace plans receive premium subsidies. Premium increases should also be considered in context. The Affordable Care Act (ACA) did not eliminate premium increases, but it did successfully slow them down. Consumers are paying lower premiums today than was projected pre-ACA and are getting plans that offer significantly better benefits for their money.
Additionally, concerned consumers should take advantage of the Marketplaces created by the Affordable Care Act to shop around. Thanks to the New York State of Health, it has never been easier for consumers to compare their health insurance options. And every New Yorker can find local, in-person enrollment assistors to help make the best choice. Rate review is one of your tools for keeping premiums down in New York – open enrollment, which starts November 1, is another.
Last week, The Atlantic published an article entitled “The Unconscionable Difficulty of Getting Health Insurance for a Newborn.” The article tells the story of contributing writer Ester Bloom and her difficulties getting immediate Child Health Plus (CHP) insurance coverage for her newborn son. Coverage for Bloom’s son did not begin until six weeks after his birth, and in the interim she instead had to pay for much more expensive individual coverage through the Marketplace.
However, the original article neglected to mention the passage of Bill S4745/A7155 in December of 2015, which allows babies born into low and middle-income families eligible for Child Health Plus from the day they are born. Under this law, which takes effect January 1, 2017, parents who apply before the baby is born, or within 60 days of birth, will have CHP coverage for the newborn from the date of birth. Those who submit an application more than 60 days after the birth will be covered from the date of application. This law addresses the 45 day gap between parent application and newborn enrollment in CHP that Bloom describes in the article. For more details please see HCFANY’s original blog post from December 28, 2015.
We were excited to see a correction published on June 21, which included information about the law and how it will improve coverage for newborns under CHP.
This article also highlights the many challenges that consumers face when navigating the health insurance system as well as the importance of the trained assistance that health care Navigators, Certified Application Counselors, and Community Health Advocates can provide. New York State has been a leader in offering consumer assistance through these programs.
Parents who would like to enroll a child in CHP can do so through the New York State of Health Marketplace or by connecting to the Community Service Society Navigator Network at (888) 614-5400 or through their website.
Guest Blog by Ciara Johnson, RWV-NY Intern and MSW Student at Columbia University
The rate of uninsured people in the United States has dropped to 11 percent, according to a Gallup poll released earlier this month. That’s the lowest uninsured rate since Gallup began tracking it eight years ago. Still, that is a lot of people facing potential penalties as this year’s tax deadline approaches. What do you need to know if you are one of these uninsured people, or you are someone working with uninsured people? Here are a few tips.
The penalty for not having health insurance has gone up again this year. April 18 (yes, the IRS has changed the deadline for this year!) is the third tax deadline for which the Affordable Care Act (ACA) penalties for not having health insurance will apply. According to the healthcare.gov, this year’s penalty went up from 2 percent to 2.5 percent of your yearly household income. With the increase, you will have to pay roughly $695 per adult and $347.50 per child under 18. The maximum penalty, which is equal to the cost of the yearly premium for a bronze plan, is $2,085.
Anyone who can afford health insurance as determined by your yearly income, but chooses not to buy it, will have to pay a penalty.
Who is exempt from the tax penalty? Generally, whether you qualify for an exemption from the tax penalty depends on your household income. If the lowest priced bronze-level health plan available to you through the health insurance marketplace in your state costs more than 8.05% of your household income, then your coverage is considered to be unaffordable. In this case, you can claim an exemption by filling out and submitting IRS Form 8965 with your 2015 tax return. You can also mail in an exemption application.
An exemption can also be granted based on a number of circumstances. Many are “hardship” exemptions for people who have suffered bankruptcy, the death of a close family member, eviction, homelessness, caring for an ill family member or other disruptive life events. Other exemptions are for categories of people, such as Native Americans and people who have religious objections to medical care. For more information on the exemptions process, visit healthcare.gov.
Couldn’t afford the expensive coverage your employer offered? You will qualify for an exemption from the tax penalty if you can show that the cost of the coverage would have been more than 8.05 percent of your income.
What if you had health insurance for part of the year? If you only lacked coverage for one or two months during 2015, then you will qualify for the “short gap exemption” from paying the penalty. If you were uninsured for a longer period, you will pay a fee that is a pro-rated fraction of the annual penalty. So, for example, if you were uninsured for six months, you would pay half the annual penalty.
If you are facing a penalty, can you sign up for coverage now and avoid paying it? No. In previous years, there was a special enrollment period that allowed still uninsured people to apply for affordable private health insurance through the ACA marketplaces at tax time. However, there is no special enrollment period this year for those facing penalties for being uninsured in 2015.
The next open enrollment period for marketplace coverage starts November 1. It would be a good idea to mark this date on your calendar if you are still uninsured and facing a tax penalty this month. However, be aware there are some circumstances in which you can apply for coverage before then. For example, if you experience a “qualifying life event,” such as getting married or having a child (and in New York, becoming pregnant or suffering from domestic violence or spousal abandonment), you may apply for coverage right away during a Special Enrollment Period. In addition, people can apply for Medicaid and Children’s Health Insurance year round. Examine whether you might qualify for one of these options by contacting a Navigator, or going to New York’s Marketplace, NY State of Health.
If you do have health insurance coverage, how must you prove this when filing your tax return? You are not required to submit proof of health care coverage when filing your tax return, but you should keep these records on hand to verify coverage if necessary. Acceptable forms of proof of insurance include: 1095 information forms sent to you by your insurer or employer, insurance cards, explanation of benefits statements from your insurer, W-2 or payroll statements reflecting health insurance deductions, records of advance payments of the premium tax credit and other statements indicating that you, or a member of your family, had health care coverage.
Here’s the quick summary of how we did:
Comprehensive coverage for immigrants
HCFANY Recommendation: Provide $10.3 million in State funding to offer Essential Plan (EP) to legal immigrants who are barred from federally-funded EP.
Full funding for Community Health Advocates (CHA)
HCFANY Recommendation: Provide $4 million in funding for CHA to help people with their insurance problems and access to health care problems, when they occur.
Result: The final budget included $3.25 million for CHA–$2.5 million from the Executive and $750,000 from the Assembly. Due to the intricacies of State contracting, this means that the CHA program faces an 18% cut from the past year.
Prior Approval of insurance plan rate increases
HCFANY Recommendation: Reject a Senate One House bill proposal to repeal the State’s right to review proposed insurance premium increases.
Health Guaranty Fund
HCFANY Recommendation: Support with modifications the Senate and Assembly stand-alone bill which sought to set up a Health Guaranty fund to reimburse providers in the wake of a health plan closing (e.g. Health Republic).
Result: The budget establishes a fund that will be financed through “settlement funds” to reimburse providers. The process for distributing the funds is unknown and it appears to include no public representation and/or public reporting on the distributions.
Medicaid beneficiary protections
HCFANY Recommendation: HCFANY opposed the following threats to Medicaid beneficiaries: elimination of spousal/parental refusal, reduction of resources that spouses of people in MLTC or nursing homes can keep, and the repeal of “prescriber prevails.”
Result: None of these proposals made the final budget. That means spousal/parental refusal remains intact, spouses of people in MLTC or nursing homes will not see a cut in the amount of resources they can keep, and “prescriber prevails” will continue to be available in Medicaid.