Premium requests made by New York’s insurance companies have been posted, and consumers have the chance to share their thoughts on these requests! New York State requires this approval for all individual market, small group, and Medicare Advantage plans. If your plan is part of this process, you should have received a letter from your insurer explaining what they requested and how you can submit comments to the state’s Department of Financial Services (DFS). The insurers’ applications are available through DFS’s website and are linked below. Public comments are due in late June and can be submitted online here.
It is important to remember that at this point, these are only requested changes; DFS will review insurers’ applications along with consumers’ comments when determining the approved rates for 2022. Last year, DFS decreased insurers’ requested rate for individual coverage from a 11.7 percent increase to a 1.8 percent increase, the lowest rate increase ever approved. The changes saved consumers over $221 million. DFS also reduced rates requests for small group coverage from 11.4 percent to 4.2 percent, a 63 percent decrease that saved small businesses over $565 million.
This year, the average request was 11.2 percent in the individual market. Healthfirst PHSP, Inc. requested the highest increase at 34.4 percent. The plan cites higher provider charges in its new service areas in Westchester and Rockland counties for most of this increase. Six other plans requested double digit increases: Highmark (18.1 percent), MVP (16.9 percent), Unitedhealthcare (13.9 percent), Oscar (13.6 percent), CDPHP (11.4 percent), and HealthPlus (10.2 percent). MetroPlus (-3.9%) and Independent Health Benefits Corporation (-.2%) each requested decreases. For small group plans, the average requested increase was 14 percent, ranging from a 17.6% requested increase by Highmark Western and Northeastern New York (formerly Healthnow) to a 4.5% requested decrease by Aetna Health.
HCFANY submits detailed comments each year, which you can see in our letters from 2020 (link) and 2019 (link). Consumers do not need to provide this much detail; if you do comment publicly, you can speak about how the proposed changes to your plan would impact you. For example, what changes would you have to make if your insurance company were allowed to increase their rates? Would you still buy insurance? HCFANY has longer instructions available (link), but the most important thing is to use your own experience.
Individual Market Applications
We’ve compiled the links to applications for each insurance carrier that participates in New York’s individual market through our health insurance exchange below. We’ve included both the narrative summaries, which are shorter (under 10 page) explanations for the requested rate changes, as well as the complete application links for those who wish to review the applications in greater detail.
- CDPHP Health Plan: Narrative Summary (link), Complete Application (link)
- Emblem (HIP): Narrative Summary (link), Complete Application (link)
- Excellus: Narrative Summary (link), Complete Application (link)
- Fidelis (NYHQC): Narrative Summary (link), Complete Application (link)
- Healthfirst PHSP: Narrative Summary (link), Complete Application (link)
- Highmark Western and Northeastern New York (Formerly HealthNow): Narrative Summary (link), Complete Application (link)
- HealthPlus Empire: Narrative Summary (link), Complete Application (link)
- Independent Health Benefits Corporation: Narrative Summary (link), Complete Application (link)
- MetroPlus: Narrative Summary (link), Complete Application (link)
- MVP Health Plan: Narrative Summary (link), Complete Application (link)
- Oscar: Narrative Summary (link), Complete Application (link)
- UnitedHealthcare of New York: Narrative Summary (link), Complete Application (link)
New York State’s uninsured rate hit an all-time low of 5.2 percent in 2019, according to new data from the U.S. Census Bureau. New York has made continual coverage gains since 2010, when 11.9 percent of New Yorkers were uninsured. Approximately 68 percent of covered New Yorkers had private plans, while 40 percent had some type of public coverage.
New York had the 8th highest rate of insurance coverage in the United States (after Massachusetts, 3 percent; the District of Columbia, 3.5 percent; Rhode Island, 4.1 percent; Hawaii, 4.2 percent; Vermont, 4.5 percent; Minnesota, 4.9 percent; and Iowa, 5.0 percent). Twenty states experienced significant increases in their uninsured rates. For children, New York has the 5th best insurance coverage in the country with only 2.4 percent of people under 19 uninsured (after Massachusetts, 1.5 percent; Rhode Island, 1.9 percent; the District of Columbia, 2.0 percent; and Vermont, 2.1 percent).
Coverage changes between 2018 and 2019 were insignificant in most counties, but there were significant coverage gains in Erie, New York, Orange, Wayne, and Warren Counties (see table below). Only one county, Tompkins, experienced a significant increase in uninsured people (from 2.3 percent without insurance to 3.7 percent).
|County||Uninsured, 2018||Uninsured, 2019|
Queens County continues to have the highest rate of uninsured residents at 9.3 percent. It is followed by Cattaraugus County (8.3 percent), the Bronx (7.9 percent), St. Lawrence County (7 percent), and Kings County (6.3 percent).
Of course, the COVID-19 pandemic means that 2020 may look very different. But New York’s leaders have taken many steps to protect New Yorkers from coverage losses, including extending open enrollment in the New York State of Health for the entire years and automatically renewing Medicaid, Essential Plan, and Child Health Plus for thousands of New Yorkers.
Everyone is experiencing enormous upheaval right now and many people are losing their jobs and with it their health insurance. Here’s a summary of actions New York State has taken to keep people covered during the pandemic.
- Medicaid discontinuances are halted. If you have Medicaid, you will not be disenrolled. If you get a discontinuance letter, contact your local district office or the NY State of Health – you will be reinstated. Thanks to the Families First Coronavirus Relief Act, this is now also a federal policy – but New York did it first!
- Medicaid, Essential Plan, and Child Health Plus renewal dates are being pushed back by four moths. If you were supposed to renew in March, April, May, or June, you no longer have to do so.
- If you are uninsured, you have special permission to buy a plan through the New York State of Health (link) until April 15. A lot of people are experiencing job and income losses – you may be eligible for help that you weren’t previously eligible for. Ask for help figuring out what your options are – the New York State Navigator program is running full speed ahead! Your insurance will start on April 1.
- There is no cost-sharing (such as co-pays) for in-network telehealth services, whether related to COVID-19 or not (link). Insurers must cover telehealth services if those services would be covered during a physical interaction. This will help people stay at home and avoid unnecesary physical interactions.
- There is no cost-sharing for COVID-19 tests. If you cannot get a test in-network, insurers must cover the test out-of-network.
Things are moving quickly! As always, if you need help getting insurance or using your insurance, the Community Health Advocates program (link) is available.
Today marks ten years since President Obama signed the Affordable Care Act (ACA). Since then, the ACA has helped over 20 million Americans enroll in health insurance.
This year in New York, nearly five million people used the NY State of Health to enroll in health insurance. Before the ACA, there was no central location to shop for health insurance plans. Almost 800,000 people enrolled in the Essential Plan this year, which did not exist before the ACA. Over three million enrolled in Medicaid, which was expanded through the ACA. And around 273,000 people purchased Qualified Health Plans, 58 percent of whom received advance premium tax credits through the ACA. No one who enrolled in these health insurance plans had to answer questions about their previous health conditions – because under the ACA, anyone can buy insurance no matter what their pre-existing conditions are.
The ACA has also meant higher quality coverage. Under the current federal administration, some states have opted to loosen their health insurance standards. But in New York, paying a premium still means getting a plan that covers a comprehensive set of benefits including prescription drugs, maternity and newborn care, and preventive health screenings and visits. Insurers are no longer allowed to impose lifetime or annual coverage limits, a common pre-ACA practice that stopped coverage when people needed it most.
There’s a lot that could be improved upon in the ACA. For example, HCFANY supports higher income limits for premium subsidies and supplemental premium subsidies funded by the state. Deductibles are too high for many New Yorkers. Network standards are not high enough. But after ten years, evidence has poured in on the law’s benefits: the ACA has reduced racial health disparities (link), kept struggling community hospitals open (link), and made America healthier (link). We are so grateful to all the people who fought to make the ACA happen – and we’re dedicated to protecting and building off of what they won.