Insurer Participation In Ny State Of Health
New York has had a robust exchange from the start, with multiple insurers offering plans in most areas of the state. For 2022, there are 15 insurers that participate in the exchange .
For the most part, insurer participation has been fairly stable in New Yorks exchange. But there have been a few changes over the years:
In September 2017, Centene announced plans to acquire Fidelis Cares assets. Centene did not previously participate in New Yorks market, but the acquisition of Fidelis Care gave the company major foothold there, given Fidelis Cares market share.
Centene agreed to pay $3.75 billion to purchase Fidelis Cares assets, but the state believed that the majority of that money should go to the state, since Fidelis Cares primary business is Medicaid managed care. A deal was reached in March 2018 that allows the state to receive $2 billion from the sale, with the money earmarked for a healthcare charitable trust to benefit New Yorkers and improve health care in the state. In April 2018, the New York Department of Health and the New York Department of Financial Services both granted approval for the acquisition, and the details were finalized by the end of 2018..
List Of Commissioners Of Health Of The City Of New York
List of Commissioners of Health of the City of New York
|Abram S. Hewitt|
|Abram S. Hewitt, Hugh J. Grant|
|Robert Van Wyck|
|Robert Van Wyck|
|Ernst J. Lederle, Ph.D.|
|John P. Mitchel|
|John F. Hylan|
|John F. Hylan|
|Fiorello H. La Guardia, William O’Dwyer|
|Robert F. Wagner, Jr.|
|John V. Lindsay|
|John V. Lindsay|
|John V. Lindsay|
|May 28, 1969 January 17, 1972||John V. Lindsay|
|John V. Lindsay|
|Abraham D. Beame|
|Edward I. Koch|
|Edward I. Koch|
|Rudolph W. Giuliani|
|Rudolph W. Giuliani|
|May 18, 2009 January 16, 2014||Michael R. Bloomberg|
|Bill de Blasio|
|Bill de Blasio, Eric Adams|
About Ny State Of Health
New York opened its health plan Marketplace, NY State of Health, in October 2013. The Marketplace’s one stop health insurance shopping experience offers high quality comprehensive health plans. NY State of Health is the only place where consumers can qualify to get help paying for coverage through premium discounts or tax credits. Eligible New Yorkers can also enroll in Medicaid, Child Health Plus and the Essential Plan through the Marketplace all year. For more information about the NY State of Health Marketplace, please visit:https://nystateofhealth.ny.gov/or call Customer Service at 1-855-355-5777, TTY: 1-800-662-1220 or find an enrollment assistor.
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Csr Funding And Its Impact On The Essential Plan
BHPs receive federal funding equal to 95% of the amount that the federal government would otherwise have spent on premium subsidies and cost-sharing reductions in the state, if the BHP hadnt been available to consumers. In October 2017, the federal government eliminated funding for CSR, nationwide. Insurers still have to provide CSR benefits to eligible enrollees, but instead of getting federal funds to cover the cost, insurers have instead added the cost to premiums in nearly every state.
In New York and Minnesota, however, insurers didnt have to add as much to their premiums to cover the cost of CSR, because very few people receive CSR benefits in those states, and the CSR benefits that are provided are very small. Thats because nearly everyone who would have been eligible for CSR in those states is eligible for BHP coverage instead. You can see how this devolves into circular logic
Fortunately for New York and Minnesota, the judge ruled in May 2018 that HHS had to pay up. The ruling called for $169 million to be paid to New York and Minnesota for the second quarter of 2018 , and for HHS to work together with the states to sort out a payment formula going forward.
That same funding methodology was maintained for 2020 and 2021. But as noted above, CMS has also given New York an additional $750 million in federal funding for the Essential Plan, as part of the American Rescue Plan Act.
Nys Undercounted Nursing Home Covid Deaths
ALBANY, N.Y. The New York State Comptroller audit found that New York States Department of Health underestimated nursing home COVID deaths. Comptroller Tom DiNapoli said that he wasnt surprised with the audit findings, but is disappointed that it confirmed what families who lost loved ones were feeling.
According to the audit, nursing home COVID deaths were underestimated by 4,100 and at times, more than 50% during the pandemic. But according to the audit, DOH was unprepared to respond to infectious disease outbreaks in nursing homes even prior to the pandemic.
With the underreporting of the deaths, relatively early on in the pandemic, the Department of Health corrected internally their accounting and the numbers, explained DiNapoli. But that never got out to the public. So there was in effect a misuse of information at the higher levels of leadership in the state beyond the department. So in effect, the department, from my perspective, had the responsibility to get the real story out. And they seemed unable to do that.
Stephen Hanse, president of the New York State Health Facilities Association, said that Gov. Kathy Hochuls proposed budget invests in long-term care. He said he believes it will help reverse years of disinvestment.
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Affordability Is Not An Option
In New York State, businesses with 50 or more full-time employees are required to provide affordable health insurance. That means the insurance plan must cover at least 60 percent of medical expenses, and not cost an employee more than 9.83 percent of their annual income. If a business fails to meet those requirements, it will pay a penalty.
Grandfathered plans are not subject to the affordability requirement.
Which Insurers Offer 2022 Coverage In The New York Marketplace
For 2022 coverage, there are twelve insurers that offer exchange plans in New York:
- Capital District Physicians Health Plan
- Excellus Health Plan
- Healthfirst PHSP
- Health Plus HP
- Highmark Western and Northeastern New York
- Independent Health Benefits Corporation
- UnitedHealthcare of New York
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The Essential Plan Debuted In 2016 By 2021 Enrollment Had Grown To 914000
In April 2015, New York State of Health announced that they would introduce a Basic Health Program in 2016 dubbed the Essential Plan. Enrollment in the Essential Plan began on November 1, 2015 for coverage effective January 1, 2016. BHPs are an option available to all states under the ACA, but only New York and Minnesota elected to establish BHPs.
Under ACA rules, BHP coverage is available to people with income too high for Medicaid but no higher than 200% of the poverty level. For 2022 coverage, thats $25,760 for a single individual.
In New York, the BHP is available from a variety of private carriers, has no deductible and no monthly premium .
Prior to 2016, enrollees with incomes between 139% and 200% of poverty were eligible for premium subsidies and cost-sharing subsidies, but switching to the BHP has resulted in lower premiums and lower cost-sharing for many of them. About 40% of NY State of Healths private plan enrollees in 2015 had incomes below 200% of the poverty level. They became eligible instead for the Essential Plan in 2016, which is a more affordable option than the coverage they had in 2015.
Thanks to the American Rescue Plan, New York received an additional $750 million in federal funding for the Essential Plan.
You Might Qualify For A Tax Credit
Depending on your income level, you might qualify for a tax credit when purchasing health insurance at the NY State of Health exchange. Those with annual incomes between 133 and 400 percent of the Federal Poverty Line will have their premium contributions capped at a maximum of 9.5 percent of their income when purchasing a Silver level plan.
For example, if your 2021 income is:
- Up to 133 percent of the FPL = your maximum premium contribution will be 2.07 % of your annual income
- 133-150 percent of the FPL = your maximum premium contribution will be 3.10 4.14 % of your annual income
- 150-200 percent of the FPL = your maximum premium contribution will be 4.14 6.52 % of your annual income
- 200-250 percent of the FPL = your maximum premium contribution will be 6.52 8.33 % of your annual income
- 250-300 percent of the FPL = your maximum premium contribution will be 8.33 9.83 % of your annual income
- 300-400 percent of the FPL = your maximum premium contribution will be 9.83 % of your annual income
Individuals in the 133 to 400 percent of the FPL range are also eligible for a premium tax credit. The premium tax credit is determined by subtracting the difference between the individuals maximum premium contribution and the unsubsidized cost of the second-lowest Silver level plan offered in an individuals geographic area. That amount is their premium tax credit.
Lets take a look at an example:
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How Much Do I Need To Pay If I Dont Want Health Insurance
Under the Affordable Care Act, everyone is mandated to have health insurance coverage.
Since 2019, the ACAs federal individual mandate penalty has been $0 and that will continue to be the case in 2021. People who are uninsured will not face a penalty unless theyre in a state that has its own mandate and penalty for non-compliance. However, in 2014 the fee for not having coverage was $95 for an individual or 1 percent of income, whichever was higher. In 2015 that penalty went up to $325 or 2 percent of income. Then, in 2016 the penalty increased to $695 or 2.5 percent of income. From 2017 to 2018, the increase in penalty was tied to an annual cost of living adjustment and based on inflation.
How Much Does The Ny State Of Health Insurance Plan Cost
Health insurance plans sold through the New York State Health Benefit Exchange have risen steadily since the creation of the NYSOH. Original estimates expected health insurance rates to fall. Unfortunately due to several factors, rates have increased annually. The major factors attributed to rate increase are
- Less carrier competition in the marketplace
- a greater pool of unhealthy insureds
- younger people not signing up for insurance as anticipated
- Congress removing promised risk optimization funding to insureds
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Is New York Prepared For The Next Health Crisis
ALBANY, N.Y. – The COVID-19 pandemic exposed New Yorks weaknesses and strengths for dealing with a health care crisis. The best thing any state can do is learn from the past to build back a better plan to handle the next health care crisis better than COVID.
Although there are challenges, the state is in a better place today than it was a year ago, according to the Trust for Americas Health . The organization released a report Thursday that ranks the preparedness of each state. There are three tiers ranking states performance in handling health crises, low, middle, and high.
New York ranked in the low tier for performance in 2021 but was able to reach the middle tier in 2022 along with 19 other states including Delaware, Maine, and New Hampshire on the east coast. TFAH looked at how much money states spend on health care, patient safety, workforce resiliency, and other indicators to rank performance.
New Yorks direct neighbors, Connecticut, Pennsylvania, Massachusetts, New Jersey, and Vermont were all ranked in the high tier. New York was one of nine states that improved by one tier. There were three states that improved by two tiers and 16 states dropped a tier. TFAH said this is in part because a new indicator was added that takes into consideration the percentage of the population served by a comprehensive public health system.
New York State Of Health Vs Ehealth
eHealth is a private, online health insurance exchange where you can shop for individual, family, and small business health insurance plans. eHealths exchange is separate from the government-run exchanges like New York State of Health, but in many states eHealth has agreements to partner with the government-run exchange. In those states, if you want a qualified health plan under the Patient Protection and Affordable Care Act that will allow you to get federal subsides, you can still shop those plans on eHealth. In addition to qualified health plans, eHealth has a wide range of health insurance plans and products that you might not find on your states health insurance exchange.
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Th Century The American Revolution And Statehood
The Sons of Liberty were organized in New York City during the 1760s, largely in response to the oppressive Stamp Act passed by the British Parliament in 1765. The Stamp Act Congress met in the city on October 19 of that year, composed of representatives from across the Thirteen Colonies who set the stage for the Continental Congress to follow. The Stamp Act Congress resulted in the , which was the first written expression by representatives of the Americans of many of the rights and complaints later expressed in the United States Declaration of Independence. This included the right to representative government. At the same time, given strong commercial, personal and sentimental links to Britain, many New York residents were Loyalists. The Capture of Fort Ticonderoga provided the cannon and gunpowder necessary to force a British withdrawal from the Siege of Boston in 1775.
In an attempt to retain their sovereignty and remain an independent nation positioned between the new United States and British North America, four of the Iroquois Nations fought on the side of the British only the Oneida and their dependents, the Tuscarora, allied themselves with the Americans. In retaliation for attacks on the frontier led by Joseph Brant and Loyalist Mohawk forces, the Sullivan Expedition of 1779 destroyed nearly 50 Iroquois villages, adjacent croplands and winter stores, forcing many refugees to British-held Niagara.
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Enrollment In New Yorks Exchange Plus A Look At Historical Enrollment Since 2014
By the end of May 2021, New York State of Health reported that it had more than 6 million enrollees. Most are enrolled in Medicaid, the Essential Plan, or Child Health Plus, with only 220,000 enrolled in qualified health plans .
Enrollment in QHPs was lower than it had been in 2020, when 272,948 people had enrolled in QHPs during open enrollment. But enrollment in Medicaid, Child Health Plan, and the Essential Plan were all higher than they had been in prior years, due in large part to the pandemic and the resulting job losses and income reductions. Its also important to note that nationwide, states are not disenrolling people from Medicaid until after the pandemic emergency period ends, resulting in higher Medicaid enrollment than wed otherwise see.
For perspective, heres a look at QHP enrollment in New York State of Health since 2014:
- 2014: 370,451 people enrolled in QHPs
- 2015: 408,841 people enrolled in QHPs
- 2016: 271,964 people enrolled in QHPs
- 2017: 242,880 people enrolled
- 2018: 253,102 people enrolled in QHPs
- 2019: 271,873 people enrolled in QHPs
- 2020: 272,948 people enrolled in QHPs
- 2021: 215,889 people enrolled in QHPs Note that 215,889 was the official CMS enrollment total as of the initially scheduled end of open enrollment. But open enrollment has been extended due to COVID, and NY State of Health reported that the enrollment total had grown to 220,000 by the end of May 2021.
A Culture Of Consumer Protections And Health Care Reform
Over the years, New York has implemented various regulations to enhance consumer protections, including
- A higher actuarial value requirement than the federal government imposes. (And as of 2019, New York requires silver plans to have an actuarial value that can only vary between 70% and 72%, not counting cost-sharing reduction variations of silver plans. Under federal rules, silver plans can have an actuarial value between 66% and 72%, but New York is no longer allowing a negative de minimis variation for silver plans.
- Surprise balance billing protections ,
- Extending the definition of small group to groups with up to 100 employees
- Not allowing premiums in the small group and individual market to vary based on age or tobacco use.
New Yorks Assembly has passed several bills over the years that would create a single-payer system in the state, but none of the bills have survived in the Senate. The 2021 legislation is A.6058 and S.5474, although neither advanced out of committee.
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