NYS 2016 Rates Approved

NYS 2016 Rates Approved

NYS 2016 Rates Approved

The rate requests for 2016 marked the first year in which insurers could rely on actual data from exchange enrollees. In many cases, insurers participating in exchanges in other states requested double-digit rate increases. New York is the second-largest state to receive final approval of its rate requests. Earlier this week, California insurance regulators approving an average rate increase of just 4 percent.

To the relief of customers of industry leader Oxford/UnitedHealthcare  the rate increase for groups will be 3.9 to 6.5%.  Importantly, the rates are a collective average and may range depending on one’s particular health plan. Additionally,  Helath Insurers can opt to tweak or remove plans.   Reminder: be sure to check back again our site in 30-60 days.   Rates will be posted upon Health Insurer’s release. Also 2016 Individual Exchange Marketplace opens Nov 15th.

Individual MarketNYS DFS 2016 Rates

On average, insurers requested a 10.4 percent increase in health insurance rates for 2016 in the individual market. DFS reduced that average increase more than 30 percent to 7.1 percent – which is below the approximately 8 percent average increase in health care costs.

Starting on January 1, 2016, New York will add a new Basic Health Plan a.k.a ” Essential Health Plan” to the plans that can be purchased by lower income New Yorkers through NY State of Health. Households at or below 150 percent of the federal poverty level ($17,655 for a household of one; $36,375 for a household of four) will have no monthly premium for the Basic Health Plan.  Those with slightly higher incomes at 200 percent of the federal poverty level ($23,540 for a household of one; $48,500 for a household of four) will have a low monthly premium of $20 for each adult.

The Basic Health Plan will provide the same covered services as other plans offered on the Marketplace.  The Basic Health Plan has no annual deductible and lower copayments, making health care even more affordable for hundreds of thousands of New Yorkers.  For example, a person who earns about $20,000 a year and uses moderate health care services including an inpatient hospital stay, prescription drugs and doctor’s visits, will pay about $730 a year for premiums and out-of-pocket costs under the Basic Health Plan in 2016 as compared to about $1,830 in 2015 if they were enrolled in a Qualified Health Plan.

Small Group Market

On average, insurers requested a 14.4 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase by 32 percent to 9.8 percent. A number of small businesses will also be eligible for tax credits that would lower those premium costs even further.

2016 Small Group Rate Actions – Overall Summary


Aetna Life23.87%21.47%-2.40%
CDPHP HMO*-19.84%-19.84%0.00%
CDPHP UBI*16.56%16.56%0.00%
Emblem HIP*29.74%29.74%0.00%
Empire Assurance8.70%3.40%-5.30%
Empire HMO9.21%4.37%-4.84%
Health Republic*20.00%20.00%0.00%
Independent IHA*-15.60%-15.60%0.00%
Independent IHBC-6.19%-6.19%0.00%
Managed Health5.60%3.94%-1.66%
Metro Plus*-0.81%-0.81%0.00%
MVP Health Plan*7.28%6.36%-0.92%
MVP Services*16.71%15.90%-0.81%
North Shore LIJ*3.27%3.27%0.00%
Oxford OHI13.61%6.75%-6.86%
Oxford OHP10.58%3.90%-6.68%
United UHIC18.79%11.61%-7.18%
All Companies Combined14.41%9.80%-4.61%


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.

See Health Reform Resource

      NYS 2015 Rates Approved 

Union Plans and Obamacare

Union Plans and Obamacare

The Con Ed lockout this Summer couldn’t come at a more heady time.  I’m not referring to the obvious temperature swelter  but more to the employee health benefits that are at the back bone of virtually every recent Labor dispute.  With the Con Ed dispute, Management’s  has acquiesced on the health insurance .  “Con Ed did accede to “public pressure” on Sunday by reinstating health insurance for the 8,500  members of Local 1-2 of the Utility Workers Union of America, a company spokesman said. The workers have been collecting unemployment benefits for two weeks but had to pay for their own prescription medicine and doctor visits because the company cut off health coverage when the old contract expired, at midnight June 30.”

Interestingly, Unions are major stakeholders in Healthcare as their benefits have been traditionally rich incentives attracting to workers.  However, with A.C.A. (Affordable Care Act) otherwise known as Obamacare their health programs are very much in danger of additional taxation or  member withdrawal.  Unions estimate these provisions will raise the cost of health coverage by an additional $1,000 a year.   In fact, a Union members may fare better on the Individual Mandated Exchange with projected individual direct insurance dropping 70% things will open up.  A lower/middle income member will likely qualify for an additional discount credit.  A more affordable health plan just may be a possibility.

There are other reasons the Individual Health Plan may be better:

  • Unions as other self insured group must now comply with added benefits for  preventive care, maternity care, Age 26 dependent care, pre-existing condition waivers.
  • No Annual Limits on essential benefits by 2014
  • No Lifetime Limits
  • No more mini-med plans – discount health plans are prohibited.  The movie John Q , based on a true story, where a father is told his son’s transplant will not be covered based on th elicited mini-med plan covering him up to $20,000. Large companies such as McDonald’s have also sponsored mini meds.
  • Cadillac Tax – By 2018 a 40% excise tax on health plans that exceed $10,200(single) and $27,500 (family).

The original Cadillac Tax was pushed back by  the behest of Unions to 2018 from the  original proposed 2014 date. Most Unions with generous health care packages would not be complaint within that time frame.

However, not all is grim for Unions.  HHS has issued waivers to 1,625 plans covering 3,914,356 individuals were exempt from these mandates through 2014.  According to Heartland  “More than half of the approximately four million individuals receiving waivers are union members, including 82.9 percent of those covered in the most recently updated list of waivers.”

With current administration posts coming from Union there wouldn’t be much surprise if these allowances continue.  Would it be that bold to predict for Union Members  in 2014  will be allowed to use their  Individual Exchange income tax credits for their Union benefits packages? Small businesses may not be as lucky.