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.
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 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.
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
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 UnitedHealthplans 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.
For more information on how a Private Exchange can help your group please contact us at (855)667-4621.
Health and Human Services had released earlier this year the final version of its 2017 Notice of Benefit and Payment Parameters. Under the Affordable Care Act (ACA) this is issued annually. While the guidance is mostly relate dot the individual marketplace itt does, however, include several items relevant to employers and group health plans, specifically:
Annual limits for cost sharing (out-of-pocket limits)
Marketplace eligibility notifications to employers
Marketplace annual open enrollment period
Small Business Health Options (SHOP) Exchange
ANNUAL LIMITS FOR COST SHARING:
The annual out of pocket limits for plan years beginning on or after January 1, 2017 are $7,150 for individual coverage and $14,300 for family coverage. These cost sharing limits apply to in-network essential health benefits offered under non-grandfathered health plans, both fully and self-insured. Annual deductibles, in-network co-insurance and other types of in-network cost sharing accumulate toward the out-of-pocket limit, including prescription drug copayments. Not included are premium payments, out-of-network cost sharing and spending on non-essential health benefits.
MARKETPLACE ELIGIBILITY NOTIFICATIONS TO EMPLOYERS:
Beginning in 2017, the Marketplace will notify an employer as soon as possible when one of its employee’s first enrolls in subsidized Marketplace coverage. Since some employers may be liable for a penalty under the ACA’s employer mandate when an employee qualifies for a subsidized Marketplace coverage, this change to a more proactive notification process will hopefully provide employers with the opportunity to work with CMS in cases where an improper subsidy has been provided.
MARKETPLACE ANNUAL OPEN ENROLLMENT PERIOD:
Open Enrollment in the Health Insurance Marketplace, Healthcare.gov, for 2017 and 2018 will take place from November 1, 2016 through January 31, 2017 and November 1, 2017 through January 31, 2018, respectively.
SMALL BUSINESS HEALTH OPTIONS (SHOP) EXCHANGE:
Beginning in 2017, small employers electing coverage in the SHOP Exchange will have the option of “vertical choice,” offering plans across all metal levels (platinum, gold, silver and bronze) from one insurer. States who opt out of the vertical choice option will continue to offer employers the choice of selecting health plans that are available at one single metal level of coverage.
Stay proactive and contact us today for a custmozied consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
The State released NYS 2017 Rate Requests with average increases of 17.3% individual market and 12% for small groups. This early 5/12/16 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.
With only 3 months of mature claims in 2016 to work of off Insurance Actuaries have little experience to predict accurate projections. Typically the rate requests must be high and in the past final approvals after negotiations were only half, see https://360peo.com/nys-2016-rates-approved/. 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.
This is one of the reasons why the individual market is significantly more costly to operate than small group as per recent United Healthcare pull out of most State Individual Exchanges, UnitedHealthcare will drop ACA Exchanges. In fact, the Health Republic NY is Shutting Down highlights how an insurer banked on the federal risk corridor reinsurance and underestimated NYS costs of care. Another local example is Oscar Health Insurance which has 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. That all translates into the need for a price correction.
Importantly, the individual market subsides may be on borrowed time. Last week, The Federal Court ruled that Obamacare subsidies were illegally funded. The ruling while the Obama administration challenges it in D.C. Circuit Court of Appeals, is still allowing the reimbursements to continue for now. The practice of some small businesses dropping group health insuarnce in favor of the Individual Plans known as “cash for insurance” is put into question by this. While the IRS ruled that this is prohibited (see below) some small business are attracted to the simplicity of a public exchange and not getting involved in the managing of plans. Prohibited: The IRS prohibits employers from giving (or reimbursing) employees pre-tax funds to buy health insurance on their own—through the state-based and federally facilitated exchanges or private marketplaces alike.1 This practice may result in a $100 per day excise tax per applicable employee, according to an IRS Q&A released in May 2014.2
Instead, 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 OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.
For more information on how a Private Exchange can help your group please Contact us at (855)667-4621.
Summary of 2017 Requested Rate Actions
INDIVIDUAL MARKET
Company Name
2017 Requested Rate Change
Aetna Life Insurance Company
19.4%
Affinity Health Plan, Inc.*
20.7%
Capital District Physicians’ Health Plan*
11.2%
Crystal Run Health Plan, LLC*
89.1%
Empire HealthChoice HMO, Inc.*
24.0%
Excellus Health Plan, Inc.*
15.9%
Health Insurance Plan of Greater New York*
14.0%
Healthfirst PHSP, Inc.*
6.6%
HealthNow New York Inc.*
6.1%
Independent Health Benefits Corporation*
19.2%
MetroPlus Health Plan, Inc.*
20.3%
MVP Health Plan, Inc.*
6.1%
New York State Catholic Health Plan, Inc. dba Fidelis Care New York*
8.1%
North Shore-LIJ CareConnect Insurance Company, Inc.*
29.2%
Oscar Insurance Corporation*
18.4%
UnitedHealthcare of New York, Inc.*
45.6%
Weighted Average Requested Rate Change – Individual Market
17.3%
*Indicates that the company makes products available on the “New York State of Health” marketplace.
SMALL GROUP MARKET
Company Name
2017 Requested Rate Change
Aetna Life Insurance Company
12.0%
Capital District Physicians’ Health Plan, Inc.
9.6%
CDPHP, Universal Benefits Inc.*
11.6%
Crystal Run Health Insurance Company, Inc.
61.9%
Crystal Run Health Plan, LLC
66.6%
Empire Healthchoice Assur Inc
10.0%
Empire HealthChoice HMO, Inc.
12.6%
Excellus Health Plan, Inc.*
12.3%
Health Insurance Plan of Greater New York*
10.6%
Healthfirst Health Plan (Managed Health)
5.0%
HealthNow New York Inc.*
5.8%
Independent Health Benefits Corporation*
11.2%
MetroPlus Health Plan, Inc.*
13.1%
MVP Health Plan, Inc.*
5.4%
MVP Health Services Corp.
6.8%
North Shore-LIJ CareConnect Insurance Company, Inc.*
16.8%
Oxford Health Insurance, Inc.*
12.9%
UnitedHealthcare Insurance Company of New York
12.8%
Weighted Average Requested Rate Change – Small Group Market
12.0%
*Indicates that the company makes products available on the “New York State of Health” marketplace.
Oxford has released an affordable new plan for 2016 and not a moment too soon. With the recent exit of popular Health Republic of NY, Health Republic NY is Shutting Down, the market is starving for an affordable option.
Today’s largest networks with in-network only GOLD are priced at $9,000/single annually. They typically are accompanied with $50 copays and non-office exposures of $1,000 deductibles and coinsurance percent in network. The new Metro network is approximately 25% smaller than NY Liberty network with up to 15% IN SAVINGS. For example, an Oxford Liberty HMO Gold is $745 vs Oxford Metro Gold $650.
In 2015 Oxford’s Garden State Network originated the same game plan of offering a third network in addition to FREEDOM and LIBERTY. After all what good is a large network when one cannot afford to visit Providers? The third network answers the call for access to Providers with half the copays priced at approximately $1,500 less.
All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists. Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Mt Kisko Medical Group are NOT in the network.
The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network.
Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
ACA Marketplace and Employer Health Plan Cost Comparison
Are you ready for 2016 Individual Open Enrollment? The #1 question we get form individuals is am I better off staying on the individual plan or joining my small employer group plan?
Starting Nov 1, 2015, the 3rd anniversary of Obamacare’s ACA Marketplace begins. Continuing through 2018, several new parts of the Affordable Care Act that affect costs and benefits will be rolled out. The remaining provisions will take effect against a backdrop of new patterns in health care spending and trends.
A frequent Employer question is how do costs compare on the ACA Marektplace vs. Employer Health Plans. The infographic from the Commonwealth Fund point out that the premiums are more favorable when factoring low income premium subsidies. In order to even the scales, an individual must earn $23,500 for a net subsidized premium of $125/month (click Kaiser calculator). This number represents 60% of marketplace enrollees. The same $125/month contribution amount represents 55% of employer health plans.
One positive point is that U.S. health care spending has slowed in the past few years. In a recent 16-month period, nearly 23 million Americans have enrolled in the Affordable Care Act, while almost 6 million people lost coverage. Research from Rand Corp. finds that of the newly insured:
42 percent are covered through employer-sponsored plans.
29 percent are enrolled in Medicaid.
18 percent have health coverage in individual marketplaces.
Take a look at the infographic:
2016 Open Enrollment Deadlines:
November 1, 2015: Open Enrollment starts — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
FYI2016 plans and prices will be available for preview the third week of October, 2015.
December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.
If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Marketplace Special Enrollment Period.
Penalty: The uninsured penalty rises to $695 or 2.5% of your income, whichever is higher.
Coverage start dates
If you enroll before the 15th of any month, your coverage starts the first day of the next month. If you enroll after the 15th of the month, you’ll have to wait until the month after that for your coverage to start. So, for example, if you enroll on January 16, your coverage would start on March 1.
Enroll using our online comparison shopping tool for both on and off-Exchange Marketplace to be released next week. Email us or Contact us at (855)667-4621.
BREAKING: The young Co-Op start up of 2014 will be shutting down Dec 31, 2015. With membership totals approx. 200,000+ the early exit comes as a shocking surprise despite their recent losses and 15-20% rate increase approved for 2016.
On Friday, a joint announcement came from the state Department of Financial Services, the Department of Health and the federal Centers for Medicare and Medicaid Services (CMS), with DFS directing Health Republic to cease writing new health insurance policies and begin an orderly wind-down of business.
“Given Health Republic’s financial situation, commencing an orderly wind down process before the upcoming open enrollment period is the best course of action to protect consumers,” said Anthony Albanese, acting superintendent at DFS. “Moving forward, we will work closely with New York State of Health and federal regulators to help ensure continuity of coverage for Health Republic’s customers.”CMS officials said decision was made after state and federal agencies determined it was likely Health Republic would become financially insolvent.
According to recent announcements Health Republic of NY was exiting the small group and individual markets for Mid-Hudson, Albany, and Utica/Watertown regions. These counties include: Albany, Columbia, Delaware, Dutchess, Essex, Greene, Hamilton, Oneida, Orange, Oswego, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Ulster, Warren, and Washington. The reasoning was the high delivery costs driven by Provider consolidation, see https://healthrepublicny.org/media/2563/faqs-service-area-reductions.pdf.
With recent exits for Insurers such Atlantis, Emblem Health/GHI and Empire blue Cross the transitions were handled differently. Some allowed groups to see their plan through renewal anniversary date or end of year. Further announcements are expected on transition of coverage.
Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please contact us info@medicalsolutionscorp.com today.
