NYS Health Exchange 100,000 Enrolled. According to a USA Today article More than 100,000 enroll in N.Y. health exchange, up a third in less than two weeks according to the state Health Department .
According to the NYS Exchange site www.nystateofhealth.ny.gov– As of today, 100,881 state residents had enrolled in a health insurance plan through the state’s exchange. Additionally, 314,146 people had “completed applications” for coverage. The state did not break down the latest data based on the number of people enrolling in private insurance versus Medicaid. The state’s already “vast” Medicaid system “has been credited with having an easier transition to the health exchange.” New York state plans to enroll a total of 1.1 million people by the end of 2016
New York already has a vast Medicaid program, at an annual cost of $50 billion, it has been credited with having an easier transition to the health exchange. Reuters reported Dec. 4 that about 29,000 people signed up for health insurance through the federal HealthCare.gov website on Dec. 1 and Dec. 2 – eclipsing the 26,000 for all of October.
According to sources and our experience half of the Exchange applicants were to determined not be Medicaid eligible. The article Federal exchange sends unqualified people to Medicaid points out that some qualified Medicaid may not in fact be eligible. “The federal health care exchange is incorrectly determining that some people are eligible for Medicaid when they clearly are not, leaving them with little chance to get the subsidized insurance they are entitled to as the Dec. 23 deadline for enrollment approaches.”
New York State, unlike 36 states, runs its own exchange. The NYS website has had less issues than the troubled Federal health Exchange www.healthcare.gov. Our blog NYS Approves Health Insurance Exchange Rates describes how the new rates lower individual insurance market by 50%.
New York has various tiers of health insurers, and customers can pick from 16 insurers and 10 dental insurers. Quotes can also be viewed on our site. The program also has a small-business marketplace that offers health insurance to businesses with 50 or fewer employees. Large businesses that do not offer employees health insurance could be hit with a fine in 2015.
The exchange also offers tax credits to those who earn less than $45,960 as an individual or $94,200 as a family of four.People without health insurance would be hit with a fine on their income taxes for 2014, starting at about $95 or 1 percent of gross income. The fine can grow to as much as $695 a year , then double in 2015 and grow over time.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
The following companies had health insurance plan rates for the health benefits exchange approved today by DFS. The rates approved today are subject to final certification of the insurers’ participation in the exchange.
Affinity Health Plan, Inc.
American Progressive Life & Health Insurance Company of New York
SHOP Exchange Delayed One Year. The White House just announced that the online Small Business Health Marketplace also known as SHOP Exchange has been delayed until 2015. Small businesses will still have the option to purchase coverage through the new marketplace but will not be able to do so online. Instead, until next fall, employers with fewer than 50 workers will need to work through a broker or agent to buy health plans for their employees.
The Small Business Health Options Program, or SHOP Exchange, has already had a troubled launch with multiple delays as the Obama administration has focused much of its efforts on launching the individual insurance marketplace where Americans can shop for subsidized health insurance coverage.
Small businesses buying coverage will still be eligible for small business tax credits to bring down the cost, according an administration memo. Also, businesses can still purchase the same plans and same rates available on Off-Exchange. Medical Insurance premiums through the business is an ordinary tax deductible expense.
According to NY Times Article, Online Health Law Sign-Up Is Delayed for Small Business – “The announcement of the delay, just before Thanksgiving, is reminiscent of the way the White House announced, just before the Independence Day weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.”
The recent setback is the latest in a stream of missed deadlines, including a postponement for a Spanish language sign-up tool announced this week. The administration also recently pushed back the enrollment deadline for individuals: People who sign up by Dec. 23 can get coverage that starts on Jan. 1. In an earlier delay, businesses with more than 50 workers were given until 2015 to meet the requirement to provide health insurance without paying a penalty. And the deadline date for individuals to avoid penalties for failing to get coverage was pushed back six weeks.
If you should have any further questions regarding the SHOP program or comments about the above or the attached, please let us know. We will continue to monitor this issue and all ACA implementation in an effort to keep you informed of new developments. In the meantime, please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
The Health Exchange also known as The Health Marketplace or Obamacare Exchanges are set to open in less than 12 hours. Are you ready or aye you like most asking What is an Exchange? Starting Oct 1 you can enroll until March 31, 2014, though you’ll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov. The prices for the marketplace plans are likely to be similar to those sold privately. A plan that is also available on the exchange may be eligible for subsidies. Heres an easy top 10 list of what you need to know.
10. Locate your State Exchange
Look up your state’s exchange here and Healthcare.gov. Some states are running their own exchange, others are running it through the federal government see www.healthcare.gov. For NY Tri-State the sites are:
NYS – http://info.nystateofhealth.ny.gov See rates here
CT – https://www.accesshealthct.com See rates here
9. Individual Mandate Penalty
For 2014, the annual penalty is $95 or 1% of your income, whichever is greater. The penalty will increase over the first three years. Coverage can include employer-provided insurance, individual health insurance, Medicare or Medicaid.
Health Insurance Individual Penalty for Not Having Insurance Pay the greater of the two amounts
Year
Percentage of Income
Set Dollar Amount
2014
1%
$95 & $285/family max
2015
2%
$325 & $975/family max
2016
2.5%
$695 & $2,085/family max
8. Individual Subsidies
Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level.
If you make under $45,960 or your family makes under $94,200, you could get a real break on health insurance costs More low-income people will also be eligible for free coverage under Medicaid For those eligible, the subsidies will cap the amount you pay for your exchange policy at between 2% and 9.5% of your income (on a sliding scale, based on your income). To find out how much you would pay, estimate your income for this year and plug it into any health subsidy calculator. You can also see estimate subsidies with these “health subsidy charts”.
7. Small Business Subsidy – SHOP Exchange
A key change is that the small business health care tax credits will only be available ONLY through the SHOP Exchange marketplace in 2014. Small businesses with 25 or fewer employees who receive less than $50,000 a year in wages may be eligible for tax credits if they purchase the plan through the SHOP marketplace. These credits will cover up to 50% of the employer’s cost (35% for non-profits) for the first two years of coverage. Click here to read more about the small business health care tax credits.
6. Your income
not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.
5. Pre-Existing Conditions Eliminated
Your insurer generally can’t drop you, as long as you keep up with your insurance premiums and don’t lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.
4. Essential Health Benefits Covered
Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you. More info here.
3. Ninety-Day Maximum Waiting Period
Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.
2. Annual or Lifetime Limits
Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits may exist in and after 2014 for non-essential benefits.
1. Not Everyone is Eligible
Immigrants who are in the country illegally will be barred from buying insurance on the exchanges. However, legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four).
members of certain religious groups and Native American tribes
incarcerated individuals
people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples)
Conclusion:
There has been a lot of news about individual Obamacare provisions getting delayed – Obamacare Employer mandate Delayed. Some people may assume that means the health law is being slowly dismantled, or put off for an additional several years. .The Affordable Care Act is an extremely complicated law with a lot of moving parts, but ultimately, the biggest provisions are still moving forward. There will likely be more hiccups along the way. As the enrollment period opens for Obamacare’s new exchanges, industry experts predict there will probably be other issues that need to be ironed out — but that doesn’t mean the whole law is collapsing
Still confused?
Don’t be. These are the common questions that we are working through with our clients daily. Am I better off going SHOP Exchange vs. Individual for my business? Am I better off going off Exchanges or onto Private Exchanges? Whats my minimum employer contribution? Do I have to cover employee and dependents? Is dental and vision included? What happens to my Healthy NY when it shuts down Jan 1, 2014? What employer notices must I be posting?
Please contact our team at Millennium Medical Solutions Corp if you have additional questions regarding how SHOP Exchanges and Individual Exchanges can benefit you Stay tuned to our site for updates as more information gets released. Sign up for latest news updates.
Health Exchange Notification Due Oct 1 – Employers Must Distribute Required Exchange Notice
If your organization hasn’t done so already, you have until October 1 to inform employees about their option to enroll in a public health exchange under theAffordable Care Act.
Notice Must Be Provided to Current and New Employees. Following a delay in the original effective date, employers will need to comply with the new requirement to provide each employee a written notice with information about a Health Insurance Exchange (also known as a Marketplace) beginning this Fall.
Employers are required to provide the written notice to each current employee not later than October 1, 2013, and to each new employee at the time of hiring (within 14 days of the employee’s start date) beginning October 1, 2013. Two model notices are available from the U.S. Department of Labor:
Model Notice for Employers Who Offer a Health Plan Model Notice for Employers Who Do Not Offer a Health Plan
Employers must provide the notice to each employee regardless of plan enrollment status (if applicable) or of part-time or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.
The notice may be provided by first-class mail, or, alternatively, it may be provided electronically if certain requirements are met. More information on the notice requirement is available from the U.S. Department of Labor.
IMPORTANT: The model notice contains an optional section about employer-sponsored coverage details. The model notice is three pages long and contains an optional section on page three (questions 13 though 16). An employer is in no way obligated to provide the optional information requested on the model notice. Also, an employer may modify the notice as long as the end result corresponds to the overall basic content guidelines. However, the employer should carefully weigh the value of providing additional information about the cost and value of the employee’s group health plan options.
Technically, the law does not impose any fines for failing to provide the notices. However, the Affordable Care Act is intertwined with other laws (this particular provision is embedded in the FLSA in a new section, 8A), so it is considered a good idea to comply to avoid possible legal complications.
Who Must Receive the Notices?
Notices must be given to all employees, whether or not they work full time, and regardless of whether they are currently receiving health benefits. The October 1 deadline is to give these notices to all employees. After October 1, the notices must be given to new hires within two weeks of coming on board.
The notices must “be provided in writing in a manner calculated to be understood by the average employee,” says the Department of Labor (DOL) in Technical Release 2013-02. They can also be provided via e-mail, but only to employees for whom accessing e-mail is “an “integral part of the employee’s duties” and who can access the system easily.
Which Employers Must Send the Notices?
The notice requirement must be met by employers that must comply with theFair Labor Standards Act (FLSA). In general, the FLSA applies to employers with one or more employees who are engaged in, or produce goods for, interstate commerce. For most firms, a test of not less than $500,000 in annual dollar volume of business applies.
The FLSA also specifically covers the following: hospitals; institutions primarily engaged in the care of the sick, the aged, mentally ill, or disabled who reside on the premises; schools for children who are mentally or physically disabled or gifted; preschools, elementary and secondary schools, and institutions of higher education; as well as federal, state and local government agencies.
Model Notices
The DOL has issued a pair of model notices you can use. One is for employers which currently offer health benefits and another for those which do not. On Part B of the forms, you will see information the employees will need if they plan to purchase coverage on the exchange, assuming they are eligible.
The Part B information would allow employees who apply to their state’s exchange (or the federal version, if no state-run exchange exists) to complete a required questionnaire to determine their eligibility for the program.
The model notice for employers that do currently offer health coverage features a lot of slots for information about your health plan in Part B. Since the law doesn’t actually require you to provide the information, and because some of the information may be hard to dig up employers may decide to disregard some or all of Part B, especially if the information is uncertain or likely to change, employers to be “cautious about volunteering too much information.”
Ask us about our Online Notification Tool developed by our payroll partner. Be sure to visit our section on Health Care Reform for information on other notices required to be provided and to download additional model notices available for employers and group health plans.
Obamacare Simplified Using Youtoon by Kaiser is just what the Doctor ordered. With less than 60 days to go to the October 1, 2013 Health Exchanges Open Enrollment Period what better way to ease the confusion than a 7 minute cartoon?
CMS maintains the HealthCare.gov website, and this is where individuals can find more information on health insurance exchanges, the enrollment for which begins on October 1, 2013. Depending on which state individuals reside in, one may be able to enroll in an exchange plan, or may be directed to their state’s own exchange enrollment site. Employers can also use this site to learn about the Small Business Health Options Program (SHOP) which can help them provide coverage for employees.
Several resources have been made available to help people weed through the information and to make you aware of what requirements and deadlines apply to you. The Kaiser Family Foundation (KFF) brought some levity to the topic by creating an animated video explaining the upcoming changes in health coverage under the ACA. Narrated by Charlie Gibson, “The YouToons Get Ready for Obamacare,” explains what is and isn’t changing under the law and is posted on the KFF site, along with other resources on the topic. KFF President, Drew Altman, was quoted as saying, ’[t]his cartoon is meant to demystify a complex law and explain what it means for you, whether you support or oppose Obamacare.”
For a comparison and additional questions on which Exchange – Individual or SHOP Exchanges is right for you please contact our team at Millennium Medical Solutions Corp. Stay tuned for updates as more information gets released. We’re inside of 45 days until exchanges open, and information will be coming quickly in the next few months. Sign up for latest news updates.
Governor Cuomo announced yesterday that New York’s Health Benefits Exchange have been approved . Additionally, the New York Times yesterday published an article highlighting that the rates in the individual market that will be offered in 2014 are at least 50 percent lower than they are now. The article link and Governor’s office press release are included below.
5 things we now know about the NYS Exchanges:
Importantly, Insurers must still confirm that they will be in either the individual exchange and/ or shop exchange
The rates approved yesterday are subject to final certification of the insurers’ participation in the exchange.
Many of the networks used on the Exchange appear to be smaller than the group rated.
Some new insurers have eneter the marketplace such as OSCAR and Freelancers. While a few such as EmblemHealth have taken a wait and see approach.
Additionally, NYS individual market rate will drop significantly in 2014 but they have been historically always the highest. An individual/Direct Pay HMO is approximately $1,000-$1,200/month. They are still approximately 18% highest.
The Department of Financial Services (DFS) has approved New York’s Health Health Insurance Exchange rates for 17 insurers seeking to offer coverage including eight new entrants into the market that do not currently offer commercial health insurance plans. Please click the following links for the Governor’s Press Release and the Individual and Small Group rates.
The following companies had health insurance plan rates for the health benefits exchange approved today by DFS. The rates approved today are subject to final certification of the insurers’ participation in the exchange.
Aetna
Affinity Health Plan, Inc.
The cheapest you’ll pay for individual health insurance in NY
American Progressive Life & Health Insurance Company of New York
Capital District Physicians Health Plan, Inc.
Health Insurance Plan of Greater New York
Empire BlueCross BlueShield
Excellus
Fidelis Care
Freelancers Co-Op
Healthfirst New York
HealthNow New York, Inc.
Independent Health
MetroPlus Health Plan
MVP Health Plan, Inc.
North Shore LIJ
Oscar Health Insurance Co.
United Healthcare
If you have additional questions regarding how SHOP Exchanges and Individual Exchanges can benefit you please contact our team at Millennium Medical Solutions Corp. Stay tuned for updates as more information gets released. We’re inside of 75 days until exchanges open, and information will be coming quickly in the next few months. Sign up for latest news updates.
