Author Topic: Any NYers catching FIRE in 2016? Health insurance  (Read 3058 times)

Upstate NYer

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Any NYers catching FIRE in 2016? Health insurance
« on: June 08, 2015, 10:29:03 AM »
Found this press release, looks like it might be a feasible option for people catching FIRE in NYS in 2016...? If your individual income is $23,540 or less.

http://info.nystateofhealth.ny.gov/news/press-release-ny-state-health-announces-expansion-private-health-insurance-coverage-through

Edit: additional details below.

http://info.nystateofhealth.ny.gov/sites/default/files/Attachment%20F%20-%20BHP%20-%20Benefits%20and%20Cost-Sharing%2C%205-15-15.pdf

« Last Edit: June 08, 2015, 02:01:18 PM by Upstate NYer »

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #1 on: June 08, 2015, 11:13:11 AM »
Thanks for the link.  More options are always nice.  I wonder how the quality of this plan will compare to other marketplace exchange plans, which can also be free or nearly free (after ACA subsidies) for those in the income level sweet spot needed for this new plan anyway.

Also note that there is proposed legislation in the works for NY to implement a single payer, universal coverage system:

http://www.healthinsurance.org/new_york-state-health-insurance-exchange/

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #2 on: August 11, 2016, 12:30:39 PM »
Bumping this old thread to see if there are any New Yorkers with experience to share regarding NY's "Basic Health Plan" option (described in the links in the OP), which has now gone live and is known as the "Essential Plan."  (There is some limited information about the program available at its official website, http://info.nystateofhealth.ny.gov/EssentialPlan.)

As I understand it, the health insurance landscape for early retirees in NY is now significantly different than in most other states.  My understanding is that if your income is low enough to qualify for the Essential Plan (below 200% of the federal poverty level), then you are not eligible to obtain subsidized coverage from the ACA marketplace exchange (which otherwise would have been available to you).  In other words, if your income is below 200% of the FPL (and you don't qualify for Medicaid), the Essential Plan is your only option for subsidized coverage in NY.

On paper, the Essential Plan looks great -- no deductibles, and very low (or non-existent, if your income is low enough) premiums and copays.  Does anyone here actually have an Essential Plan policy?

In particular, is there any intel on the enrollment logistics?  With ACA exchange plans, there has been much discussion in the forum re: problems establishing eligibility for subsidies in the first year after retiring (before you have tax records to demonstrate your newly-lowered income).  That problem is mitigated by the fact that you can purchase a policy on the exchange at full cost and then get your premium tax credits applied to your tax liability when you file your taxes the following year.  However, if you encounter problems signing up for the Essential Plan (despite your actual eligibility), there may be no similar remedy (because, as described above, your eligibility for the Essential Plan disqualifies you from receiving premium tax credits).

jim555

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #3 on: August 11, 2016, 01:46:19 PM »
Premium tax credits do not apply to the Essential Plan or Medicaid since they are not "insurance" in the conventional sense.  Both have no "open enrolment" period, they are open all year.  I am on NY Medicaid (UHC Community Plan) right now but plan to bump my income up before I turn 55 yo to get to the Essential Plan, which is not subject to estate recovery.

CanuckExpat

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #4 on: August 11, 2016, 02:04:31 PM »
I'd also like to get more information on these plans, or experience from anyone who has enrolled on one.

If I'm reading correctly, the advantage of this plan compared to ACA exchase with subsidy  is low to no premiums, and low out of pocket costs, is that correct?

Does anyone have information on what the out of state coverage/network is like for someone who elects to domicile in NY state but spend most of the time travelling?
Was targetting Freedom35 but ended up retiring a couple years early. Currently Based in Buffalo for the summer.

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #5 on: August 11, 2016, 02:06:05 PM »
Premium tax credits do not apply to the Essential Plan or Medicaid since they are not "insurance" in the conventional sense.

Right, and my understanding is that if you are eligible for the Essential Plan, then you cannot purchase an exchange plan and collect premium tax credits.  So if you face a scenario where the state won't allow you to enroll for Essential Plan coverage after you retire because you have no tax history to support the low income you're now claiming to have (a problem many early retirees have reported with respect to enrolling for subsidized exchange plan coverage), then you may be stuck having to purchase coverage at full freight until you actually get enrolled for Essentail Plan coverage (because you won't be able to purchase exchange coverage and get premium tax credits, given that your actual eligibility for the Essential Plan disqualifies you from receiving premium tax credits).

jim555

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #6 on: August 11, 2016, 02:17:34 PM »
Premium tax credits do not apply to the Essential Plan or Medicaid since they are not "insurance" in the conventional sense.

Right, and my understanding is that if you are eligible for the Essential Plan, then you cannot purchase an exchange plan and collect premium tax credits.  So if you face a scenario where the state won't allow you to enroll for Essential Plan coverage after you retire because you have no tax history to support the low income you're now claiming to have (a problem many early retirees have reported with respect to enrolling for subsidized exchange plan coverage), then you may be stuck having to purchase coverage at full freight until you actually get enrolled for Essentail Plan coverage (because you won't be able to purchase exchange coverage and get premium tax credits, given that your actual eligibility for the Essential Plan disqualifies you from receiving premium tax credits).
That was not a problem for me.  I went from a full year salary with severance package to just UI.  I just put in my new estimated income and I wasn't even asked for any documentation.  After my UI ran out I dropped into Medicaid mid year, and not asked for any documentation.

Frugal_NYC

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #7 on: August 11, 2016, 02:18:36 PM »
Quick question for any NYers getting a plan through the NYS exchange.  Does it seem reasonable that the individual plans cost about $375-$600 per month if you don't have a low income?  If one person is medicare eligible but the other is not, does the older person usually go on medicare them self and the other buys their own plan?

Reason I ask is my father has been delaying retirement because my mother is too young for medicare so he's worried about costs....trying to get some decent ranges on what a plan would cost her.


jim555

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #8 on: August 11, 2016, 02:33:23 PM »
Quick question for any NYers getting a plan through the NYS exchange.  Does it seem reasonable that the individual plans cost about $375-$600 per month if you don't have a low income?  If one person is medicare eligible but the other is not, does the older person usually go on medicare them self and the other buys their own plan?

Reason I ask is my father has been delaying retirement because my mother is too young for medicare so he's worried about costs....trying to get some decent ranges on what a plan would cost her.


I had a Platinum Plan in 2015 that was $575 a month.  You should check the NYSOH web site to see if they show plans available.

CanuckExpat

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #9 on: November 05, 2016, 01:46:03 AM »
I'm bumping this old thread to see if anyone has any experience with the NY Essential plans and can share.
Any comparison to NY Medicaid plans?
Was targetting Freedom35 but ended up retiring a couple years early. Currently Based in Buffalo for the summer.

jim555

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #10 on: November 05, 2016, 06:21:51 AM »
I'm bumping this old thread to see if anyone has any experience with the NY Essential plans and can share.
Any comparison to NY Medicaid plans?
It looks like the Medicaid plans have dental and vision while Essential plans don't.  The drug formulary list is different as well.

CanuckExpat

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #11 on: November 05, 2016, 07:39:24 AM »
I'm bumping this old thread to see if anyone has any experience with the NY Essential plans and can share.
Any comparison to NY Medicaid plans?
It looks like the Medicaid plans have dental and vision while Essential plans don't.  The drug formulary list is different as well.

Are Medicaid plans in NY also through private insurer? Seems essential plans are fixed, or no cost, but delivered through a private insurer.
Would be curious about provider network of the essential plans vs medicaid plans, and difference in out of state care.
Was targetting Freedom35 but ended up retiring a couple years early. Currently Based in Buffalo for the summer.

jim555

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #12 on: November 05, 2016, 08:20:19 AM »
I'm bumping this old thread to see if anyone has any experience with the NY Essential plans and can share.
Any comparison to NY Medicaid plans?
It looks like the Medicaid plans have dental and vision while Essential plans don't.  The drug formulary list is different as well.

Are Medicaid plans in NY also through private insurer? Seems essential plans are fixed, or no cost, but delivered through a private insurer.
Would be curious about provider network of the essential plans vs medicaid plans, and difference in out of state care.
The Medicaid plans are all by private insurer.  Got to the web sites to check the difference between the two plans.

CanuckExpat

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #13 on: November 05, 2016, 12:54:45 PM »
The Medicaid plans are all by private insurer.  Got to the web sites to check the difference between the two plans.

Unfortunately it doesn't seem that easy (at least for us), there are multiple plans, and it seems to depend by county. We haven't picked our state of domicile yet, let alone where within that state we will get an address, so it makes it very hard to compare. I was hoping someone with experience might have some input.
With medicaid, it seems out of state coverage is emergency only, I think essential plan seems the same, but I haven't found confirmation.
Was targetting Freedom35 but ended up retiring a couple years early. Currently Based in Buffalo for the summer.

August

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #14 on: November 05, 2016, 06:12:37 PM »
My understanding is the Essential plans are similar to the state Medicaid plan but sold through the health exchange.  You have to qualify for an Essential plan based on income.

The monthly premium is either free or cheap (like $20) and there is a relatively low out of pocket max.  The benefits looks similar to a typical HMO: preventative, office visits, outpatient, inpatient, ER, labs, therapy, mental health, DME, pharmacy.

One thing to be aware of is the provider network is different, you should make sure your doctor participates with this specific plan type.  Only in-network services are covered.

waltworks

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #15 on: November 09, 2016, 08:11:03 PM »
As of this morning, I think you should assume FIRE is going to require an extra $200k or more for health insurance, folks.

-W

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #16 on: August 11, 2017, 02:18:48 PM »
Resurrecting this old thread to link to an article recently published on the blog of the Empire Center for Public Policy (an Albany-based think tank) explaining why Trump's ongoing threat to end ACA cost-sharing reduction (CSR) payments represents a potentially existential threat to NY's Essential Plan:

"NY's Essential Plan Remains in Jeopardy"

Almost $1 billion of the Essential Plan's federal funding--which represents approximately one quarter of its total budget--consists of CSR payments made directly to the state government, so if the federal government cuts them off it will blow a $1 billion hole in the budget.*  This would force the state to choose between making up for the shortfall (which seems highly unlikely) and shutting down the Essential Plan health program altogether.

*Unlike in most other states, there would be little to no counterbalancing increase in federal premium tax credits to offset the loss of CSR payments, because most CSR-eligible consumers are enrolled in the Essential Plan rather than a commercial plan purchased on the ACA exchange, so the elimination of CSR payments would not impact exchange-plan premiums (on which the amount of premium tax credits are based) to the same extent as in other states that don't have Basic Health Plans like the Essential Plan.