2017 Individual Open Enrollment

2017 Individual Open Enrollment

2017 Individual Open Enrollment

Everything you need to know ahead of tomorrow’s 2017 Individual Open Enrollment.  This Open Enrollment  marks the 4th anniversary of Obamacare a.ka. The Affordable Care Act.  As a helpful resource, the new NY and NJ rates with important deadlines are listed below.   33 States such as NJ use the healthcare.gov website or at https://medicalsolutionscorp.demo.hcinternal.net/individual/individual/homePage.  States such as NY and CT use their own Marketplace –  NYS of Health and AccessHealth CT.  Importantly,  individuals not expecting a subsidy may also apply Off-Exchange which in many case has  more options and Insurers.

2017 NY Individual Health Plans

2017 Individual Open EnrollmentThese rates are for New York City unless otherwise indicated, and for a single person. For a family premium, multiply by 2.85, Husband/Wife
multiply by 2.0 and Parent/Children multiply by 1.70.  The non single deductibles are  out of pocket maximums are doubled. These are for standard plans, which two-thirds of customers enrolled in during 2016.

While deductibles for platinum, gold and silver plans have stayed the same, many bronze plan deductibles have increased 33 percent. That means consumers who purchase a bronze plan — presumably for its lower monthly premium — are paying more out of pocket for their medical costs before their insurance company kicks in a dime. A family of four that purchased a bronze plan will have an $8,000 deductible in 2017, up from $6,000 in 2015. For someone young and relatively healthy, that might be OK, but that person is vulnerable to a very large bill if he or she needs expensive medical care. It’s the platinum plans where New York State really shows itself to be a national outlier. Roughly 18 percent of New Yorkers chose a platinum plan in 2016, compared to 2 percent across the nation, according to the Kaiser Family Foundation.

Here are the 2017 rates:

2017-nys-marketplace-rates-1

2017 NJ Individual Health Plans

NJ Dept of Banking and Insurance posted the 2017 NJ  individual health plans Monday. Only two carriers will offer plans on the state’s Obamacare marketplace next year: Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth.

Additional insurers are participating  off-exchange or outside the Marketplace.   Examples:  Aetna, CIGNA and Oxford.  There are additional 20 plan options available off exchange. A notable new entrant, Health Republic of NJ, will no longer be available for 2017.  See – Health Republic NJ Shutting Down.

Here are the 2017 rates:

2017-new-jersey-individual-health-benefits-plans-and-rates

 

2017 NJ Individual Health Plans

2017 NJ Individual Health Plans

2017 NJ Individual Health Plans   2017 NJ Individual Health Plans

NJ Dept of Banking and Insurance posted the 2017 NJ  individual health plans Monday. Only two carriers will offer plans on the state’s Obamacare marketplace next year: Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth.

Additional insurers are participating  off-exchange or outside the Marketplace.   Examples:  Aetna, CIGNA and Oxford.  There are additional 20 plan options available off exchange. A notable new entrant, Health Republic of NJ, will no longer be available for 2017.  See – Health Republic NJ Shutting Down.

Here are the 2017 rates:

2017-new-jersey-individual-health-benefits-plans-and-rates

NYS 2017 Final Rates Approved

NYS 2017 Final Rates Approved

NYS 2017 FINAL Rates Approved   2017 Healthcare Costs

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 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.Obamacare NYS 2017 Rates

* 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.

Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017

Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017

Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017  Crains Health Pulse June 27_2016 Oxford Indiv Exit

A neat quote mentioned in yesterday’s Crains Health Pulse.  I only wish it were for better news.
 
1. Oxford will be leaving NY Individual health plans.  The popular Oxford Metro plan offered off-exchange marketplace will no longer be offered next year.  Notably, this is the only plan that contained par excellence cancer hospitals such as Memorial Sloan Kettering.
Oxford Metro will still be available for NY Small groups.
2.  Oxford Liberty HMO plans will be leaving ALL segments – Individuals to commercial large groups.  For restaurants and retail shops, as an example, this is a very popular platform as this allowed flexibility of NO minimum participation.  If only 1 person wanted to enroll on plan out 20 that was OK.
Oxford will be sending these letters out to Employers starting with Jan 2017 renewals.

Oxford Health Plans (NY), Inc. (OHP) License Withdrawal, Effective January 1, 2017, Upon Renewal

Please note the following:

  • This change does not affect their regular  Oxford Health Insurance, Inc. (OHI) plans. Their OHI portfolio in New York offers a wide range of coverage options for employers of all sizes. 
  • Impacted groups and members will receive a notice from us approximately 180-days prior to their 2017 coverage end date. The notice will outline the actions they need to take and other available coverage options.

Stay proactive and contact us today for a customized consult on how your organization can prepare  ahead  for ACA, Benefits, Payroll and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

NYS 2017 Rate Requests

NYS 2017 Rate Requests

NYS 2017 Rate Requests

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.   NYS of Health 2017 Rates request

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 Name2017 Requested Rate Change
Aetna Life Insurance Company19.4%
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 Market17.3%

*Indicates that the company makes products available on the “New York State of Health” marketplace.

SMALL GROUP MARKET

Company Name2017 Requested Rate Change
Aetna Life Insurance Company12.0%
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, LLC66.6%
Empire Healthchoice Assur Inc10.0%
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 York12.8%
Weighted Average Requested Rate Change – Small Group Market12.0%

*Indicates that the company makes products available on the “New York State of Health” marketplace.

Source:  https://myportal.dfs.ny.gov/web/prior-approval/summary-of-2017-requested-rate-actions
Resource:
What to Expect in 2016 -BrochureCopy