END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

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New York: NY State of Health announces Basic Health Plan details

As I noted back in April, the New York Affordable Care Act exchange (NY State of Health) will become the second state (besides Minnesota) to offer a "Basic Health Plan" under a fairly little-reported on provision of the ACA:

The BHP will offer qualified individuals and families a choice of plans from high-quality, private health insurers through NY State of Heath (NYSOH), the state’s official health plan Marketplace. New York State health insurers were invited to offer plans through the BHP when the NYSOH plan invitation was issued today to New York State licensed health insurance companies. The invitation includes requirements for insurer certification and recertification for Qualified Health Plans and Stand-Alone Dental Plans, and for the new Basic Health Program which will start on January 1, 2016. 

Minnesota's BHP, "MinnesotaCare" has actually been around since 1992, and has simply continued as an ACA-compliant BHP. New York's, however, is brand new...and will ironically have a negative impact on the number of exchange QHP enrollees:

 BHPs are sort of like “Medicaid on steroids” for people under 200 percent of the Federal Poverty Level. Ironically, this ACA provision will likely lead to exchange enrollment being reduced substantially in New York, since about 40 percent of New York’s QHP enrollees fell below 200 percent FPL this year. (73.5 percent were subsidized, of whom 54 percent were below 200 percent FPL.) That could lop up to 200,000 off of the QHP tally.

While this is bad news for the exchange total from a PR perspective (and could also have a negative impact on the QHP risk pool), it's actually good news for those who qualify to enroll in the program. Why? Well, as announced today by the exchange:

NY State of Health (NYSOH) also announced the insurers that will be offering the new Essential Plan to eligible, lower income New Yorkers.  The Essential Plan has no annual deductible and offers the same essential benefits as other plans, including free preventive care.  Consumers pay just $20 a month per adult or nothing at all depending on their income.

Here's a few more details:

What is the Essential Plan?
A new health plan for New Yorkers. It costs much less than other health plans. And it offers the same essential benefits.

Who can buy it?
Lower-income people who don’t qualify for Medicaid or Child Health Plus.

Household Size Income Limits:

  • 1 person: $23,540
  • 2 people: $31,860
  • 3 people: $40,180
  • 4 people: $48,500

How much does it cost?
Either $20 a month per person — less than a dollar a day or NOTHING.

How else does it save me money?
It has NO DEDUCTIBLE, so the plan starts paying for your health care right away. You get FREE PREVENTIVE CARE like routine doctor exams and screenings to keep you healthy.

What does the Essential Plan cover?
The same services covered by other plans:

  • doctor visits, including specialists
  • tests ordered by your doctor
  • prescription drugs
  • inpatient and outpatient care at a hospital