New York’s Prior Approval law protects consumers
Each year health insurance companies in New York submit applications to the Department of Financial Services (DFS) that explain their requests to raise, lower, or maintain the premiums they charge consumers for health insurance coverage. Thanks to a strong state law, New York’s DFS can reduce rate increases proposed by health insurers if they find the proposed rate is “unreasonable,” “excessive” or “unfairly discriminatory.” Under the 2010 Prior Approval law, DFS may review rates in the individual and small group (2-50) markets. Most proposed rate increases will go into effect on January 1, 2016.
DFS considers many factors when deciding whether to approve a rate proposal, including the costs of medical care and prescription drugs and the insurer’s past claims experience and financial condition.
Consumers, consumer groups, and small businesses can submit comments to challenge rate proposals that they believe are too high, but the time period to comment is extremely short. Comments must be submitted within thirty days after the insurer’s filing is posted on the DFS website.
The rate increases began to be posted on June 2. Check the DFS website (myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company) to get the exact deadline for your own health insurer. Many comments are due before July 2nd.
You can make a difference!
Last year, many consumers were faced with double-digit rate increase proposals, but consumers weighed in and the average rate increases were almost cut in half.
In 2014, DFS reduced the average proposed rate increase from 12.5% to 5.7% for consumers on the individual market and from 13.9% to 6.9% on the small group market, saving policyholders in New York an estimated $1 billion!
This year, many consumers and small businesses are again facing rate increases over 10%. The weighted average for rate increases is 13.5% on the individual market and 14.3% on the small group market. Increases like these can seriously cut into family budgets and small business owners’ ability to provide health care for their employees.
What You Can Do:
1. Write a comment challenging your rate increase. You can do this online, through the DFS web page, or you can send it in by regular mail. The DFS web page shows you how.
To comment online:
- Go to https://myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company
- Find your insurance carrier in the left column and click
- Go to “Pending Applications” and “Under Review” in the right column
- Click on your plan – IND for individuals and SG for businesses
- Create an account and leave a comment
2. Get others to submit comments
- Share our Policy Brief on rate review with friends and family: http://hcfany.org/resources/issue-brief-you-can-weigh-in-on-next-years-health-insurance-premiums/
3. Get the word out on rate review and the need to act by writing a letter to the editor or through social media.
- Sample tweet: My insurance company wanted to raise my premiums by X% next year! I spoke up and you can too! http://on.ny.gov/1ALYFCs #RateReview @HCFANY
What Your Comments Should Say:
Your comments don’t need to be long or complicated. DFS wants to know how a premium increase would affect your life. A short explanation is fine. You may want to include:
- The name of your insurance company and plan
- How a premium increase would affect you and those covered by your plan
- What changes you would have to make to afford the insurance
- Whether you are likely to keep health insurance if the increase goes through
Your Comments Really Matter!
“The Affordable Care Act gave me a chance and ended my six year nightmare of living without health insurance. It was way more simple and affordable than people think.”
–Karen E., Ulster County
The Affordable Care Act is working in New York, according to HCFANY’s new publication, The ACA is Working: New Yorkers Tell Their Stories.
The new publication shares stories from New Yorkers like Karen, a single mother from Ulster County, who was finally able to get affordable health coverage for her family after being uninsured for six years, thanks to federal subsidies. Ben, from Broome county got covered thanks to the ACA’s Medicaid Expansion and enrolled in the same plan as his son. And Engracia got help from a local Navigator to enroll in a plan that saves her $4,500 a year.
The ACA is Working: New Yorkers Tell Their Stories features twelve consumer stories and quotes from New Yorkers in all regions of the State who enrolled in private Qualified Health Plans, Medicaid, Child Health Plus, and small business plans, all through the NY State of Health Marketplace during the first Open Enrollment period. Many got help to enroll from Navigators, who offer free, unbiased, in-person enrollment help. The stories are paired with key statistics and facts about how the ACA is working for New York – and most importantly, New Yorkers.
View HCFANY’s full press release here.
Outreach Worker Engracia Jamieson and Volunteer Jan Kenyon at Great Day in Harlem (above) and RWV-NY Community Organizer Liza Lederer (right) at Brooklyn Pride
This coming Labor Day Weekend marks the unofficial end of summer, and it’s been a busy one for health coverage advocates and volunteers! Here’s an update from the field from the Get Covered NY Campaign, a grassroots effort to raise awareness about the new insurance options available through NY State of Health, and help NYC residents get covered. Get Covered NY is a project of Health Care For All New York, Greater NYC for Change, and Raising Women’s Voices – NY.
Guest Post by Aliza Lederer-Plaskett, Community Organizer for Raising Women’s Voices-NY
Raising Women’s Voices and our partners in the Get Covered NY initiative are wrapping up a busy summer of outreach to uninsured New Yorkers. We have tabled and leafleted at a wide variety of events in low-income communities in Upper Manhattan, Brooklyn and the Bronx, as well as Westchester and Rockland counties.
We’ve been to the Hunts Point Summer Fish Festival in the Bronx. We’ve reached out to LGBT people by tabling at Pride Festivals in Harlem, Brooklyn, the Bronx, Rockland County and lower Manhattan. We’ve been to book fairs, Harlem Week and back-to-school events where we can reach families with children who may be eligible for Child Health Plus. In Westchester and Rockland Counties, we have done outreach at cultural festivals and presentations on the Affordable Care Act and NY State of Health for members and staff of local nonprofit organizations.
Our dedicated and trained Get Covered New York volunteers have been taking clipboards and handouts around the events, interacting with attendees and taking down the names of people who would like to be contacted by a Navigator to begin the application process. Through this hands-on approach, we have collected more than 900 names of uninsured and underinsured individuals throughout July and August.
As we speak with uninsured people in the field and collect their information, we have noted who has experienced a major life change – which may qualify them for a special open enrollment period. We also flag people who we think might qualify for Medicaid, for which there is year-round enrollment. We then forward their contact information directly to a Navigator at the Community Service Society. Other uninsured individuals are entered into the Get Covered NY database, to be called by volunteers at phone banks that will start up again as the November 15 start of the next open enrollment period draws closer.
We have begun to pack our September and October schedule chock full of community events to ensure that we can reach as many people as possible prior to the start of the new enrollment period. Got an event you’d like to see us at? Interested in becoming a volunteer? Please contact Liza Lederer at firstname.lastname@example.org and we’ll get you set up to help get New York covered!
We already knew that nearly a million New Yorkers had enrolled through NY State of Health during the first open enrollment period from October 1 to March 31. But now we know more than ever about who they were, where they live, and how they enrolled. That’s thanks to the new enrollment report released yesterday by NY State of Health, the official health plan marketplace, which includes eagerly awaited demographics data such as age, race and ethnicity of enrollees.
HCFANY issued a press release, highlighting key findings from the data, such as the importance of in-person assistors in helping New Yorkers obtain health insurance. Nearly 50% of insurance applications were completed with help of in-person assistors, including Navigators, Certified Application Counselors, and brokers. In-person assistance was particularly critical for low-income New Yorkers: more than half (59%) of the Medicaid enrollees used in-person assistance to complete their application.
For the first time, the report offers a glimpse into the race and ethnicity, as well as preferred language, of New York enrollees. Though the data is incomplete – about one in four enrollees chose not to respond to the application on race – it nonetheless will help direct future outreach and enrollment efforts across the state. About 37% of enrollees who answered the question reported their race as Black/African American, Asian/Pacific Islander, or “other” non-white race. About 20% of Medicaid enrollees chose a language other than English, but no enrollees reported their preferred language as Korean, Russian, or French Creole, pointing to potential gaps in these communities. As useful as this data is, it only provides a statewide picture – there is still a need for race, ethnicity and preferred language by county in order to target outreach to the communities that need it most.
Financial assistance was key to the high enrollment numbers in Qualified Health Plans (private health insurance). Nearly 3/4 of enrollees got private health plans with financial assistance in the form of Advanced Premium Tax Credits (APTC) or a combination of both APTC and cost-sharing reductions. An average New Yorker who was eligible for financial assistance saved $215 per month in premium.
And, while some enrollees (about 13%) clearly benefited from the Medicaid expansion that made them newly eligible for public insurance, a whopping 93% of Medicaid enrollees were newly insured overall. That means many of those who enrolled in Medicaid were previously eligible but, for whatever reason, had been unable to enroll. New York clearly did something right in building it’s health insurance marketplace – the single, streamlined web application our State officials built is working. And, boy, did New Yorkers come.