Author Topic: Any NYers catching FIRE in 2016? Health insurance  (Read 6008 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?

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?

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.

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.

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.

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #17 on: December 21, 2017, 10:15:53 AM »
The latest update in this saga is that federal officials have reportedly notified the state of New York that they are cutting off a major portion of the funding for the Essential Plan (the portion representing the amount of cost-sharing reduction payments that would have been payable to insurance companies in respect of individuals enrolled in the program had they instead purchased standard qualified health plans through the ACA market) as a result of Trump's executive order terminating the funding of cost-sharing reduction payments, blowing a roughly $1 billion hole in the state budget and jeopardizing the continued existence of the Essential Plan.

See the reports below for details.  The last link describes an argument for why the decision to cut off federal funding might be based on faulty legal reasoning (in a nutshell, the argument is that Trump's order terminates the payment of cost-sharing reduction payments to insurance companies, but should not affect the payment of funds owed to New York State which are based on the amount of cost-sharing payments that would be owed to insurance companies in the absence of the Essential Plan).

https://www.politico.com/states/new-york/albany/story/2017/12/08/feds-may-stop-paying-portion-of-states-essential-plan-139591

https://www.empirecenter.org/publications/cuomos-essential-dilemma/

https://www.healthaffairs.org/action/showDoPubSecure?doi=10.1377%2Fhblog20171208.304459&format=full

pablo

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #18 on: January 03, 2018, 07:07:35 PM »
NY's Gov. Cuomo gave his annual State of the State speech today. More than an hour and a half long and 373 pages of text. Endless proposals on all sorts of topics, including health care. But not one single word about the Essential Plan and what will happen with the loss of $1 billion in CSR funding. This is a very, very bad sign for the future of the Essential Plan. Cuomo is up for re-election this year and supposedly has his sights on the presidency in 2020. One would think that those two items point to the continued survival of the Essential Plan. But the silence is very troubling, especially given that he has a proposal for nearly every other conceivable issue.
I hope that local media would pick up on this issue, as they did in the links above.

jim555

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #19 on: January 04, 2018, 05:29:47 AM »
Doesn't look good for the Essential Plan.  Too bad, was a great option to have.

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #20 on: January 04, 2018, 08:42:26 AM »
But not one single word about the Essential Plan and what will happen with the loss of $1 billion in CSR funding.

The Essential Plan is definitely in mortal danger, but I'm not sure that Cuomo's failure to specifically mention it by name in his speech is especially meaningful.  He did refer to the state budget crisis inflicted by federal cuts to health care spending (the most salient quote is pasted below) and identified multi-pronged plans to challenge the "federal assault" (primarily the impact of the new tax legislation, but presumably also including the termination of CSR-based Essential Plan funding).  As noted above, there are colorable legal arguments that the federal defunding is invalid, so, given the dollar amounts at stake, it's a good bet that the state (which, as Cuomo indicated, is not shying away from mounting legal challenges against the feds) will vigorously pursue those arguments, and try to develop workarounds to mitigate the impact if unsuccessful.

Quote from: Governor Cuomo
Our third challenge is in many ways the greatest.  The budgetary and economic challenges we face short-term and long-term compounded by the federal assault on New York.  This is literally going to define the future of this state.  President Ford may have metaphorically told New York to drop dead in 1975—but this federal government is the most hostile and aggressive toward New York in history.  It has shot an arrow aimed at New York's economic heart.  We must start this year with a $4 billion deficit compounded by a $2 billion cut primarily from the federal government and health care.

popcornflying

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #21 on: January 06, 2018, 08:30:25 PM »
Hi fellow NY Mustachians, just wanted to bring up the NY Health Act since I haven't seen it mentioned here before.  It is for universal health care in NY.

http://www.nyhcampaign.org/

The Act has passed the State Assembly in previous years, but the State Senate never brings it up for a vote because the Senate is controlled by Republicans -  largely because of the IDC and Simcha Felder, who are Democrats during election season and caucus with Republicans the rest of the time. 

All State Senate seats are up for grabs in 2018, and Ballotpedia's State Senate 2016 page shows some of these districts were decided by only a few hundred votes, so it's possible some Senators will be replaced this time and the Act will pass in 2019. 

I personally don't live in a district represented by an IDC member, but wish I did so I could call and pressure them to represent Democratic interests, or vote against them in the primaries.

brooklynguy

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Re: Any NYers catching FIRE in 2016? Health insurance
« Reply #22 on: January 17, 2018, 08:58:59 AM »
The Essential Plan appears to have survived unscathed in Cuomo's newly-released FY 2019 Executive Budget.  Most of the discussion of the Essential Plan can be found on page 98, where it says in pertinent part:

Quote from: FY 2019 Executive Budget
Despite the Federal withholding of CSR payments, which amount to 25 percent of the Federal funding for the EP [i.e., the Essential Plan], the Executive Budget continues to support the EP program. In order to offset this loss of funding, the State will utilize EP Medical Loss Ratio (MLR) remittances, reduce reimbursement rates to plans, and accelerate trust fund monies to maximize Federal benefits.

It also notes, on page 50:

Quote from: FY 2019 Executive Budget
The Executive Budget Financial Plan assumes the continuation of these programs [i.e., the Essential Plan and certain other government-subsidized health insurance coverage programs, including the Children’s Health Insurance Program (CHIP)], and establishes a statutory reserve to address the potential loss of Federal funding and authorizes program modifications, if necessary, to preserve vital services in the event of Federal reductions.