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Hooray!

Posted on March 21, 2013 by Arianne Slagle

outlikea

While we haven’t seen all the fine print, HCFANY is delighted to report that this year’s budget deal includes important protections for New York’s health insurance consumers.  The new budget deal includes:

  • Co-premium assistance for people between 138-150% of poverty (people with children that are currently eligible for Family Health Plus ).  Those who enroll in the Exchange with Silver-level plans will pay no premiums.  This measure is NOT conditional on federal financial participation.
  • Protection for people who currently have out-of-network coverage in the individual market.  These consumers will have the option to pay for a Platinum-level plan on the Exchange with an out-of-network rider and be “risk pooled” with the rest of the State’s individual market.
  • A requirement for SDOH to create a workgroup to study whether New York should adopt a Basic Health Plan
  • Fair consumer protections on the State’s new Navigator program
  • Funding for consumer assistance for New York’s health insurance consumers through Community Health Advocates
  • Still waiting details on Medicaid budget, but it looks like most optional benefits have been saved….

A special thanks to everyone who added their names to our sign-on letter, called the Governor’s office, and worked hard to get these important consumer protections. These budget victories would not be possible without you!!!

Stay tuned for more on the budget!

 

 

Filed under: Consumer Assistance, Governor Cuomo, New York State Budget, Premiums, State budget | Tagged: , , , | Comments Off

Prior approval law saves New Yorkers $500 million

Posted on January 7, 2013 by Arianne Slagle

Yes folks, it's the Hoover Dam!

A press release issued by Governor Cuomo’s office yesterday announced that New Yorkers will save over $500 million on health insurance premiums this year thanks to the Department of Financial Services’ (DFS) utilization of the State’s prior approval law.  As you may remember, New York’s 2010 prior approval law allows DFS officials to review insurance rate increases before they go into effect and scale them back if they are too high.

Health insurers had requested overall increases averaging around 12.4%, which were then cut down to an average of 7.5% by DFS.  Rate increases for small group plans will increase an average of 9.5%, down from the average 15.7% increase requested by the insurance plans.  Prior to passage of the prior approval law, annual premium rate increases averaged 14%. 

These modest increases stand out at a time when many states are experiencing double-digit increases in premiums.  For example, an article in Saturday’s New York Times notes that states like Florida and Ohio have seen rates rise by as much as 20%, with similar rate increases proposed in California.

The Affordable Care Act requires states to review any proposed rate increases above 10%, however New York is one of 37 states which allows state officials to deny excessive rate increases (an issue that is explored further in the Times article). 

So, thanks again to our Senate Democrats who really championed this issue back in 2010 and made savings like this possible today.  We appreciate the work you do!!!

 See below for a breakdown of the average requested rate increase and what the DFS ended up actually approving.  For the full list of increases by insurance plans, see the Governor’s press release.

 

Health Insurance Market Segment
Total Number
of Members Affected
Requested Annual Rate Increase (Weighted Average)
Approved Annual Rate Increase (Weighted Average)
Reduction by DFS
Individual, direct-pay
52,383
+9.54%
+4.48%
-5.06%
Small Group
1,280,649
+15.77%
+9.59%
-6.18%
Large Group
611,780
+7.84%
+5.20%
-2.64%
HealthyNY
117,859
+24.84%
+11.81%
-13.03%
Medicare Supplement
319,722
+3.27%
+2.59%
-0.68%
Overall
2,382,393
+12.37%
+7.52%
-4.85%

Click here to read the Governor’s press release.

Click here to read the NYTimes article, titled “Health Insurers Raise Some Rates by Double Digits.”

 

 

Filed under: ACA, Accountability, Affordable, Employer Sponsored Health Insurance, Federal health reform, Governor Cuomo, Governor Paterson, HealthyNY, New York Health Reform, Premiums, Small Business | Tagged: , , , , , | Comments Off

New York Selected EHB Benchmark – Oxford EPO

Posted on October 4, 2012 by Arianne Slagle

On Monday, October 1, New York State selected the benefits of the State’s largest small group plan, Oxford EPO, as the Essential Health Benefits (EHB) benchmark plan.

The state also outlined the coverage areas in which the Oxford plan’s benefits will be supplemented to meet ACA requirements:

  • Pediatric dental/vision coverage – NYS will supplement the Oxford plan’s benefits with the current pediatric dental/vision benefits offered through NY’s CHIP coverage.
  • Habilitative services – will have parity with rehabilitative services.
  • Mental health/substance abuse parity – benefit limits in the Oxford plan will be removed.
  • Annual/lifetime dollar limits – quantitative limits will be substituted when further federal guidance is available.

As we explained in our August 13 post, the selected benchmark EHB will apply to all non-grandfathered plans both inside and outside the State Health Insurance Exchange (the Exchange), as well as the benefits included in a Basic Health Plan, if New York implements such a plan.

In our written comments to the State, HCFANY urged the State to select the New York State Employee Plans’ Empire Plan, which has more comprehensive benefits than the Oxford plan. Among other differences, the Empire Plan covers adult dental care, and covers some services (like physical therapy and speech therapy) according to medical necessity rather than limiting those services to a set number of visits.

The State balanced value to consumers and small business employees of the more comprehensive benefits with the predicted additional cost these benefits would add to premiums. According to Milliman, the consultant that studied the EHB benchmark options for the State, selecting the Empire Plan would add $15 more to monthly premiums than selecting the Oxford plan would. The complete report by Milliman on EHB is available here.

The State received extensive feedback, including 60 written comments from the public.  Some of the comments, like this comment from the Hemophilia Association of New York, urged the State to select the Empire Plan because consumers need comprehensive coverage. Others, including this comment from the New York State Conference of Blue Cross and Blue Shield Plans urged the State to select an Oxford plan to keep premiums lower.

Input at the Regional Advisory Committees was similarly mixed, with stakeholders including carriers and small business advocates urging the State to keep premiums low, and stakeholders including consumer advocates urging the State to choose a more comprehensive benefit package.

While consumer advocates are disappointed in the State’s decision, there are some consolations for consumers:

  • The EHB will serve as a floor, not a ceiling, for benefits offered by individual and small group plans in New York.
  • The EHB will raise the floor for many New York consumers, including consumers who currently have coverage through Healthy NY plans.
  • Benefits that are not covered by the EHB, like adult dental, will be available through more comprehensive plans or coverage riders.
  • The EHB decision may be revisited for 2016.

HHS will offer the public one more opportunity to comment on this decision through a Notice of Proposed Rulemaking. We will keep you posted about opportunities to comment at that time.

Filed under: ACA, Comprehensive Coverage, Employer Sponsored Health Insurance, Federal health reform, HealthyNY, Insurance Exchange, Premiums, Small Business, State Department of Health | Comments Off

Thanks to the ACA, Premium Increases Are Slowing Down

Posted on September 11, 2012 by Arianne Slagle

Today, the Kaiser Family Foundation and Health Research & Educational Trust (HRET) released the 2012 Employer Health Benefits Survey. Thanks to the Affordable Care Act (ACA), in 2012, premium increases are at an all time low and workers are getting more affordable benefits from their employers. The survey found that employer-sponsored family health coverage reached $15,745, an increase of 4 percent from last year. Workers pay, on average, $4,316 toward the cost of their coverage.

Fewer plans are considered grandfathered in 2012 than in 2011 (48% down from 56%), resulting in more workers benefiting from preventive care with no co-pays and access to an external appeals process, keys provisions of the ACA that have been implemented for non-grandfathered plans.  For plans to remain grandfathered, employers must not make significant changes to their plans to reduce benefits or increase employee costs.

According to the survey, 2.9 million young adults are currently enrolled on their parent’s coverage because of the dependent coverage for children up to age 26 provision in the ACA. This provision has largely contributed to the decline in the percentage of uninsured adults ages 19-25 over the past year, from 33.9% to 27.9%.

Unfortunately, the survey showed that workers with coverage at lower-wage firms (where at least 35 percent of workers earn $24,000 or less a year) may fare worse with some employer-sponsored health benefits than workers at higher-wage firms (where at least 35 percent of their workers earn $55,000 or more a year).

  • Workers at lower-wage firms on average pay $1,000 more each year for family coverage than workers at higher-wage firms.
  • Workers at lower-wage firms are more likely to face high deductibles than those at higher-wage firms.
  • Large employers are more likely than small ones to allow workers to pay their share of premiums with pre-tax income (91 percent, compared to 41 percent) and to contribute pre-tax dollars to Flexible Spending Accounts (76 percent, compared to 17 percent).

As states and the feds continue to implement the provisions of the ACA, workers will reap the benefits through their employer-sponsored coverage. We look forward to the 2014 survey, when many more substantial provisions of the ACA will be in effect. For the impatient in the audience, tomorrow the U.S. Census Bureau will release its Report on Health Insurance Coverage on 2011.

Filed under: ACA, Employer Sponsored Health Insurance, Premiums, young adult | Comments Off

Yes, it’s that time of the year again…

Posted on July 25, 2012 by Arianne Slagle

That’s right – its health insurance rate review time! This means that our health insurance plans are now diligently submitting their proposed rate increases to the Department of Financial Services (DFS) for approval.  Some of you may have already received a letter from your health plan letting you know that they plan to “adjust” your premium rate.  Health plans are required to give you 120 days notice of any proposed rate increases (and 60 days notice before the approved increase goes into effect).

It’s up to DFS to decide whether the proposed rate increases are necessary.  Comments and objections from policyholders and the public can be submitted for up to 30 days after a health plan submits its application for an increase.  You can find any pending rate increase applications, and supporting documentation, on the DFS website by clicking here.

HCFANY is, of course, on top of this and is once again submitting comments on proposed rate increases.  First on the agenda is Oxford/United Healthcare, which is requesting rate increases of between 15.1% and 46.5% for its various small groupproducts.  After combing through the supporting documentation provided by the plan – particularly around medical trend and member migration – we are not convinced that that increases of this magnitude are necessary.  Our recommendation to the DFS is that the proposed rate increases be denied.

Click here to read HCFANY’s comment to the DFS in response to the proposed rate increase for Oxford Health Plans (NY), Inc., Oxford Health Insurance, Inc., and UnitedHealthcare Insurance Company of New York.

If you’d like to submit your own comments to the DFS, you can do so online by clicking here, or via regular mail to:

Mr. Charles Lovejoy
Health Bureau
New York State Department of Financial Services
25 Beaver Street
New York, NY 10004

 

Filed under: Accountability, Insurance reform, Premiums, Prior Approval | Tagged: , , | Comments Off

Happy Independence Day!

Posted on July 4, 2012 by Arianne Slagle

Yes, of course we will be celebrating our independence from Great Britain today.  But, thanks to the ACA, this year we can also celebrate our independence from several other things as well!

  • Our independence from the high cost of prescription drugs in the Medicare donut hole.
  • Our independence from pre-existing condition exclusions for kids.
  • Our independence from insurance lifetime benefit limits.
  • Our independence from out-of-pocket costs for preventive care.
  • Our independence from going uninsured just because we graduated from school.
  • Our independence from grossly inflated health insurance premium rate increases.
  • And so much more!

So, as you’re getting ready to settle down for the evening and take in those dazzling fireworks displays, be sure to save a round of applause for the Affordable Care Act!

 

Filed under: ACA, Federal health reform, Insurance reform, Premiums, Prior Approval, Uninsured | Tagged: , , , , | Comments Off

THE AFFORDABLE CARE ACT IS UPHELD!!!

Posted on June 28, 2012 by Arianne Slagle

It’s true! The decision was just handed down just a little bit ago.  The verdict? The entire law is upheld – including the individual mandate! 

It looks like there will only be one small change to the Medicaid expansion.  The ACA had originally stated that states could expand Medicaid eligibility to people up to 133% of the Federal Poverty Level, and that the federal government would basically pick up the entire cost for it, but that if they didn’t expand they could risk losing their existing funds.  The Supreme Court changed this so that states who don’t choose to expand their Medicaid eligibility won’t risk losing funding. 

Overall, this is a HUGE win for Americans, and a HUGE win for New Yorkers! And who do we have to thank? Justice Roberts! Who miraculously took a big one for the team by siding with the left-leaning justices on this.  That is one man who will be heavily toasted to (and cursed) by millions tonight.

So, what should we do with this information? Why, let’s celebrate of course!!!  Join HCFANY around this great State of New York TODAY at a series of public events for folks to speak up and celebrate this big victory!!! 

  • Albany: 3:00 PM at the Capital (State Street side). Contact Bob Cohen at bcohen@citizenactionny.org or (518) 465-4600 x104 for more info.
  • Binghamton: 4:00 PM at the Federal Building, 15 Henry Street. Contact Mary Clark at cabing@citizenactionny.org or (607) 723-0110 for more info.
  • Buffalo: 3:00 PM in the lobby of Congressman Higgins’ office, 726 Exchange Street. Contact Natalie Luczkowiak at nluczkowiak@citizenactionny.org or (716) 855-1522 x2 for more info.
  • Cortland: 5:00 PM at the U.S. Post Office, 88 Main Street. Contact Janet Steck at jsteck@twcny.rr.com or (607) 749-7016 for more info.
  • New York City: New Location! 5:30 PM (assemble at 5:15 pm) in Foley Square in lower Manhattan, across from the Federal Courthouse at the African American Burial Ground Monument (Take 4, 5, 6, J, M, N, or R trains to City Hall-Brooklyn Bridge stations). Contact Mark Hannay at metrohealth@igc.org or (917) 318-5008 for more info.
  • Syracuse: 4:00 PM at the Federal Building, 100 Clinton Street. Contact Lanika Mabrey at lmabrey@citizenactionny.org or (315) 435-2480.

We hope to see you there!!!

 

Filed under: ACA, Accountability, Affordable, Consumer Assistance, Employer Sponsored Health Insurance, Federal health reform, Insurance Exchange, Insurance reform, New York Health Reform, Premiums, Underinsured, Uninsured, Women, young adult | Tagged: , , , , | Comments Off

Your ACA Money-Back Guarantee

Posted on June 21, 2012 by Arianne Slagle

This summer, insurance companies are sending money back, thanks to the ACA’s “medical loss ratio” rule. The Department of Health and Human Services (HHS) announced today that insurance companies will be sending out $1.1 billion in rebates to 12.8 million consumers around the country. In New York, over 1 million consumers will receive more than $86.5 million in rebates, or an average of $138 per family. The average rebate for a New York family with small group coverage is $632.

Why the rebates? The ACA requires insurance companies to spend at least 80 percent of every premium dollar (85 percent for plans in the large group market) on medical care and quality. HHS calls it the “80/20 rule.” If a plan spends less than 80 percent of premiums on medical care, it has to give back the extra money. Here in New York, of course, we raised the bar a little. Insurance plans for individuals and small groups have to spend 82 percent of every premium dollar on medical care.

So what can you expect from your insurance company? First, you can expect to get a letter explaining the rule and whether the plan met the 80 (or 82 or 85) percent minimum spending on medical care. If not, the letter should explain how far off they were, and how much is owed in rebates.

If your insurance company owes a rebate you might receive:

  • a rebate check in the mail;
  • a lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card;
  • a direct reduction in your future premiums; or
  • a rebate from your employer using one of the above rebate methods, or a rebate “in a manner that benefits its employees.”

Filed under: ACA, Affordable, Employer Sponsored Health Insurance, Federal health reform, Insurance reform, Premiums, Prior Approval | Comments Off

Let health reform buy you lunch!

Posted on May 7, 2012 by Arianne Slagle

Or dinner!  Or drinks!  Or whatever else it is that you’d like!

See, as part of the ACA, insurers who offer health coverage to individuals and small businesses must spend at least 80% of what their enrollees pay in premiums on health care claims and quality improvement activities (in NY, state law actually requires this to be slightly higher, at 82%).  The other 20% or so can be used for administrative expenses like marketing and profits.  For large employer plans, insurers have to spend at least 85% on claims and quality improvement.

These new rules went into effect on January 1st of last year, which means the rebates have now started to trickle down to us real folks.   Here in New York, some of us have already gotten our rebates.  A new report issued by the Kaiser Family Foundation (KFF) is estimating that rebates in New York will average around $150 for people who buy insurance on their own, and $125 for small business enrollees.  For large employer enrollees, rebates are expected to average $142. 

In total, individuals and businesses in the US are expected to get back a total of $1.3 billion – that’s no small peanuts.  Thanks health reform!

Click here to read the full KFF report, titled “Insurer Rebates under the Medical Loss Ratio: 2012 Estimates.”

Or, to learn more, here are a couple more articles on the subject from around the Web:

 

Filed under: ACA, Affordable, Employer Sponsored Health Insurance, Federal health reform, Insurance reform, Premiums, Small Business | Tagged: , , , | Comments Off

Got questions about the NYS Health Insurance Exchange?

Posted on April 18, 2012 by Arianne Slagle

If so, then you are in luck! Yesterday, HCFANY’s own Elisabeth Benjamin made a guest appearance on WNYC’s Brian Lehrer Show to talk about Governor Cuomo’s Executive Order and what it means for New York.

Specifically, she goes over what’s at stake for consumers, why the Governor needed to take action via Executive order, and how the Exchange will actually work.

Click here to listen to an audio recording of the show.

Correction to the webcast: In New York State, more than 800,000 small business workers have lost their employer health insurance in the past decade.

 

Filed under: ACA, Federal health reform, Governor Cuomo, Insurance Exchange, New York State Politics, Premiums, Uninsured | Tagged: , , , | Comments Off

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