Last month Gov. Andrew Cuomo announced that New York State would extend open enrollment. The cause was the coronavirus pandemic, and its effects on residents who were either finding themselves in-between health insurance coverage, or simply looking for a new, less expensive policy.
Health Care For All New York, which advocates for universal health insurance, estimates that 2.7 million New Yorkers do not have health insurance. The state’s open enrollment extension could help that, but even those who work in health insurance everyday understand that the system is complex. “Time of year, December and January — people are under the gun so to speak — because of the holiday — and then there’s the pandemic,” Kelly Smith, VP of Sales at MVP Health Care said of the circumstances. “It’s not usually on people’s priority list until late-December or early-January, and then they’re trying to search for a plan that meets their needs, or their families needs.”
She says that it’s an annual struggle. Especially for families that experience what the health insurance world considers a ‘life changing event’. “2020 was an extremely challenging year for everyone,” Smith continued. “We’re extremely excited to support New York State’s extension of the open enrollment period.” It runs through March 31, 2021, but those who want coverage to start as soon as possible will need to sign-up before the 15th of the current month. For example, those who want to have their coverage start on March 1, will need to sign-up before February 15.
But healthcare is complex. Insurance is complicated. For a lot of consumers, even the most-educated or aware, it can be an intimidating process. Smith says that despite many being conditioned by technologies that we’re accustomed to using — like Amazon, eBay, or other online shopping platforms — a decision shouldn’t be made immediately upon search.
“You really want to make sure you’re looking at least 30 days ahead,” Smith added, noting that even if a life-changing event occurs, there are ways through the state’s portal to get assistance with back-dated medical expenses. “If you can start looking earlier than that — take 45 to 60 days to consider your options. Policies can be very challenging to understand. And that’s one of the big reasons why we also encourage people to visit the insurance provider’s website to learn specifics.” She explained that as a person uses the state’s online marketplace for coverage — they might be confused by the information available there. Using MVP as an example, Smith says that the shopping experience is a lot easier to digest on their own website. “The state marketplace has a purpose, but before you decide it’s really important to visit the provider’s website and read the details. MVP places a lot of emphasis on this point.”
The state has a tiered approach to dealing with healthcare. It starts with Medicaid and Medicare, which are public guarantees of the sorts. Those plans have the most-stringent income restrictions. The next step up from there are the Essential plans. Depending on household size, those super-low cost plans, typically between $20 and $40 per month, cap out around $28,000 in annual income. But, there are subsidies available for those who make more than that because the cost increase between those essential plans and the state’s open marketplace are significant.
Without subsidy plans start around $380 per month for an individual, and grow significantly from there for families. The subsidies take a number of factors into consideration — and act as an employer match in cases where there isn’t one available to the worker.
“It’s daunting,” Smith said. “They ask for things like Adjusted Gross Income, or other items that the average person might not understand just glancing at a pay stub. There’s a lot of people out there who are able to get subsidy relief, but don’t know that they’re eligible.” The marketplace has a tool online that allows an individual to estimate their monthly cost with subsidy included. “It gives the consumer an idea about what to expect heading into it from a month-to-month cost perspective.”
For Smith and others in the industry — the point of emphasis is the power of knowledge. “I think it’s extremely important for people to not only understand all of the health plans that are available to them, but understand the types of benefits they offer. The marketplace is a great tool, but meant to be a Step #1 of shopping. They have done a great job of streamlining the purchase process, but you get a better apples-to-apples comparison if you’re comparing plans on companies websites,” she said. “Once you find a plan you think is right on the marketplace — get over to their website to look at the details.”
If you’re looking for health insurance visit nystateofhealth.ny.gov to learn more.