Out-of-Network Coverage Proves Popular in New York State of Health Enrollment Statistics
Posted August, 25 2015 by Hannah Lupien
By Heidi Siegfried, Esq., Project Director of New Yorkers for Accessible Health Coverage and Health Policy Director for Center for Independence of the Disabled, NY
In its second Open Enrollment report, the New York State of Health Marketplace (NYSOH) identified trends in plan selection. One stand-out trend is the high uptake of out-of-network products in the areas in which they are offered.
An “out-of-network” product provides insurance coverage for services delivered by providers that do not belong to the carrier’s network. During the 2015 Open Enrollment period, carriers offered Qualified Health Plans (QHPs) through NYSOH with out-of-network coverage in 11 counties of the state: Albany, Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Rensselaer, Saratoga, and Wyoming counties.
In these 11 counties, a whopping 21 percent of QHP enrollees selected plans with an out-of-network benefit. QHPs with an out-of-network benefit are more expensive than plans that only cover in-network providers – costing 7% to 40% more in monthly premiums – but a significant share of consumers clearly value this option when it is offered.
HCFANY will continue to advocate that carriers should offer out-of-network options in all counties. New York is one of only three states where out-of-network coverage is not widely available in the individual market. As insurers have moved to narrower networks and more limited networks, it has been especially hard for people with serious illnesses and disabilities who are receiving care from many providers to find a network that includes all of their providers. Even with improved network adequacy and external review appeal processes, many consumers would prefer to purchase a more expensive plan with out-of-network coverage than a cheaper plan that requires them to say in-network. People paying for vital treatments with trusted providers – HIV and cancer specialists, for example – should retain the right to see these providers without having to pay out-of-network rates and cover the cost entirely out-of-pocket.
Eleven New York counties (shown in green) offer out-of-network plans in the Marketplace
This is the fifth in a series of blog posts about the NYSOH 2015 Open Enrollment Report.
Nathanael Nerode • Sep.23.2015 at 11:39:pm
Lack of out-of-network coverage, combined with only two companies offering plans at all, makes the options in Tompkins County a joke. Entire specialties have only the worst providers “in-network”, meaning that for real coverage, you pay out of pocket.
Single payer now.