Press-Republican

August 21, 2013

New York launches health-benefit market

KIM SMITH DEDAM
Press-Republican

ELIZABETHTOWN — New York launched its health-benefits exchange program Tuesday in compliance with the federal Affordable Care Act, offering local plans and providers.

The health-plan marketplace, structured by the State Department of Health, is called New York State of Health.

With 20 health-care insurance providers and 12 dental plans, the system is designed to supply affordable health insurance for state residents ages 19 to 64, officials say.

Nearly 2.7 million New York residents age 65 and younger do not have health insurance.

New York State of Health includes insurance tailored for small-business owners with two to 50 employees.

ANNOUNCED ONLINE

Donna Frescatore, executive director of the state’s New York Health Benefit Exchange, unveiled the new brand and its interactive website Tuesday in an online Livestream broadcast.

Leo Mamorsky, executive account director of DDB New York, the ad agency that developed the brand, said their research looked at statistics across the state, recognizing that “one size does not fit all.”

DDB’s contract for the Health Benefit Exchange advertising and public outreach is more than $40 million.

“New York state received $40.17 million from (U.S.) Health and Human Services for marketing and advertising over a two-year period,” State Department of Health spokesman Jeffrey Hammond told the Press-Republican Tuesday. 

“This figure represents the DDB contract value.”

RATES QUALIFIED

In July, Gov. Andrew Cuomo announced approval of the first group of insurance providers.

Rates — qualified by DOH for the exchange  — represent a 53 percent reduction compared to direct-pay individual rates found in the wider health-care market, according to the official announcement Tuesday.

“New York’s health-benefit exchange will offer the type of real competition that helps drive down health-insurance costs for consumers and businesses,” Cuomo said in a prepared statement last month.

Plans had to be approved for inclusion in the exchange based on strategic guidelines, according to the Department of Health announcement, “that set limits on out-of-pocket expenses — such as deductibles, co-payments and federal out-of-pocket maximums, and meet other state and federal requirements.”

In live remarks, Frescatore said hundreds of insurance brokers have been trained to roll out the new system.

“All New Yorkers can be assured they will have qualified, trained individuals to help them throughout the state,” she said.

PLAN PRICES VARY

There are many options in sorting insurance plans, and rates vary widely.

A sample calculation done by the Press-Republican for a family of four — two parents with two children who live in Essex County — showed 13 private insurance plans with monthly base rates ranging from $377.28 to $4,455.38 (per month), with zero deductible and no charge for mental-health care or substance-abuse disorders.

None of the plans include dental care, which has to be purchased separately. 

Of the 13 offerings in the sample search, one is lower than $400 per month; one between $600 and $700 per month; three plans between $700 and $900 per month, and eight plans are $1,000 per month and above.

The Healthy NY plan in the sample search was $1,095.17 per month with no deductible as part of a health maintenance organization (HMO) program. Mental-health care was not available in this plan, which carries a $500 co-payment for hospital fees.

The least expensive health-care plan, TraditionPlus Indemnity, is estimated for a family of four at $377.28 per month and is a “fee-for-service” program.

Two other programs with a monthly cost of less than $1,000 for a family of four are Healthy NY HDHP (high-deductible health plan), without prescription coverage, at $616.88 per month and Healthy NY HDHP, with prescription coverage for $873.45, per month. Both plans are Health Savings Account eligible. Neither offer mental-health coverage or substance-abuse treatment.

HELP WITH COSTS

New York State of Health does offer financial assistance to lower the cost of coverage for people with incomes below 400 percent of the federal poverty level: $45,960 for individuals and $94,200 for a family of four.

The median household income between 2007 and 2011 in Essex County was $46,629 compared to the state median of $56,951, according to the U.S. Census Bureau.

Email Kim Smith Dedam: kdedam@pressrepublican.com

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TO LEARN MORE

Enrollment opens Oct. 1 with coverage to start on Jan. 1, 2014.

The New York State of Health interactive site is at http://www.nystateofhealth.ny.gov.

An insurance calculator to compare insurance plans is at: http://finder.healthcare.gov.

REGIONAL PROVIDERS

New York State of Health has various providers approved for each county in the state.

Here are the North Country providers:

CLINTON COUNTY

The Health Exchange in Clinton County offers four providers in the Individual Marketplace: Empire Blue Cross, Excellus, Health Now, and MVP.

For small businesses in Clinton County, three providers are available: the same as above, minus Empire Blue Cross.

ESSEX COUNTY

Six plans are available in Essex County for the individual market: Capital District Physicians Health Plan; Empire Blue Cross; Excellus BlueCross BlueShield; Freelancers Co-Op dba Health Republic; HealthNow dba BlueShield of Northeastern NY; and MVP Health Plan.

Five plans are available in Essex County for small-business owners, the same as above, minus Empire Blue Cross.

FRANKLIN COUNTY

In Franklin County, four providers are qualified for the individual marketplace: American Progressive Life & Health Insurance Co., Excellus, Fidelis and MVP.

There are two providers for Franklin County's small-business marketplace: Excellus and MVP.