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.

 

By Claudia Calhoon, MPH, Director of Health Advocacy, New York Immigration Coalition; Laura F. Redman, Director, Health Justice Program, New York Lawyers for the Public Interest; and Sarika Saxena, Staff Attorney, Health Justice Program, New York Lawyers for the Public Interest

 

The release of the 2015 Open Enrollment report from the New York State of Health (NYSOH) demonstrates that NYSOH made important progress in reaching New York’s culturally diverse immigrant communities this year. The New York Immigration Coalition (NYIC) and New York Lawyers for the Public Interest (NYLPI) supported a number of strategies for effective outreach, such as a Spanish-language version of the web portal and outreach materials in 17 different additional languages. HCFANY is excited to see that New York has made concrete progress toward making the Marketplace friendly and accessible for all immigrant communities.

Other important accomplishments in the report include:

• 13% of enrollees selected Spanish as their primary language (as opposed to 10% in 2014)
• 25% of Marketplace enrollees describe themselves as Hispanic, a population that is disproportionately likely to be uninsured (an increase from 21% in 2014)
• Help from the NYSOH call center was given in 92 different languages, suggesting that information on coverage is reaching a wide array of diverse communities.
• Availability of an interactive calendar of events, navigation tools, and new “How to” videos in English and Spanish.

These successes point to the Affordable Care Act’s approach of working with in-person assistors, NYSOH Navigators and certified application counselors. Many Navigators and CACs work at strong culturally competent and language proficient immigrant-serving organizations, offering enrollment assistance in a total of 48 different languages.

The report also highlights important areas for improvement for open enrollment 2016 and beyond. Enrollment for French, French Creole, Italian, Korean, and Russian speakers does not appear to have increased. Consumers who speak languages other than English and Spanish would benefit from a calendar, navigation tools, and videos in other languages. And improved data on racial and ethnic minority and language groups will be essential to help inform targeted and innovative outreach and engagement strategies to make sure all immigrant communities can benefit fully from the ACA. While it is evident that information may be getting to diverse communities, information on enrollment outcomes is not available. Unfortunately, 31% of enrollees chose not to report their race, and 12% chose not to report their ethnicity, which represents a large gap in our knowledge. HCFANY members like the NYIC and NYLPI will continue to work with NYSOH to identify strategies to improve data collection and to educate health consumers about why sharing racial and ethnic identity information is safe and important.

This is the fourth in a series of blog posts about the NYSOH 2015 Open Enrollment Report.

By Andrew Leonard, Sr. Policy Associate for Health, Housing and Income Security, Children’s Defense Fund – NY

The release of the 2015 New York State of Health (NYSOH) Open Enrollment Report confirms that the Affordable Care Act (ACA) is working for children and families across New York. As the State continues to move ahead with the implementation of the ACA, more and more children have access to care, many for the first time.

Since the NYSOH opened in October 2013, more than one quarter of all Marketplace consumers have been children under the age of 18. In total, well over half a million (564,263) New York children have enrolled in health insurance through the NYSOH: nearly 400,000 in Medicaid, about 160,000 in Child Health Plus, and over 12,000 in Qualified Health Plans (QHP).

One of the major signs of success is that nearly one third (30%) of QHP enrollees were ages 18 to 34. These are the consumers known as “Young Invincibles,” whom many believed would not enroll in health insurance because they perceive themselves as not needing health care services. Many people believe it is important to have a large number of Young Invincibles in the marketplace risk pool, because young people tend to be healthier, which helps keep premium costs down for everyone in the Marketplace.

New York has a strong history of working to provide all children with access to health insurance, regardless of income or immigration status. Prior to the implementation of major ACA reforms in 2014, New York had already extended health care coverage to 96% of children. With the dramatic increase in the number of children enrolled in the Marketplace, that number will be far closer to 100% when new figures are calculated.

We look forward to seeing how the availability of the Essential Plan in 2016 will benefit the parents of many children covered through the Marketplace. As we know, when parents are better connected to health insurance, children are more likely to receive the care they need.

We will continue to advance a consumer-friendly implementation of the ACA in New York so that, one day soon, all New York children will have access to high quality, comprehensive health care.

This is the third in a series of blog posts about the NYSOH 2015 Open Enrollment Report.

By Bob Cohen, Esq., Policy Director of Citizen Action of New York and the Public Policy and Education Fund

 

As we discussed in the first blog post of this series, 2.1 million New Yorkers have enrolled in health coverage through the NY State of Health Marketplace (NYSOH) as of the end of the marketplace’s second open enrollment period. NYSOH’s second annual open enrollment report shows one of the key reasons why: the strong program the State has established to provide one-on-one in-person assistance to consumers and small businesses to compare and enroll in health plans.

Two-thirds (67%) of total marketplace enrollees used in-person assistors – Navigators, certified application counselors (CACs) and brokers – in the marketplace’s second year, a significant increase from the first year, when 49% got one-on-one help. All three kinds of in-person assistors are trained and certified by the State. Navigator agencies are funded by NYSOH.

The State’s investment in Navigators and other in-person assistors has really paid off. In the second year, New York made significant progress in enrolling hard-to-reach populations – exactly the New Yorkers that Navigators and CACs are intended to reach. Eighty-nine percent of consumers in the second year didn’t have insurance at the time they enrolled, versus 81% in the first year. Thirteen percent said their preferred language was Spanish, versus 10% in the first year. The state’s Navigators know the communities they serve and are trusted by community members to provide accurate and unbiased information. When you’ve never had health insurance before, or you have limited English proficiency, you’re much more likely to prefer getting help from a community group in your neighborhood than to call a toll-free number. Navigators work evenings and weekends, which is particularly attractive for those with more than one job, irregular work hours, or child care obligations.

The in-person assistance program also expanded in 2015: there were 11,388 trained assistors (Navigators, CACs, and brokers) as of the end of February of 2015, versus 8,960 in 2014, according to the state report. In-person assistance will continue to be a key to the success of NYSOH in 2016, as more and more people hear from their friends, co-workers, relatives and neighbors about the value of assistors in navigating the complexities of health insurance enrollment.

 

This is the second in a series of blog posts about the NYSOH 2015 Open Enrollment Report.