by Admin. | Aug 6, 2018 | CT, group health insurance, Health Exchanges, healthcare, latest health insurance news, NJ, NY News, Obamacare, Small Business Group Health
NYS 2019 Final Rates Approved 
NYS has approved 2019 Final Rates last Friday. Small group rates will increase 3.8% and 8.6% for individuals.
As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2019 Rate Requests. Despite only 3 months of mature claims data experience for 2018 health insurers’ original requests were noticeably below average 7.5% for small group and 24% for individuals. Ultimately NYS reduced this request substantially by approximately 50%.
Experts are concerned over the long term effects. Example, the Individual mandate was removed last December by Presidential order. Without the Mandate anyone can drop insurance without penalty. A comparable take away for similar auto insurance industry would be something like this -Drivers ought not be mandated to buy auto insurance as its a profit scheme by Insurers. While a popular decision this will hardly bend the curve long term and reduce competition. Furthermore, the new order of Selling Across State lines makes NYS most unwelcoming.
OTHER STATES
Insurers have been filing to sell Obamacare plans that will go into effect in 2019, and in some states they appear to be pricing in for the fact that the mandate is going away next year. Other states are seeing mild increases, but that is in part because they saw significant hikes for the previous year.
Insurers have concluded that fewer people will enroll without the mandate than otherwise, so in some places they are pricing their plans higher based on the assumption that sicker people will be left behind, which will increase medical costs for those left. It is well worth pointing out that in recent years the loss federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.
How are neighboring States doing?
In NJ, not that bad. Last year the average increase were 5.5% for small groups and some popular plans such as Horizon Blue Cross Blue Shield’s OMINA increasing only 4.8% increase. This year the increase is only 5.2. Other insurers offering EPO and HMO plans in the individual market for 2019 include Oscar Health and Oxford Health Plans.
With individual mandate repeal fewer people will buy health insurance raising the prices for those who do. NJ Banking and Insurance Department officials said premium prices would have increased, on average, by 12.6 percent.
For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases last year. The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year: The proposed average small group rate increase request is a 10.22 percent and ranges from -5.0 percent to 21.1 percent. This compares to the average increase request of 18.06 percent requested last year.The proposed average individual rate increase request is 12.3 percent and ranges from -10.9 percent to 31.0 percent. This compares to the average increase request of 25.51 percent requested last year.
Final plan rates in New Jersey & CT will be finalized and released in the fall, state officials said. ACA open enrollment begins Nov. 1
- Trend: Trend is a factor that accounts for rising health care costs, including the cost of prescription drugs, and the increased demand for medical services.
- Uncertainty in Washington:
- Removal of penalty for individual mandate: The elimination of the penalty means that individuals who are typically younger and healthier would have no inducement to participate in the insurance pool, which could further destabilize the market. Lack of participation shrinks the pool and increases the cost of insurance to the remaining members.
- Short-duration health plans and Association Health Plans: Still pending are final federal regulations on non-ACA compliant short-duration plans, which may have implications for the ACA risk pool. Also, Connecticut along with other state insurance regulators, are awaiting clarification from the federal government on new federal regulations allowing association health plans, which could further shrink the ACA risk pool.
A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.
Finally, a tax on health insurance premiums has been reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested for 2019 and for 2019
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit. Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see – Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.
The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.
Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.
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by Admin. | Jun 12, 2018 | family health insurance, Health Care Reform, Individual Exchanges, individual health insurance, latest health insurance news, NJ
New Jersey Enacts Individual Health Mandate
A new law entitled the “New Jersey Health Insurance Market Preservation Act” was signed by Governor Phil Murphy on May 30, 2018 to reestablish the recently repealed “shared responsibility tax”. The law, which will take effect on January 1, 2019, will require every New Jersey resident to obtain health insurance with minimum essential coverage or pay a fee, essentially adopting the rules of the ACA.
This legislation will directly impact residents of NJ and indirectly affect employers with employees residing in the state.
State Individual Mandate
The New Jersey Health Insurance Market Preservation Act will require all New Jersey residents to have Minimum EssentialCoverage (MEC) beginning January 1, 2019, or pay a penalty.
In light of Federal repeal on Dec 29, 2017, Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019, NJ’s mandate is scheduled to take effect on January 1, 2019, making NJ the second state, after Massachusetts, to enactan individual mandate. The mandate includes an annual penalty of 2.5% of a household’s income or $695 per adultand $347 per child – whichever is higher. The maximum penalty is based on household income and will not exceed theaverage yearly premium of a bronze plan.If it’s based on a per-person charge, the maximum household penalty will be $2,085.
A “hardship exemption” will be available for individuals who cannot afford coverage, determined by the State Treasurer. NJ expects to collect between $90 million and $100 million in penalties. This money, along with additional federal funding, willbe used on a reinsurance program, which Murphy also signed into law.
Employer Action
While these bills do not directly affect employer sponsored plans, the individual mandate requirement for NJ residents will likely require education for employees. As residents in NJ will now be required to obtain health overage to avoid a state income tax penalty, employers may see an increase in plan enrollment. Unlike Massachusetts which requires specific coverage components, the NJ law only requires that coverage be MEC. Thus, most traditional employer-sponsored group health plans should meet this definition. However, coverage for only dental benefits, certain medical indemnity policies and vision benefits are likely not sufficient for purposes of avoiding the state tax. For now, employers with employees who reside in New Jersey may wish to educate employees at Open Enrollment that by January 1, 2019 health coverage will be required for NJ residents to avoid a penalty.
Conclusion
New Jersey lawmakers feared the repeal would drive healthier people out of the marketplace causing premiums to spike. They believe this law is pertinent to stabilize the marketplace, keep people insured, and prevent a death spiral of the individual market.
Resource:Obamacare Indivudal Mandate & Individual Mandate ACA Flow Chart and https://www.healthcare.gov/fees/fee-for-not-being-covered/
by Admin. | Aug 24, 2017 | group health insurance, Health Care Reform, latest health insurance news, NY News, Obamacare, Small Business Group Health, Tax
CareConnect Withdraws from NYS Market
CareConnect today has announced their intent to withdraw from the NYS 2018 market. The ACA Risk Adjustment Program was penalizing CareConnect again $100 Million for 2018 after a $112 million tax in 2017.
The problems CareConnect was facing were not new and was covered in last month blog. This problem has bipartisan recognition and Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program. While this tax or “risk adjustment penalty” was intended to increase competition it is blamed as the single largest bankruptcy cause for the 12 of 16 Obamacare Co-Ops such as the Health Republic of NY and for start-ups like Oscar and CareConnect.
The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as many claims data, and therefore their membership base looks healthier than it is. In a twisted way, the young companies in need of help were actually subsidizing mature Insurers with legacy data systems.
Who is CareConnect?
CareConnect is a physician/hospital-owned Insurer by Northwell Health also formerly known as North SHore LIJ. Careconnect manages the health of 400,000 individuals, including 125,000 customers. Outside of the risk adjustment penalty the Insurer was managing population health and would have posted a profit. Their past rate increases were single digits.
Sadly, this is a tremendous consumer market hit. Their growth was predicated on delivering excellence of care while still mindful of consumer affordability, see chart below. Not only were they on average 20-30% less expensive but their benefits were typically enhanced. Example: A Tradition Gold plan member would NOT have a deductible nor coinsurance for surgeries and hospital stays at a time when all competing Gold plans did.
Regrettably, no State appeal has been victorious as of yet. With logger-head federal conflicts in Government today on repairing Obamacare flaws the victims will once again be the middle-class consumer.
See Press release:
https://www.northwell.edu/about/news/press-releases/while-preserving-its-population-health-commitment-northwell-withdraw-careconnect-nys-insurance-market
Next Step:
Please sign up for the Sept 13th webinar below on CareConnect Exit & Next Steps for Your Group.
by Admin. | Aug 20, 2017 | family health insurance, group health insurance, Health Care Reform, healthcare, Individual Exchanges, individual health insurance, latest health insurance news, NY News, Obamacare, Small Business Group Health, State Exchanges
NYS 2018 Final Rates Approved 
NYS has approved 2018 Final Rates last week. Small group rates will increase 9.3% while the individual rate average increase will be 13.9%.
As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2018 Rate Requests. With only 3 months of mature claims, experience for 2017 health insurers’ requests are historically above average. Ultimately the State reduces this request substantially. This year, however, NYS acknowledged that medical costs increased, citing a 7-percent average increase on the individual market and an 8.5-percent increase on the small group market. The administration also acknowledged drug prices have impacted insurers, pointing specifically to blockbuster drugs for Hepatitis C.
OTHER STATES
The national rate trend, however, has been much higher than in past years due to higher health care costs Like other states throughout the nation, the 2017 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program. The loss of the program’s a.k.a. federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.
How are neighboring States doing? In NJ, not that bad. According to a review of filings made public last week the expected rate increase will likely be half. Example: Horizon Blue Cross Blue Shield requested a 4.8% increase on their OMINA Plans. For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases.
While the individual mandate is still the law, Washington has made it clear that they aren’t going to enforce the mandate. That means fewer people will buy health insurance raising the prices for those who do.
A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.
Finally, a tax on health insurance premiums is due to be reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested last year.
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
The new premium hikes ranged from as little as .8% percent for Hudson Valley’s Crystal Run Health Insurance Company to a whopping 20.4% percent increase for Albany region’s CDHP. Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit.
Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see – Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.
The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.
* All amounts are rounded to the nearest 1/10.
**Indicates that the company makes products available on the “New York State of Health” marketplace.
Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.
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by Admin. | Jun 7, 2017 | family health insurance, group health insurance, Health Care Reform, Health Exchanges, individual health insurance, latest health insurance news, NY News
Yesterday, NYS 2018 Rate Requests filings were released. The total weighted average increases were 11.5% small groups and 16.6% individual market. This early filing request deadline request requirement is not an Obamacare requirement. As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.
These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year. The news comes as insurance companies across the country brace consumers for another year of large rate hikes, owing in part to the composition of the individual market, and in part to the uncertainty over the future of the law under the Trump administration.
Background:
By comparison last year NYS 2017 Rate Request early filings were higher at 12.3% small group and 19.3% for individuals. The final filing rates were lower NYS 2017 Final Rates were 8.3% small group and 16.6% for individuals. The NYS 2016 Rates final rates were 9.8% small group and 17.1% for individuals. Using these past figures one projects a 2018 Final Rates of 7% small groups and 14% individuals.
With only 3 months of mature claims in 2017 to work of off Insurance Actuaries have little experience to predict accurate projections. Simply put the less credible information presented to actuarial the higher the uncertainty and higher than the expected rate increase. The national rate trend, however, has been much higher than in past years due to higher health care costs and the loss of Federal reinsurance fund known as risk reinsurance corridor.
Individuals:
Individual rates are expected to be higher than the small group market. The national rate trend, however, has been much higher than in past years due to higher health care costs Like other states throughout the nation, the 2018 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program. The loss of the program’s aka federal risk reinsurance corridor funds accounts for 5.5 percent of the rate increase.
This is one of the reasons why the individual market is significantly more costly to operate than the small group as per recent Aetna and United Healthcare pull out of most State Individual Exchanges. Another local example was last year’s Oscar Health Insurance which had lost $105 million and is asking for up to 30% rate increase. The 3-year-old company said the increase was necessary because medical costs have risen, government programs that helped cover costs are ending, and its members needed more care than expected. For 2018, with successful pivotal changes, Oscar is asking below average 11% individual increase and a decrease of 3.2% small group next year.
Small Groups:
While small group rates are better risk and naturally lower rates. There is some rate shock with notably Careconnect. CareConnect, the financially struggling health insurance arm of Northwell Health, has asked the Cuomo administration to allow an average 30 percent premium hike on the individual market in 2018. The company, which lost $157 million in 2016, is asking for small group increases that range between 9 and 24 percent.
THE THREE R – RISK CORRIDOR, RISK ADJUSTMENT & REINSURANCE designed to mitigate the adverse selection and risk selection. The problem, according to many insurance companies, is that the formula is flawed, and CareConnect executives have consistently complained that they are at an unfair disadvantage. The Cuomo administration has taken steps to ameliorate some of those problems, giving the DFS the authority to essentially overrule the federal numbers. In its first-quarter financial report, executives made clear that the risk adjustment penalty was a threat to its business.
Defined Contribution Choice:
Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange. This is a true defined contribution empowering employees with the choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as THE RISK OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.
You may view the NYS 2018 Rate Requests DFS press release, which includes a recap of the increases requested and approved by clicking here.
For a custom analysis detailing YOUR upcoming 2017-2018 renewal please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Summary of 2018 Requested Rate Actions
INDIVIDUAL MARKET
| Company Name |
2018 Requested Rate Action |
| Affinity |
23.5% |
| Care Connect |
29.7% |
| CDPHP |
15.2% |
| Crystal Run Health Plan, LLC |
8.7% |
| Emblem (HIP) |
24.9% |
| Empire ** |
N/A |
| Excellus |
4.4% |
| Fidelis |
8.5% |
| Healthfirst Insurance Company, Inc. |
13.0% |
| Healthfirst PHSP, Inc. |
22.1% |
| HealthNow New York |
47.3% |
| IHBC |
25.9% |
| MetroPlus |
7.9% |
| MVP Health Plan |
13.5% |
| Oscar |
11.1% |
| UnitedHealthcare of New York Inc |
38.5% |
| Total Weighted Average |
16.6% |
SMALL GROUP MARKET
| Company Name |
2018 Requested Rate Action |
| Aetna Life |
14.2% |
| Care Connect |
19.3% |
| CDPHP |
21.1% |
| CDPHP UBI |
8.6% |
| Crystal Run Health Insurance Company |
0.0% |
| Crystal Run Health Plan, LLC |
3.9% |
| Emblem (HIP) |
8.5% |
| Empire Healthchoice Assurance |
12.9% |
| Empire Healthchoice HMO |
13.8% |
| Excellus |
8.0% |
| Healthfirst Health Plan, Inc. |
10.0% |
| Healthfirst Insurance Company, Inc. |
10.0% |
| HealthNow New York |
8.9% |
| IHBC |
14.5% |
| MetroPlus |
5.1% |
| MVP Health Plan |
8.5% |
| MVP Health Services Corp |
11.7% |
| Oscar |
-3.2% |
| Oxford Health Insurance Inc |
11.4% |
| UnitedHealthcare Ins Company of New York |
15.2% |
| Total Weighted Average |
11.5% |
*These averages may change based on DFS’s review of the rate applications.
** Empire submitted a filing that DFS is evaluating.
by Admin. | Jun 28, 2016 | individual health insurance, latest health insurance news, NY News, United Healthcare
Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017 
A neat quote mentioned in yesterday’s Crains Health Pulse. I only wish it were for better news.
1. Oxford will be leaving NY Individual health plans. The popular Oxford Metro plan offered off-exchange marketplace will no longer be offered next year. Notably, this is the only plan that contained par excellence cancer hospitals such as Memorial Sloan Kettering.
Oxford Metro will still be available for NY Small groups.
2. Oxford Liberty HMO plans will be leaving ALL segments – Individuals to commercial large groups. For restaurants and retail shops, as an example, this is a very popular platform as this allowed flexibility of NO minimum participation. If only 1 person wanted to enroll on plan out 20 that was OK.
Oxford will be sending these letters out to Employers starting with Jan 2017 renewals.
Oxford Health Plans (NY), Inc. (OHP) License Withdrawal, Effective January 1, 2017, Upon Renewal
Please note the following:
- This change does not affect their regular Oxford Health Insurance, Inc. (OHI) plans. Their OHI portfolio in New York offers a wide range of coverage options for employers of all sizes.
- Impacted groups and members will receive a notice from us approximately 180-days prior to their 2017 coverage end date. The notice will outline the actions they need to take and other available coverage options.
Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
