ALBANY – New York’s health exchange will open for its annual enrollment Tuesday as the number of customers soars and amid ongoing questions about the future of the national program.
While the federal government on Oct. 24 said rates would increase 25 percent, New York set its own rates in August with a lower hike: an average of nearly 17 percent.
State officials boasted of the success of its New York State of Health exchange, saying it has exceeded 3.3 million enrollees. About 850,000 of them are getting health insurance for the first time since the exchange started in 2013.
Also, while the federal government said more than one in five consumers in the national program next year would only have one insurer available, New York has 15 insurers offering private insurance through the exchange.
Overall, the rate of New York’s uninsured population fell from 10 percent to 5 percent between 2013 and 2015, according the Centers for Disease Control and Prevention.
The enrollment period runs through Jan. 31, 2017, but the deadline is Dec. 15 to ensure coverage by Jan. 1.
“We want people to come and shop the marketplace, just as in prior years and see what it has to offer them,” Donna Frescatore, the program’s executive director, said.
Insurers, too, seem less critical this year of the exchange in New York. They have long clamored for the ability to significantly raise rates, saying expenses were outpacing revenue.
This year, the state Department of Financial Services gave them largely what they wanted: They sought a 19 percent increase for individuals and got the 17 percent.
The state “acknowledged that plans were seeing losses over the previous two or three years and that they needed to do something to address those ongoing losses,” said Leslie Moran, spokeswoman for the state Health Plan Association, which represents insurers.
“They were more reasonable this year.”
Still, the New York exchange faces questions about its long-term viability because a mere 7 percent of its enrollees are on private insurance.
The rest are on government-funded programs that may strain the state’s budget and increase rates for those who remain on private plans, experts said.
New York’s exchange this year has 2.3 million on Medicaid, 565,000 on a new program called the Essential Plan and 227,000 on Child Health Plus – a plan for low-income children.
The state’s private plans are being drowned out, in particular, by the Essential Plan that started Jan. 1 -- a low-cost option for poor customers that limits premiums to $20 or less a month.
The state likes the program because it is heavily subsidized by the federal government, and customers do too because there’s no annual deductibles and low copays.
In fact, the state estimated in an August report that the average consumer would save about $1,100 a year through the Essential Plan compared to private coverage.
As a result, the Essential Plan is leading to fewer people in the private insurance pool – which was part of the goal of Obamacare: to get more people paying for insurance and thus lowering costs for everyone.
Last year, the state estimated 615,000 would enroll for private plans by the end of 2016. But the Essential Plan has essentially wiped out those estimates.
Now the private insurance customers are down to just 225,000, according to the state Health Department.
A year ago, there were 415,300 people enrolled in private plans – so that’s a drop of 46 percent in just one year.
Dealing with challenges
The result is that only the sick and elderly who might not qualify for Medicaid or its offshoots may remain in private plans – increasing costs to consumers and insurers, said Bill Hammond, director of health policy at the Empire Center, a conservative think tank in Albany.
For the private plan, he said, the state is “having trouble getting customers. In particular, they are having trouble getting younger, healthier customers.”
The marketplace is tailored toward young people: 61 percent of New Yorkers on the exchange are age 34 or younger, the state’s figures show.
Florida, a state of similar size to New York, had 1.5 million people on its private exchange, Hammond recently wrote.
“That means that’s what is left in those exchange plans is an older, sicker population,” Hammond said. “And that means higher premiums and accentuates the problem of the so-called death spiral – where sick people go in, the premiums go up, healthy people drop out.”
State officials, though, remain bullish on its exchange and continue to encourage enrollment in the Essential Plan.
For a family of four, the household income cannot exceed $48,600 to be eligible for the Essential Plan. For an individual, it’s $23,760.
“We’re finding that many people are surprised to find there is financial assistance or perhaps, based on their income or family composition, that they qualify for the Essential Plan for $20 a month,” Frescatore said.
The exchange weathered its most difficult situation last year: Health Republic, which enrolled nearly 20 percent of customers in the public marketplace, shut down due to mounting financial problems.
It was the largest nonprofit cooperative in the nation under the Affordable Care Act, and it was the top insurer in many counties: including Dutchess, Ulster, Putnam and Westchester counties.
The state re-enrolled those customers with new insurers, and the same plans in 2016 will be available in 2017.
The only change is Wellcare, which enrolled less than 1,000 people on qualified, private health plans, is no longer doing so.
Additionally, Health Now – part of BlueCross BlueShield of Western NY – will begin offering the Essential Plan in the region.
This year, the number of insurers by county ranged from 10 in New York City to two in Chemung, Schuyler and Tompkins counties. Most counties have at least four insurer options, the state’s report in August said.
Even before the Affordable Care Act went into effect in 2013, New York had an expansive Medicaid program – at a cost of $62 billion, the most expensive in the nation. It has more than 6 million enrollees, including those in the exchange.
New York is one of 13 state-based marketplaces. Other states are managed largely by the federal program.
So New York already had much of the infrastructure in place to deal with the influx of customers from the exchange, giving it an edge over most other states.
Excellus BlueCross BlueShield, based in Rochester, said it’s looking forward to the enrollment period after New York set the rates in August.
“Now our focus is on retaining our current customers and winning over new customers,” the company said in a statement.
How to enroll
Individuals who are currently enrolled in the NY State of Health will receive information about renewing their coverage for 2017 directly from the state.
New customers can enroll online or over the phone starting Nov 1.
For additional information, visit the NY State of Health website at https://nystateofhealth.ny.gov or call 1-855-355-5777.
There are also “navigators,” who can advice a customer on how to enroll in person. The list of advisers is on the same website.
Key enrollment dates
- November 1, 2016: Open enrollment starts.
- December 15, 2016: Last day to enroll in or change plans for new coverage to start Jan 1.
- January 1, 2017: Coverage starts for those who enroll or change plans by Dec. 15.
January 31, 2017: Open enrollment ends for 2017 for coverage starting March 1.