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NYS Health Exchange is down again. Not surprisingly a large volume of late comers trying to beat t0morrows deadline for Jan 1, 2014. Last week a 34% enrollment spike in 1 week alone. Despite the 1 week extension the enrollments are still falling short of the original 600,000 projection. A significant percentage have instead been qualified under expanded Medicaid in NYS. At the same time many New Yorkers have had sole prop and husband/wife groups shut out of the small group market place. In addition, popular programs such as Healthy NY have been increased by 25-35% and new $600/single or $1200/family deductibles.
Facts:
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Important: If the web site is down we can sign up via paper application to avoid the penalty. A surge of 34% enrollments in one week caused some technical delays last week.
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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.
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.
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
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
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.
Last Friday, June 1, 2018, the NYS 2019 Rate Requests filings were released. Great news for SMB! The total weighted average increases were a modest 7.5% small groups but 24% for the 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.
By contrast last year’s NYS 2018 Rate Request early filing request were higher at 11.5% small group but much lower 16.6% for individuals. The NYS final August 2018 rate approval are expected to be lower. For example, the final filing rates were aproved NYS 2018 Final Rates at 9.3% small group and 13.9% for individuals. Incidentally, the NYS 2017 Rates final rates were 8.3% small group and 12.3% for individuals. Using these past figures one projects a 2019 Final Rates of 6.5% small groups and 19% individuals.
With only 3 months of mature claims in 2018 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.
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 2019 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.
The single biggest justification offered by insurers for the requested increases is the recent repeal of the individual mandate penalty –Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019. The individual mandate, a key component of the Affordable Care Act, helped mitigate against dramatic price increases by ensuring healthier insurance pools. Insurers have attributed approximately half of their requested rate increases to the risks they see resulting from its repeal. Without the federal action, the average requested rate increase would be 12.1%. As DFS reviews all of the submissions, we will continue to ensure that any rate increases are fully and actuarially justified by appropriate medical cost increases and are not inadequate, excessive or unfairly discriminatory, in accordance with New York law.
Most encouraging to see the average rate requests for the small group market reflect the increased stability of that market in New York State. The combination of 2-50 and 51-100 market underscores the stability for msall bsuinesses under 50 employees. Prior to the NYS regulatory combination, the 2-50 market was running an average 12-13% trend.
The Obamacare health insurance tax, aka The HIT, is responsible for approximately 2.5%. Whiel the HIT moratorium was approved it had indeed come back last year. The total projection is $14 Billion. Notably, Empire Blue Cross has filed a modest 6% increase as their portfoliio is running stable. Additionaly, Oscar’s inbdustry low 3% filing is practially at break-even considering the HIT.
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.
| Company Name | 2019 Requested Rate Change |
|---|---|
| Aetna Life | 16.2% |
| CDPHP | 6.7% |
| CDPHP UBI | 6.1% |
| Crystal Run Health Insurance Company | 11.5% |
| Crystal Run Health Plan, LLC | 12.5% |
| Emblem | 12.0% |
| Empire Healthchoice Assurance | 6.0% |
| EmpireHealthchoice HMO | 5.2% |
| Excellus* | 3.8% |
| Healthfirst Health Plan, Inc. | 21.0% |
| Healthfirst Insurance Company, Inc. | 7.0% |
| Healthnow New York | -0.1% |
| IHBC* | 3.8% |
| MetroPlus* | 4.7% |
| MVP Health Plan | 7.0% |
| MVP Health Service Corp* | 10.3% |
| Oscar | 3.0% |
| Oxford Health Insurance Inc* | 8.3% |
| UnitedHealthcare Ins Company of New York | 7.2% |
| Weighted average: | 7.5% |
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.
To be clear: These trends affect a small subset of the insurance market—non-group plans that cover less than 2 percent of the population. Many qualify for tax credits that lower their net costs and reduce or eliminate the impact of year-to-year rate increases.However, non-group customers with incomes above 400% of the poverty level ($48,560 for a single adult) get no subsidy—and feel the full brunt of any hikes.
*These averages may change based on DFS’s review of the rate applications.** Empire submitted a filing that DFS is evaluating.
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All groups renewing starting 12/1/17 will no longer be accepted. Currently active group business will end on the last day of their policy year (For example, a 9/1/17 effective will remain in force until 8/31/18).
With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition to the NY Small Business market is especially important. In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI. Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health. Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.
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HEALTHFIRST HOSPITAL NETWORK 2017
DEC 2017 HEALTHFIRST PRO EPO PLANS
JAN 2018 HEALTHFIRST PRO EPO PLANS
Healthfirst has released affordable new 2018 plans for NY small businesses and not a moment too soon. With the recent exit of popular CareConnect of NY the market is starving for an affordable option.
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilin
gual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
Healthifrst’s new January 2018 rates are in fact virtually the same as 4thQ 2017. Example, a single rate is approximately $2-$3 higher. Today’s largest networks with popular in-network only GOLD are priced at $857/single monthly. By comparison the Healthfirst Gold plan is $717 annualy or 15% less expensive. For platinum the price gap jumps are even higher – $1050/single vs $850/single.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to vsisit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
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.
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.
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.
NYS has approved 2017 Final Rates. Small group rates will increase 8.3%, a reduction from the 12.3% average originally requested. In the individual market, the average increase will be 16.6%, a reduction from the originally requested 19.3%.
As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2017 Rate Requests. With only 3 months of mature claims experience for 2016 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.
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 lost of the program’s aka federal risk reinsurance corridor funds accounts 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 be likley ve 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 individual marketplace with average 25% rate increases.
The new premium hikes ranged from as little as 5.6 percent for Oxford Small group to a whopping 58.5% percent increase for Crystal Run Health Insurance Company, an insurer that covers parts of the Hudson Valley and Catskills. Importantly, small group market are 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. Earlier this 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. This is a true defined contribution empowering employees with 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.
***After rate applications were filed on 5/9/2016, additional information, including the final results of the federal risk adjustment program, prompted several insurers to update their initially filed rates.
2/12/15
Last days for 2015 Individual Open Enrollment is ending this week. This deadline applies to both On and Off Exchange!
If you’re wondering about the penalty for not having insurance: yes, there is one, and no, you can’t really get out of paying for it. You’ll pay the penalty when you file your taxes for 2015. Even if you get coverage midway through the year, you’ll still need to pay a penalty for the months you weren’t insured. So get covered!
You can check here at the New York State of Health Marketplace calculator. If you are eligible or think you might be eligible, you can contact the marketplace directly to purchase a plan or ask questions about financial assistance.
Please remember that during open enrollment you are permitted to switch carriers. Choose wisely because after February 15, one cannot switch plans until open enrollment 2015, unless you have a “qualifying event,” such as marriage, divorce, birth or adoption.
How does your health plan’s quality rank? The National Committee for Quality Assurance put out its 2014-2015 NCQA annual list of the best health plans, based on clinical performance, member satisfaction and NCQA accreditation surveys. Topping the list are Massachusettes insurers – Tufts, Harvard Pilgrim Health and Blue Cross Blue Shield of Massachusettes. The NY Metro area winners were Upstate’s Independent Health Association, Capital Districts Physician Health Plan and MVP.
The NCQA believes its own health plan accreditation program and program data could useful to exchange programs, the NCQA says. With so much more individual choice on both, the Marketplace Health Exchange and off-Exchange along with new Health Insurers this is an important consumer tool.
About NCQA
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.
NCQA accreditation ratings are based on three sets of measurements HEDIS®, CAHPS® and NCQA accreditation standards. Health plans in every state, the District of Columbia and Puerto Rico are NCQA Accredited. These plans cover 109 million Americans or 70.5 percent of all Americans enrolled in health plans.
HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare health care quality. The Consumer Assessment of Healthcare Providers and System (CAHPS) is a survey mailed to select members asking them to rate their experience with the care given by their doctors and the services provided by their plans.
How the Results of HEDIS and CAHPS Help Consumers
Results from HEDIS and CAHPS enable consumers to understand how well Insurers are fulfilling our clinical agenda to help members stay healthy, get better quickly or live effectively with chronic illness. In addition, the scores facilitate our ability to identify areas of care and service where we can continue to improve. The results also enable us to compare our companies’ performance with other local and national health plans.
The “Excellent” ratings our plans received demonstrate that members continue to receive high-quality health care and that they are satisfied with the service that their physicians, health care practitioners and health plans provide.
HEDIS® (Healthcare Effectiveness Data and Information Set) is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® (Consumer Assessment of Healthcare Providers and Systems) is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
For more information about these plans and the full range of offerings available through MMS Inc. contact us today at (855) 667-4621.
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