Health Insurance Blog

New York health insurance is ahead of the game when it comes to health care reform according to the article “Feds must consider NY situation in fixing care” by Kenneth Adams on poughkeepsiejournal.com.  New York is one step ahead of the nation when it comes to health care infrastructure, medical education, research, health insurance mandates, and insurance taxes.

New York’s plan isn’t perfect and is much more expensive than other states’ plans.  This is why New York is an important state to look at as Congress tries to put together health care reform.  According to the United Hospital Fund, NY ranks 25th across the country with 15% of New Yorkers without health insurance under 65.  If federal policies make New York health insurance more expensive NY cannot improve their numbers. 

59% of people in New York still get their health insurance from employer sponsored plans.  New health insurance taxes without reform to offset the increasing prices will force more New York companies to stop offering health insurance benefits to their employees.  That will cause even more uninsured residents since it will be harder for them to obtain individual health insurance.

According to the article “Sen. Chuck Schumer report: Rise in health insurance costs is sickening for New Yorkers” by Rachel Monahan on nydailynews.com, New York health insurance costs are up 81% since 2000.  New Yorkers with health insurance are spending on average one out of every ten dollars on health care costs. 

This information comes from a report by Senator Chuck Schumer D-NY who is pushing Congress towards Obama’s health care reform plan.  Schumer states the skyrocketing costs of New York health insurance not only hurts people who buy their own insurance, but also hurts companies who are trying to offer health insurance as a benefit.  They can’t hire as many employees, they make layoffs and make cuts on the health insurance benefits they offer. 

Schumer revealed that 3.5 million New Yorkers pay over 10% of their income for health care despite insurance.  Insurance costs have risen faster than medical care according to Schumer.  He believes there is limited competition in the industry causing the high rises in group and individual health insurance rates.  He said the solution lies in Obama’s plan for a public health insurance plan to compete with private health insurance companies.

According to Valerie Bauman at Newsday.com, New York’s Governor David Paterson wants to ensure health insurance is more affordable by requiring health insurance companies to get state approval if they are going to raise premiums.

This bill is one of four that Paterson has proposed to help people who can’t afford private health insurance, but do not qualify for Medicaid.  One third of New York’s uninsured is between the ages of 19-29.  Paterson’s proposal would permit families to cover their children up to 29 under insurance through their employer.   Most plans currently stop this kind of coverage at 23.  This could dramatically help families stay insured that fall into this category. 

Also, part of Paterson’s plan is to extend COBRA from 18 months to 36 months, and to cut down on the amount of claims that are inappropriately delayed or denied.  If the deadline cannot be met to review a claim, then the claim would have to be approved by the health insurance company.   All aspects of this proposal have the goal of ensuring health insurance is a fair and smooth process.

In the New York Post, Brendan Scott reported on shocking findings that New York City health insurance premiums have seen a significant increase over the past year, while many New Yorkers are already struggling economically. Here are some sobering statistics:

• From April 2008 to April 2009, the average monthly health insurance premium for a family has risen from $3,866 to $4,354; a 13% increase.
• Six out of the eight health insurers in the NYC area have increased their rates, including Aetna, Atlantis Health Plan, and Oxford Health Plans, Brendan says.
• Insurance companies blame the rate increases on an exodus of healthy policyholders leaving them with only the sickest (and costliest) patients, in addition to the state’s co-payment structure and high mandated coverage minimums.

On the bright side, Empire HealthChoice HMO actually decreased its premiums. Not to mention that patients who remained in-network for their health care pay less: a family who agreed to stick to in-network providers paid just $2,996 per month on average. That’s still a 12% increase over last year, but a significant savings nonetheless.

(Photo credit: bridgepix under CC 2.0)

The New COBRA Subsidy Bill that subsidizes COBRA payments for workers who have recently lost their jobs, is causing some difficulties for New York health insurance agents.   The subsidy pays for 65% of an eligible  workers COBRA health insurance premiums for up to 9mo.

However, COBRA health coverage, and subsidy, do not apply to employer groups of fewer than 20 employees. For these groups, the New York continuation of coverage program (sometimes called mini-Cobra) applies. Under the “mini-COBRA” program, health insurance companies fund the subsidy and seek reimbursement from the government.

Apparently there is mass confusion among these small employer groups, the health insurance companies are supposed to be paying but they are still trying to get a handle on the situation.

For more information there is guidance on this situation at www.ins.state.ny.us.

The New York State legislature has approved an increase in health insurance taxes to reduce the budget deficit, according to Alphonso O’Neil-White in the Buffalo News. Approximately $350 million worth of “patient services surcharges” and “covered lives assessments” (among other names for the fees) will be added to the already expensive cost of New York health insurance. There might be more to come: the upcoming budget for 2009-2010 looks to include about $420 million in new health insurance taxes and surcharges.

Alphonso states that the average NY State family pays anywhere from $900 to $1,500 per year of their health care premiums solely on these taxes! Also, these taxes make employers increasingly unable to afford to provide health insurance to their employees. More people will become uninsured and have to search for individual health coverage as a result.

Julie Appleby of USA Today reports that New York Attorney General Andrew Cuomo has reached an agreement with UnitedHealth Group that will protect policyholders against paying more than they should to see out-of-network doctors. While this immediately affects New York health insurance, the settlement could have far-reaching impact across the country.

UnitedHealth insurance used a subsidiary’s database (Ingenix)–as do many other health insurance providers nationwide–to determine how much doctors should be paid, through the insurers’ own reports of regional charges. Cuomo calls this a conflict of interest, and will establish a non-profit agency that will publicly post typical medical costs on a Website. UnitedHealth has agreed to donate $50 million to that agency.

On average, UnitedHealth underpaid out-of-network doctors by over 25%. Consumers suffer when doctors do not consider those incomplete reimbursements as full payment, since they have to cover the difference. The rules surrounding reimbursement of non-network care are often murky and confusing. According to Julie, Cuomo claims that many insurance plans don’t even tell consumers how much they’ll end up having to pay! 

Get UnitedHealth quotes for the second-largest health insurer in America.

Keith L. Martin of the Insurance and Financial Advisor just reported on a new proposal by Governor David Paterson regarding New York health insurance. He wants to expand health care coverage by mandating that health insurance companies cover policy dependents up to age 29, at the policyholder’s own expense. Currently, parents’ health insurance plans in New York state cover their children until they are either 18 if they aren’t enrolled in college, or 22 years old if they are.

This age group is at increased risk for being without health insurance: many 19-to-29 year olds are either unemployed and struggling to find jobs, laid off, or working in positions that don’t offer health insurance. Individual health plans are usually far more expensive than group coverage.

Paterson’s legislation will address those issues, in addition to possible provisions for any grandchildren of the policyholder. Keith says that this proposal is a step towards universal health care reform by controlling medical costs and including a large group of generally healthy people in the pool to spread risk. This demographic is a low-risk pool for insurers, but could have a negative effect on smaller employers.

(Photo credit: jimbowen0306 under CC 2.0)

TradingMarkets.com reports that Aetna health insurance has made improvements to NYC Community Plan, its slate of health care offerings for small business owners and their employees. The plan, launched one year ago, is intended to make New York health insurance more accessible for groups that are traditionally underserved. It’s currently available in the New York City boroughs of Brooklyn, Manhattan, Staten Island, the Bronx, and Queens. Hopefully, Aetna will soon introduce similar products in other markets.

Changes to the plan include:

• unlimited generic pharmacy benefits in a calendar year
• discounts on branded medications
• lower co-payments for hospital visits

With cooperation from doctors, hospitals, and other providers, Aetna has actually managed to lower premiums of small business health insurance to as little as $243 per month!

(Photo credit: fergusonphotography under CC 2.0)