Insurers offering products in New York’s individual, small group, and Medicare Advantage markets submit applications to the Department of Financial Services (DFS) each year which describes how premiums will change and why. DFS (and HCFANY!) encourage consumers to respond to these requests by share their experiences with DFS. How affordable do you think your current plan is? What would happen if your premiums went up as much as your insurer asks for? You can read HCFANY’s guidance for how to comment here, and submit your comments to DFS here.
Insurers have requested an average increase of 11.2% for 2022 on the individual market, which is very high given that consumers are still navigating the economic and health-related repercussions of the COVID-19 pandemic; in addition, insurers will likely continue to benefit financially from depressed utilization and the increased use of telehealth as a result of the pandemic. In some cases insurers didn’t give enough information about why they think premiums should increase. This isn’t fair to the public.
In our comments, HCFANY discussed many reasons why DFS should consider reducing the rate requests, including both market-wide conditions and specific factors in each insurer’s application. Find your carrier in the list below to see what we had to say!
- CDPHP Health Plan
- Emblem (HIP)
- Highmark Western and Northeastern New York (Formerly HealthNow)
- HealthPlus (previously Empire)
- Independent Health Benefits Corporation (IHBC)
- MVP Health Plan
More New Yorkers than ever turned to NYSOH for affordable health coverage at the beginning of 2020. The latest NY State of Health (NYSOH) report shows that 25 percent of New Yorkers (4.9 million) enrolled in health coverage through the NY State of Health during 2020’s Open Enrollment Period. This represents a 150,000 increase over 2019. The report documents enrollment between November 1, 2019 and February 7, 2020. Enrollment through NYSOH has increased every year since it was created, an indication of the need New Yorkers have for health coverage.
Most New Yorkers who used NYSOH enrolled in public plans like Medicaid (3.4 million), Child Health Plus (452,000), and the Essential Plan (797,000). Medicaid and the Essential Plan cover New Yorkers who earn up to 250 percent of the federal poverty level. Child Health Plus covers New Yorkers under the age of 19 with subsidies for families at lower incomes. About 273,000 New Yorkers used NYSOH to purchase private health insurance (Qualified Health Plans or QHPs), 60 percent with financial assistance through premium subsidies. QHP enrollees continued to show a preference for lower-cost options, with Bronze and Silver plans (plans with lower premiums) being the most popular throughout the State. Increasing premium costs are likely the cause of this trend towards lower premium plans, but those lower premiums come with higher deductibles. Even insured New Yorkers report struggling to afford health care – the trend towards enrollment in plans with lower premiums but higher cost-sharing is an important one for advocates to monitor.
Assistors continued to play a key role in the success of last year’s Open Enrollment period, with around 80 percent of last year’s enrollments being conducted by assistors. Navigators, who are trained and certified by the state, are available to provide assistance all across New York – you can find help in your own community by calling 888-614-5400.
NYSOH has proven itself resilient over the years, from the early days when it was unclear whether or not consumers would use it at all through the Trump era when federal policy changes hurt Marketplaces in other states. In the months after this report covers, NYSOH took steps to ensure that New Yorkers were able to keep enrolling in health coverage even as millions lost their jobs or experienced other disruptions during the pandemic. Preliminary data shows that between February 2020 and February 2021, an additional 885,000 New Yorkers used NYSOH to obtain health insurance, and now a record 5.8 million people are enrolled through NYSOH—nearly a third of the state’s entire population. This was only possible because of the investments New York has made over the years towards building a strong, integrated Marketplace where consumers have lots of help available to make the best choices for themselves.
Consumers in New York have the chance to comment on requested premium increases in the individual and small group health insurance markets. The applications, where insurers justify their requests, are available through the New York State Department of Financial Services (DFS) (you can submit comments online here; see below for direct links to each individual application). Comments are due by July 5.
This process is called prior approval because in New York, the state must approve the changes insurance companies want to make to their premiums ahead of time. DFS reviews the applications to make sure that premium increases are linked to actual increases in costs, instead of things that insurers could do better at controlling.
In the individual market, the average request was 11.7 percent this year. The average requested increase was 11.4 percent in the small group market. Insurers attribute an average of 3.1 percent of the increases to the impact of the COVID-19 pandemic. Some plans cite COVID-related testing and treatment, increase in hospital costs, and the possibility of a vaccine next year as reasons to approve rate increases. It is also important to note that this year health care utilization dropped as consumers cancelled and postponed doctor’s visits and non-urgent surgeries because of the pandemic, while insurers continued to collect premiums.
DFS takes its regulatory duties seriously, and they want to hear from consumers about what it means for their families when premiums go up year after year. Last year, DFS decreased insurers’ requested rate for individual coverage from 9.2 percent to 6.8 percent, which saved consumers over $50 million. It also reduced rates for small group coverage from 12.2 percent to 7.9 percent, a 35% decrease that saved small businesses over $313 million.
HCFANY submits detailed comments every year – you can see the types of arguments we make in our letters from 2019 (link) and 2018 (link). However, consumer comments do not require as much detail as HCFANY provides. If you decide to comment, you can simply provide the name of your insurance company and plan and discuss how a rate increase would affect you. What changes would you have to make if your insurance company was allowed to increase their rates? Will you still buy insurance? We’ve written some longer instructions if you want more guidance (link), but the important thing is to speak frankly about your own experiences.
Comments are posted publicly. That means your comment won’t just inform DFS; it will be part of the bigger conversation occurring about the affordability of health care in New York. Consumers are not a big enough part of those discussions – we should take advantage of every chance we get to change that!
Individual Market Applications
Direct links are provided below for each insurance carrier that participates in New York’s individual market through our health insurance exchange. The narrative summary is a short (under ten pages) explanation for why the insurance company thinks it has to raise rates. The full applications are very long but links are provided for those who want to examine them more closely.
- CDPHP Health Plan: 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)
- HealthNow: Narrative Summary (link), Complete Application (link)
- HealthPlus Empire: Narrative Summary (link), Complete Application (link)
- HIP/Emblem: Narrative Summary (link), Complete Application (link)
- Independent Health: 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)
The New York State Department of Health has announced a special enrollment period in response to the spread of COVID-19. That means if you are uninsured, you have special permission to buy health insurance through the NY State of Health Marketplace (https://nystateofhealth.ny.gov/). This special enrollment period ends April 15 – so don’t wait!
What does this mean? Open enrollment periods exist to discourage people from waiting until they know they have big bills coming to buy insurance. If everyone did that, health insurance would quickly become unaffordable to almost everyone. During open enrollment, people have to decide – can I afford health insurance? And does it make sense to me to buy health insurance given my usual health expenses? Some people gamble that they won’t have any serious health problems during the year and chose not to enroll. But once open enrollment ends, those people cannot decide to buy insurance if say, they need an x-ray or were exposed to COVID-19 at work. There are always special enrollment periods for big life changes – for example, becoming pregnant or losing a job.
Open enrollment for 2020 ended on February 7 in New York. Two months later, during a public health emergency, there may be some uninsured people who feel differently about their decision. This announcement means you can turn back the clock and get insurance! Are you worried about costs? Navigators and other assistors are working throughout the emergency to help you! For enrollment questions, dial 1-888-614-5400 and choose option 1, and then 1 again.
Other things to remember:
- Any plan you enroll in through the State, including a private plan you buy through the NY State of Health, is required to cover COVID-19 testing without cost-sharing.
- You can enroll in Medicaid, the Essential Plan, or Child Health Plus at any time of the year based on your income. Enrollment uses the same NY State of Health application that you fill out to buy health insurance.
- If you have lost your job or experienced a decline in pay, talk to an assistor about it. You might be eligible for premium subsidies or programs that you weren’t eligible for during open enrollment.
This is a fluid and scary situation. Obtaining health insurance is one step New Yorkers can take to prepare for the next few weeks.