What to know: NY health exchange opens Nov. 1

ALBANY - Four million New Yorkers will have to re-enroll for their health insurance starting Nov. 1 amid uncertainty over the future of the federally funded program.

NY State of Health hit nearly 4.1 million enrollees earlier this month and continues to grow: Now one in five New Yorkers get their insurance through the exchange.

But with President Donald Trump and congressional Republicans vowing to do away with Obamacare, the enrollment period will open with its long-term future in doubt. Also, two insurers providing individual plans will not participate in 2018.

New York officials, though, said the turmoil in Washington shouldn't discourage residents from signing up for health insurance through the exchange.

Since New York runs its own program, it has more autonomy than most states, whose programs are federally managed.

"That’s what we want consumers to know: They’ve seen and read a lot, but we want them to know that the reality here in New York is we are open for business," said Donna Frescatore, the executive director of NY State of Health.

Here's what you need to know about enrollment this year:

What's new

While the federal government has wanted the enrollment period to end Dec. 15, New York said it would not do so.

Instead, New York's enrollment period will run from Nov. 1 through Jan. 31 -- as it has done in most years since the program started in 2014.

"The marketplace is open for business and is going to be strong in 2018," Frescatore stressed.

For 2018, 12 insurers are on the exchange offering individuals private insurance, called qualified health plans.

Two insurers, CareConnect and Affinity, are dropping individual insurance in 2018.

Consumers enrolled in those plans are receiving a renewal notice with information about how to enroll in other plans, state officials said.

What about cost?

In August, the state Department of Financial Services approved insurance rates for 2018 that will increase, on average ,17 percent for individuals and 11.5 percent for group plans.

State officials said federal tax credits that are available to most enrollees in the exchange would blunt any system-wide increase.

"On average, consumers who select the most popular silver level plan will see a premium decrease by 5 percent," the state Health Department said.

Meanwhile, 15 insurers will offer the Essential Plan, which is available for lower income New Yorkers who are ineligible for Medicaid.

Monthly premiums on the Essential Plan will continue to be $20 per person or less, the Health Department said.


What about the plans available?

The number of insurers available depends on the county where you live.

You can find the list of insurers by county here: info.nystateofhealth.ny.gov/plansmap

There's also a new online tool.

The exchange created a provider and health plan look up, which lets customers shopping for health insurance check to see what insurance their doctors or hospitals accept.  Here's the link for that site: pndslookup.health.ny.gov

Who is enrolled?

While individuals can buy private insurance on the exchange, customers doing so continue to be a small percentage of the total enrollment.

With nearly 4.1 million customers, 69 percent of them are enrolled in Medicaid because they are income eligible. So just 228,000 customers are enrolled in a qualified health plan.

The Essential Plan has been popular for those who earn more than Medicaid allows, but can still get a subsidized plan. About 682,000 New Yorkers are on the Essential plan, while 346,067 children are on Child Health Plus.

People can enroll at any time for Medicaid, but they must do so by Jan. 31 for a private insurance plan -- if they don't get their health insurance through their employer.

There are still income-tax penalties under Obamacare if you go without health insurance.

What about the federal debate?

Trump and congressional Republicans have vowed to repeal and replace Obamacare, but so far they haven't been able to garner the votes to do so.

New York spends $60 billion a year on Medicaid, so any cut in federal aid would have a major impact on its finances, Gov. Andrew Cuomo has warned. And that could impact the health exchange.

"In totality, there are billions and billions of dollars in cuts pending to the state," Cuomo said Wednesday in Glens Falls. "If those federal cuts happen, we couldn’t even imagine how we could fill that hole in the budget."

The Essential Plan also faces uncertainty if Obamacare is overhauled. The program is funded almost entirely through federal reimbursements.

But what changes will ultimately be made is too speculative and is unlikely to affect New York's program in 2018, industry officials said.

"I don’t think there would be sweeping changes in the immediate future," said Leslie Moran, spokeswoman for the state Health Plan Association, which represents insurers. Plus, she added, "New York already has pretty strong consumer protections in place."

Indeed, Cuomo and Attorney General Eric Schneiderman have vowed to sue if the federal government looks to strip New Yorkers' insurance.

Moran said one of the challenges for insurers to make sure customers know that despite the wrangling in Washington, New Yorkers can still get insurance through the exchange.

"We still have a really healthy market here in New York," Moran said.

How to enroll?

Visit nystateofhealth.ny.gov or call the state's customer service line at 1-855-355-5777 for more information or to enroll.

The state will also have "in-person enrollers" at events across the state to help people pick their plans.

Those locations will be posted on the NY State of Health website.

© Gannett Co., Inc. 2017. All Rights Reserved


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