The annual open enrollment period for health insurance is now upon us. New York State of Health is entering its fourth year of facilitating health insurance enrollment on the New York State of Health Exchange (an online health benefit exchange marketplace). The marketplace offers two separate enrollment channels: The Small Business Health Options Program and the individual marketplace for individuals and families. Open enrollment will begin on Tuesday, Nov. 1, and conclude on Tuesday, Jan. 31.
Since its start three years ago, New York State of Health has had tremendous success, enrolling more than 2.8 million New Yorkers in health coverage through the marketplace. The number of uninsured New Yorkers has declined by nearly 850,000. The rate of uninsured declined from 10 percent to 5 percent between 2013 and September 2015.
Consumers are encouraged to shop for the best value. The amount of tax credits changes each year, and many individuals will find that they are eligible for increased federal financial assistance to help make coverage more affordable. The same plans are available to consumers in 2017 as in the current year. All qualified health plans offer the 10 essential health benefits, and some options offer additional services such as adult dental and vision coverage in 2017.
New York State of Health’s Essential Plan, designed for lower-income New Yorkers, launched in 2016 and has met with enormous success. The Essential Plan lowers premiums to $20 or less a month and provides comprehensive benefits with no annual deductibles, free preventive care and low co-payments.
Employers can enroll in health insurance through SHOP at any time of the year. The marketplace offers flexibility in the level of employer contribution, choice of insurance providers, benefit levels and coverage tiers. Bookkeeping is simplified in that the marketplace combines premiums from multiple companies into one monthly bill. The marketplace is the only place where employers can get tax credits (eligibility required). Employers with up to 100 employees and at least one common law employee can enroll in SHOP. Whether or not you offer health insurance to your staff, both you and your employees are subject to the Affordable Care Act’s Individual Responsibility Mandate and are required to maintain minimum essential coverage. Employers can still support their employees by providing information about how they can enroll in health insurance on the individual marketplace.
Individuals and families
Those who are eligible to enroll on the individual market are:
- Sole proprietors with no employees
- Self-employed individuals
- Employees without access to employer-sponsored coverage
- Retirees not yet on Medicare
- Families and children
The marketplace makes it easy to shop for, compare and enroll in health insurance. You can see all the available insurance carriers and compare plans side-by-side. It is the only place to receive financial assistance (subject to eligibility).
If you miss the open enrollment period, you must qualify for a Special Enrollment Period. Examples of qualifying events include getting married, having a baby or adopting a child, or losing employer-sponsored coverage. There are some exceptions to the SEP rule: people eligible for Medicaid, the Essential Health Plan or Child Health Plus can enroll all year long (all New York state children are eligible for CHP, although a waiting period may apply).
There are three ways to enroll in health insurance on the marketplace:
1. Enroll with the help of a navigator. These in-person assisters have helped enroll almost 70 percent of applicants. Services are confidential and free.
2. Enroll over the phone using the call center. These helpful folks can answer your questions and help you complete your applications. They are open from 8 a.m. to 8 p.m. Mondays through Fridays and 9 a.m. to 1 p.m. Saturdays. The call center telephone number is (855) 355-5777.
3. Enroll in the comfort of your office or home. Go to nystateofhealth.ny.gov and choose either small businesses (for SHOP) or individuals and families (for everyone else). Read each screen carefully and follow the instructions. Use the call center for any questions in case you get stuck.
The Cayuga County Chamber of Commerce and the Cayuga/Seneca Community Action Agency have collaborated to provide in-person navigator assistance throughout Cayuga and Seneca counties. A current site schedule showing locations and times can be found at cscaa.com/health.
For more information or to make an appointment, call the Cayuga County Chamber of Commerce at (315) 252-7291, the CSCAA (Cayuga County) at (315) 255-1703 or the CSCAA (Seneca County) at (315) 539-5647.