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What You Need to Know About Buying Your 2017 Insurance Plan

By Nicole Levy | November 2, 2016 11:04am
 Premium rates for insurance plans available through the New York state marketplace will go up 17 percent on average in 2017.
Premium rates for insurance plans available through the New York state marketplace will go up 17 percent on average in 2017.
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Shutterstock/Robert Kneschke

MANHATTAN — New Yorkers without employer-provided health insurance can now shop for 2017 plans through the state's Affordable Care Act marketplace.

The exchange’s open enrollment period launched Tuesday and will continue through Jan. 31. 

Enrollment rose 33 percent in 2016 with more than 2.8 million New Yorkers enrolled in marketplace programs last year — 15 percent of the state’s population. Over half of those enrolled in the programs lived in New York City. 

Still, roughly 800,000 state residents remain uninsured, according to Elisabeth Benjamin, vice president of health initiatives at the antipoverty group Community Service Society.

“I don’t think anybody thinks all 800,000 people will enroll this year, but each year the number of uninsured keeps going down,” Benjamin said.

The uninsured rate among children nationwide has seen an especially significant drop, she said, citing a recent Georgetown University study of 2014 census data.

Asked to address the national conversation about Obamacare's success in light of rising insurance rates and shrinking provider networks, a hot topic during this presidential election, Benjamin insisted the verdict lies among the people who have benefited so far.

"I can't tell you how many people have come into my office and gotten coverage who are so relieved ... to know that they can go to a doctor," she said of the federal health law's significance. "Is it perfect? Of course not. Nothing is."

"We can all sit around and Monday morning quarterback the program, but at the end of the day, I think it's telling that there are so many more people with coverage in New York state that wouldn't have it but for Obamacare," Benjamin said. 

Here’s what you need to know if you’re a freelancer or employee scoping out the market for your next year’s health plan:

► No insurance carriers are dropping out of the New York state marketplace in 2017.

Back in April, the country’s biggest health insurer, UnitedHealthCare, announced its intent to exit small and high-risk state exchanges, which comprise the majority across the nation, in 2017. The company has decided to continue coverage in New York.

“There was a concern that United[Healthcare] would drop out, but they did not,” Benjamin said.

That’s good news for the 5,651 city residents enrolled in UnitedHealthcare plans this year, should they decide to stick with them.

► But their rates are increasing.

The rates for individual plans in New York will rise on average by nearly 17 percent in 2017, according to the state Department of Financial Services.

Plan by plan, the breakdown of rate hikes is as follows:

• Affinity — 22.4 percent
• MetroPlus — 29.2 percent
• Fidelis Care — 11.6 percent
• Oscar — 19.6 percent
• Care Connect — 29.2 percent
• UnitedHealthcare — 11.5 percent
• Healthfirst — 7.4 percent
• Excellus — 15.4 percent
• Empire Healthchoice — 15.2 percent

Driving the increase in rates are three factors: insurers now have the claims data to calculate and distribute the costs of their sickest consumers across their plans; the federal reinsurance program that paid plans taking enrollees who need costlier care has ended; and medical costs — particularly drugs — are trending upwards.

► Insurance rates may be rising, on average, 17 percent in 2017 statewide, but you won’t necessarily have to pay that much more. You may actually see a decrease in price if you qualify for federal subsidies or a low-cost plan.

“Some kind of financial assistance or low-cost coverage should be available to you if you’re a single person making up to $47,000 a year,” Benjamin said.

An annual income as high as $97,000 may qualify a four-person household for subsides.

Low-income New Yorkers who aren’t eligible for Medicaid can look into New York’s “Essential Plan,” entailing monthly premiums of $20 or less, low payments for doctor’s visits and medication, and free preventative care. The plan has no annual deductible, which means consumers are paying for their care up front. Here’s who can buy it.

“It’s a really great option for self-employed people whose adjusted gross incomes can be quite low given their [tax] deductions,” said Benjamin.

► Ask about financial assistance — you might be surprised what your income qualifies you for.

A single New Yorker making $45,000 a year could be eligible for government money, even if it's a small monthly sum, Benjamin said.

Those with incomes at the lower end of the pay range might find they're eligible for Medicaid.

“Over the years, I can’t tell you how many people come in and say, ‘I can’t believe I’m eligible for Medicaid,’ and it’s great: it’s free coverage, super comprehensive, and there’s almost no cost-sharing," Benjamin said.

► If you’re buying your own insurance, you should shop around for the best deal. As you compare plans, you’ll need to decide whether you prefer to pay more up front or pay more later.

Some people who qualify for tax breaks find that the plans they can afford have high deductibles, the amount a consumer has to pay to cover illness — or injury-related costs before an insurance company will pay a claim.

More “expensive” insurance policies require higher monthly payments, or premiums, which then guarantee you’ll pay less later if you do need a lot of medical assistance.

“You have to do that calculation between paying in premium versus paying in deductible if you get sick,” Benjamin explained.

If you buy a plan with a high premium, “you have the peace of mind that if you get sick, everything’s covered, you’ll have very small co-payments … But if you don’t get sick, you might have spent a lot of money that you really didn’t need to pay.”

Healthy people typically choose high-deductible plans; people with long-term health conditions often select high-premium plans.

► Review a plan’s list of participating providers and covered medications before you make your choice.

“There are some changes to provider networks, so it’s really important to double check … your doctors are going to stay with the network,” Benjamin said.

You can do that by calling your doctor directly, or checking your insurance company directory.

Oscar, for example, has been cutting its hospital list in New York, taking New York-Presbyterian-affiliated institutions off the list.

► If you need help making your selection, there are professional trained to guide you through the process.

Choosing your plan “can be daunting,” Benjamin said, “and that’s why there are these navigator organizations where you can sit down with someone who is not working with an insurance company … and who can walk you through the process and talk to you about your options.” (Benjamin’s nonprofit is one of them.)

As of the end of the 2016 enrollment period, the state had trained and certified more than 13,000 people to provide New Yorkers free and in-person enrollment assistance in at least 38 languages.

You can find a directory of marketplace navigators here.

► Thinking about opting out? The federal government can't force you to buy health insurance, but it can make you pay a penalty for going without a plan.

The Affordable Care Act penalizes non-participants with a fee that amounts to either 2.5 percent of your household income, or $695 per person — whichever is higher.