New York

Last spring I noted that New York announced that they were launching not just one, but two important new expansions of financial assistance to ACA enrollees.

First, they went live on April 1st with expanding their wildly popular Basic Health Plan program (called the Essential Plan), which was already providing comprehensive, affordable healthcare coverage to 1.4 million New Yorkers, up the income scale from maxing out at 200% of the Federal Poverty Level up to 250% FPL. This increased enrollment in the program to 1.5 million people.

In addition, however, there was a second expansion program announced which was sort of buried at the time:

Originally posted 6/13/24

Via the New York Dept. of Financial Services, the preliminary, weighted average rate increases being requested for individual market health insurance policies for 2025 sound bad: 16.6% overall according to DIFS. I get a slightly lower weighted average of 16.2%, but it still ain't pretty.

Two of the highest increases are for carriers which are only offering policies off-exchange next year and which have fewer than 100 enrollees each anyway (Aetna and UnitedHealthcare Insurance Co. of NY); I assume they're both winding down their operations in the state.

As for the rest, they range from requested average increases of "only" 8.8% for the other UHC division to a stunning 51% rate hike by Emblem (HIP). The justification summaries are below the table.

It's important to remember that these are not final rate increases--New York in particular has a tendency to slash the requested rate hikes down significantly before approving them.

As I've written about several times before, starting April 1st, New York State expanded their wildly popular Essential Plan program (NY's name for the ACA's Basic Health Plan program) up the household income scale from 200% of the federal poverty level (FPL) to 250% FPL:

On March 1, 2024, the U.S. Department of Health and Human Services (HHS) and U.S. Department of Treasury approved New York's Section 1332 State Innovation Waiver application to expand the Essential Plan.  Section 1332 State Innovation Waivers allow states to pursue innovative strategies for providing residents with access to high quality, affordable health insurance.  The waiver was approved for five years, from 2024 through 2028.

...Key Components of the Waiver

This approved State Innovation waiver expands health insurance and covers health-related social needs, improving health care and advancing health equity.  The waiver includes the following key components: 

via NY State of Health:

Effective January 1, 2025, Waiting Periods Will No Longer Be Permitted for the Majority of Adult Dental Services Offered Through the Marketplace

• New York State Continues to Explore Improvements to Adult Dental Benefits for 2026 and Beyond

ALBANY, N.Y. (April 4, 2024) – The New York State Department of Health, NY State of Health, and the Department of Financial Services announced today that, effective January 1, 2025, there will no longer be waiting periods for the majority of adult dental services for Individual Stand-Alone Dental Plans available to purchase on the Marketplace. This change is the first of a multi-phased initiative to improve dental products and to improve the dental plan shopping experience for consumers. 

Earlier today I noted that New York has officially implemented their expansion of the Essential Plan, their branding of the ACA-funded Basic Health Plan (BHP) program that currently covers 1.2 million New Yorkers, from residents earning under 200% of the Federal Poverty Level up to those earning as much as 250% FPL.

In doing so, around 100,000 additional people are now enrolled in the BHP program, with roughly 62,000 of them now saving an average $4,700/year versus the ACA exchange plans they were previously enrolled in, plus another ~32,000 who I presume are completely new to either program.

New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves 1.2 million New Yorkers, or over 4x as many residents as ACA exchange plans do.

Whenever I write about BHPs I always throw in a simple explainer about what it is, with an assist from Louise Norris:

Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.

New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves 1.2 million New Yorkers, or over 4x as many residents as ACA exchange plans do.

Whenever I write about BHPs I always throw in a simple explainer about what it is, with an assist from Louise Norris:

Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.

via NY State of Health:

Enrollment Remains Open Across All Marketplace Programs for Duration of Public Health Emergency Unwind

Albany, N.Y. (February 28, 2024) – Representatives from NY State of Health, the state’s official health plan Marketplace, will make an appearance at job fairs across the State beginning next month to inform New Yorkers about their options for quality, affordable health insurance. Certified enrollment assistants will be available to help uninsured job seekers find a plan that fits their budget and health needs and guide existing enrollees through the new renewal process to keep their coverage current.

via NY State of Health:

• Certified Enrollment Assistors Visit Colleges Across New York State
• New Yorkers Who Enroll by February 15 Will Have Coverage in Place for March 1

ALBANY, N.Y. (February 9, 2024) – NY State of Health, the state’s official health plan Marketplace, today announced an informational college campaign, with events taking place on campuses throughout New York State. Certified enrollment assistors will be visiting schools to talk to students about affordable, quality health insurance through the Marketplace, and help current enrollees renew their coverage. Enrollment for 2024 coverage is currently open for Medicaid, Essential Plan, Child Health Plus, and Qualified Health Plans (QHP). Consumers who enroll by February 15 will have coverage for March 1.

As I noted last week, while the 2024 ACA Open Enrollment Period ended in most states back on January 15th, and in several more as late as January 31st, there are two remaining states where it's technically still going on: California, which bumped their final Open Enrollment deadline out by an extra 9 days at the last minute on the 31st, and New York, which announced last fall that they're keeping enrollment fully open to anyone all the way out until the end of May, to coincide with the end of the ongoing Medicaid Unwinding process.