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.
“The deadline for individuals and families to enroll in a qualified health plan through NY State of Health is February 15, 2015. However, the Marketplace will provide additional assistance to those individuals who have taken steps to apply for coverage but have been unable to complete the enrollment process before the deadline. All applications and enrollments in health plans must be completed by the end of the day on February 28, 2015. Those who complete their enrollment after February 15, 2015 but on or before February 28, 2015 will have coverage starting on April 1, 2015.”
2/12/15
Last days for 2015 Individual Open Enrollment is ending this week. This deadline applies to both On and Off Exchange!
If you’re wondering about the penalty for not having insurance: yes, there is one, and no, you can’t really get out of paying for it. You’ll pay the penalty when you file your taxes for 2015. Even if you get coverage midway through the year, you’ll still need to pay a penalty for the months you weren’t insured. So get covered!
Think you might be eligible for a subsidy or aren’t sure?
You can check here at the New York State of Health Marketplace calculator. If you are eligible or think you might be eligible, you can contact the marketplace directly to purchase a plan or ask questions about financial assistance.
Please remember that during open enrollment you are permitted to switch carriers. Choose wisely because after February 15, one cannot switch plans until open enrollment 2015, unless you have a “qualifying event,” such as marriage, divorce, birth or adoption.
Individual Online Enrollment Resources for On and Off Exchange:
For NYS – To view Oscar’s plans, rates and simple online enrollment application, click here.
For more information on enrollment please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available.
Open enrollment for the 2015 New York individual market season is right around the corner. Below are answers to commonly asked questions pertaining to individual market coverage for residents of New York State:
Q: What is the New York State of Health (NYSOH) exchange website? A:NYSOH provides NYS residents living between 139%-400% of the Federal Poverty Level, access to lower cost health insurance by supplying them with tax credit premium subsidies. Additional Cost Sharing subsidies are available to those living between 139%-250% of the FPL. All subsidy programs are subject to eligibility requirements. Additionally, NYSOH is where individuals can enroll in Medicaid (for those living below 139% of the FPL).
Q: Is the NYSOH government health insurance? Is that what “Obamacare” means? A: No. Individual health insurance is a relationship between a consumer, and a private health insurance company. NYOSH slips in between this relationship by forwarding tax credit money to the carrier on behalf of the subsidy-eligible consumer, and then the carrier bills the consumer for the difference in premium owed. “Obamacare” is simply the nickname of the new health insurance law, which (in part) assists individuals in obtaining health insurance.
Q: Do I have to have health insurance? A: Yes. As part of the individual mandate, all US citizens must enroll in Affordable Care Act-compliant health insurance…be it through your employer, the individual market, Medicare, or Medicaid. Citizens not enrolled in coverage will be fined by the IRS (less those who qualify for exemptions).
Q: What is the fine for not having health insurance? A: In 2015, the fine is 2% of household income per uninsured month. In 2016, this increases to 2.5% of household income per uninsured month.
Q: Do I have to enroll in individual coverage through NYSOH? A: No. Only people in need of tax credit subsidy assistance must enroll through the NYSOH exchange website.
Q: What if I don’t earn enough income to qualify for subsidy assistance for on-exchange health plans? A: People in NY living below 139% of the FPL will be eligible for Medicaid. Medicaid enrollments are conducted on the NYSOH website.
Q: If I am over the subsidy income limit threshold, how do I apply for coverage outside of the NYSOH website? A: You can enroll directly with a carrier, or, by contacting a licensed insurance broker for assistance. Off-exchange carrier applications are extremely simplified, requiring only a 1-2 page paper/PDF application to be completed in most cases, and with no government intervention.
Q: Can brokers assist me with my individual coverage written through the NYSOH website as well? A: Yes. Licensed brokers, who are also certified to write health plans on the exchange, can be found in the Broker directory on the NYSOH website. You can search using a specific broker’s first and last name, by selecting a specific Agency from the drop down list, or you can enter your ZIP Code to find one in your region.
Q: Do brokers charge fees for helping me secure an individual health plan? A: Brokers are not allowed to charge fees for assisting individuals with writing their health insurance.
Q: How do brokers get paid? A: Every time you pay your health insurance bill, a portion of your payment is allocated towards compensating a broker (just like with your auto or homeowners insurance). Most carriers pay broker commissions on the back end, which is completely transparent to the consumer. If no broker is utilized by the consumer, the carrier retains the commission. This means that whether you use a broker or not, you’ll be paying for one anyway.
Q: Don’t Navigators already provide these broker services? A: No. Sometimes referred to as “in person assistors” or “experts” by the NYSOH, Navigators are not licensed to write health insurance. They are trained employees or contracted agencies of the NYS government (funded by Federal grant money) to help individuals navigate the enrollment process on the NYSOH website only. They are not required by federal law to undergo criminal background checks, nor are they licensed by the NYS Department of Financial Services, which means they cannot make plan recommendations to health insurance consumers.
Q: Can a certified broker process my NYSOH enrollment for me? A: Yes. Brokers that are certified to write business on the NYSOH exchange website can drive the entire online enrollment process for the consumer. You just need to authorize a broker through your NYSOH account by logging in, and then clicking “Find a Navigator/Broker” towards the bottom left side of your NYSOH account home page. Once authorized, the broker you have selected will receive an email from the NYSOH that you are in need of assistance, and can now enroll you on your behalf.
Q: When can I enroll in individual health insurance? A: Like Medicare, the individual health insurance market is setup to have an open enrollment season. The individual market open enrollment window is from 11/15/14 through 2/15/15.
Q. Are there any exceptions to the open enrollment period?
A. Enrollment in Medicaid, Child Health Plus and the Small Business Marketplace continues all year.
Have a Qualifying Event?
Enroll Now using our online shopping tool where you can compare plans and prices and enroll
Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance. Qualifying Events for Exchange Marketplace. 76 percent of the uninsured are unaware of the looming March 31 sign-up deadline. Contact us at (855)667-4621.
Q: Can I enroll in coverage outside of the open enrollment season? A: Consumers can enroll in individual coverage outside the open enrollment season so long as a “Qualifying Life Event” exists. Examples of such events include the loss of a job, marriage, divorce, birth of a child, a change in subsidy eligibility, and others. Written proof of the QLE will be required when enrolling outside of the open enrollment season as established by the US Department of Health and Human Services.
Q: If I am subsidy eligible, and my income changes, what do I do? A: Consumers enrolled through the exchange who receive tax credits must notify the NYSOH Marketplace whenever a change of income is experienced. You can contact the marketplace call center at 855-355-5777 to update your income information.
Q: Am I limited to certain insurance companies if I am subsidy-eligible? A: No. Consumers who are subsidy-eligible may pick any plan they wish that is available on the NYSOH exchange website. However, subsidy-eligible individuals may not apply those tax credits towards health plans written outside of the NYSOH website (for example, Oxford Liberty plans, which are only available outside of the NYSOH Marketplace).
Q: I have completed the income portion of my on-exchange application, and I’m now ready to pick a plan. How can I find out more specific information pertaining to the available options in the market? A: A licensed insurance broker can help you understand the available health plans in the market, and can make plan recommendations specific to your needs and financial situation.
Q: I started my current individual plan in July 2014. Do I have to renew my plan on January 1st 2015? A: Yes. All individual market plans have calendar year deductible and maximum out of pocket accumulation periods, which resets on January 1st of any given year. So for example, if you lost your job (and your health insurance) effective 12/1/14, and then you enroll for individual coverage effective 12/1/14, you must renew your individual plan the following month (for 1/1/15) at the new carrier plan structures and rates.
Q: I already have individual market based health insurance. Can I change plans during the open enrollment season? A: Yes. Existing individual health insurance policyholders may change their plan during the open enrollment season. You may also change carriers should you wish to find a better solution for your needs. Talk to your licensed insurance broker about the available plan options in the market for 2015.
Q: My employer is offering me a health plan that I am not interested in. Can I waive my employer health plan and replace it with an individual plan, and receive tax credit subsidy assistance? A: The answer to the first part of the question is yes. Employees can choose to opt out of employer-sponsored health insurance, and can replace their coverage in the individual market.
With regards to receiving tax credit subsidies in these situations, yes, an individual can receive tax credit subsidies to help pay the cost of individual health insurance. However, in addition to the employee needing to meet tax credit eligibility requirements as discussed earlier, one of two additional conditions must be met to be eligible to receive subsidy assistance: 1) The employer’s health plan does not meet the minimum actuarial value of 60%, or 2) The employee’s single rate cost (self-only coverage, no dependents) for employer-sponsored coverage exceeds 9.5% of their household adjusted gross income (defined as “unaffordable” under the health care law).
Q: I’m applying for a tax credit subsidy. How do I determine my adjusted gross income? A: Your adjusted gross income can be found on line 37 of your 1040 tax return. Subsidy applicants who have a steady income can use this figure as a guide when determining tax credit eligibility for the upcoming tax year.
Those that do not have a steady income (e.g. sole proprietors, freelancers, single-person businesses, etc.) should speak with their accountants to determine their estimated adjusted gross income for the upcoming tax year.
Q: I was determined Medicaid eligible after applying for tax credit subsidy on the NYSOH website. However, my doctors do not take Medicaid. Can I opt out of medicaid and get a subsidized individual health plan instead? A: You may choose to opt out of Medicaid if you wish. However, those who are Medicaid eligible will not qualify for tax credit subsidies for individual health plans. You can enroll in a health plan, but you must pay the full price of the plan.
Q: I was determined subsidy eligible, and I want to pick a plan to enroll in through the NYSOH website. Can I put my children on my health plan with my spouse and I? A: No. Those who are subsidy eligible must insure their dependent children through a Child Health Plus plan. CHP (or “chip”) plans are selected during the plan check out process at the end of the NYSOH application. Only the applicant and spouse will qualify for a private health plan with subsidy assistance. If you choose to opt your children out of CHP, you and your spouse will lose subsidy eligibility for your private health plan.
Q: How can I find out if my doctors take a particular health plan? A: Your licensed insurance broker can provide you with carrier-specific tools to look up providers in particular networks.
Q: How can I get a copy of the full benefit summary for a particular health plan I’m interested in? A: Your licensed insurance broker can provide you with electronic benefit summaries for most health plans upon request.
Q: How can I find a licensed broker to assist me? A: Licensed insurance brokers, and who are also certified to write on-exchange plans, can be found in the Broker directory on the NYSOH website. You can search using a specific broker’s first and last name, by selecting a specific Agency from the drop down list, or you can enter your ZIP Code to find one in your region.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
The NCQA believes its own health plan accreditation program and program data could useful to exchange programs, the NCQA says. With so much more individual choice on both, the Marketplace Health Exchange and off-Exchange along with new Health Insurers this is an important consumer tool.
About NCQA
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.
NCQA accreditation ratings are based on three sets of measurements HEDIS®, CAHPS® and NCQA accreditation standards. Health plans in every state, the District of Columbia and Puerto Rico are NCQA Accredited. These plans cover 109 million Americans or 70.5 percent of all Americans enrolled in health plans.
HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare health care quality. The Consumer Assessment of Healthcare Providers and System (CAHPS) is a survey mailed to select members asking them to rate their experience with the care given by their doctors and the services provided by their plans.
How the Results of HEDIS and CAHPS Help Consumers Results from HEDIS and CAHPS enable consumers to understand how well Insurers are fulfilling our clinical agenda to help members stay healthy, get better quickly or live effectively with chronic illness. In addition, the scores facilitate our ability to identify areas of care and service where we can continue to improve. The results also enable us to compare our companies’ performance with other local and national health plans.
The “Excellent” ratings our plans received demonstrate that members continue to receive high-quality health care and that they are satisfied with the service that their physicians, health care practitioners and health plans provide.
HEDIS® (Healthcare Effectiveness Data and Information Set) is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® (Consumer Assessment of Healthcare Providers and Systems) is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
For more information about these plans and the full range of offerings available through MMS Inc. contact us today at (855) 667-4621.
Your plans NCQA 2014 Rating
NCQA Health Insurance Plan Rankings 2014-2015
Click on any Plan Name for details.
Methodology and other information about the rankings is here
The NYS Department of Financial Services has reviewed individual and small group health carriers’ rate increase requests for 2015, and announced the results of their review.
Interestingly, North Shore LIJ Care Connect was the only insurer to request a rate reduction. With significant expansion steps they are well positioned for Wescthester, Bronx, NYC, SI, Queens and LI. These numbers are across the board and specific plan rate renewal may vary.
Reminder: Individual Exchange Marketplace opens Nov 2015. Rates will be posted upon Health Insurer’s release, check our site.
Individual Market
On average, insurers requested a 12.5 percent increase in health insurance rates for 2015 in the individual market. DFS reduced that average increase more than in half to 5.7 percent – which is below the approximately 8 percent average increase in health care costs.
Small Group Market
On average, insurers requested a 13.9 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase more than in half to 6.7 percent – which is also below the approximately 8 percent increase in health care costs.
You may view the DFS press release, which includes a recap of the increases requested and approved by clicking here.
For specific details on all available health plans in 2015, contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
COBRA members have a special enrollment period extension according to new CMS guidance. If you have individuals eligible for, or currently enrolled in COBRA you can enroll them on the Individual Exchange through June 30th 2014. Direction from The NY State of Health confirms that current COBRA Eligible Individuals have been granted a one-time open enrollment window.
Therefore, anyone who does not like his or her current COBRA coverage or cost, can now switch to Individual Exchange!
ASpecial Enrollment Period (SEP) is the time outside of Open Enrollment that allows individuals and families facing special circumstances (Qualifying Life Events) to enroll in a Qualified Health Plan. Eligible individuals have 60 days to enroll after their Qualifying Life Event.
Individual or dependent loses minimum essential coverage due to: job loss; employer no longer offers coverage; divorce; death of a spouse; becoming ineligible for Medicaid or Child Health Plus; expiration of COBRA; or health plan is decertified
Marriage, birth, adoption, or placement for adoption
Gaining status as a citizen, national, or lawfully present individual
Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
Permanent move to an area that has different health plan options
Marketplace staff or contractor enrollment error
Qualified Health Plan violated a provision of its contract
American Indians can enroll or change plans one time per month throughout the year
Other exceptional circumstances, as defined by HHS
To ensure your clients get great health insurance get in Contact us at (855)667-4621!
Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance
Health Republic NY is Shutting Down
