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2015 News & Updates
Children's Health Coverage from Birth
Starting January 2017, children will be able to get Child Health Plus health insurance from the day they are born, thanks to a new bill signed into law by Governor Cuomo.
The law says Child Health Plus coverage will start the day of a baby's birth, so long as their parents enrolled them before birth or within 60 days of birth. Today, parents may have to wait weeks after applying for Child Health Plus coverage to begin for their child. During that gap in coverage, families might be concerned about medical costs or even hold off on getting checkups and care for their newborns. Starting in 2017, new parents will no longer have to worry about waiting for coverage.
Child Health Plus is New York's insurance program built for kids. The program is free or has a sliding scale fee depending on a family's income. All New York children under 19 are eligible regardless of income or immigration status.
You can enroll your child in health coverage any time of the year online, over the phone, or in-person. Help is available in many languages.
Call: 855-355-5777 or 311 for help to enroll.
Wishing you a happy, healthy, and fun New Year!
All Pregnant Women Can Now Enroll in Health Insurance Coverage Any Time through the State's Health Insurance Exchange
Last Updated: December 23, 2015
On December 23rd, Governor Andrew Cuomo signed legislation making New York the first state in the country to add pregnancy to the list of "qualifying life events" that allow individuals to enroll in health insurance outside of the normal open enrollment period through the state's health insurance exchange, the New York State of Health. Prior to this legislation, only pregnant women with incomes up to 223% of the federal poverty level could enroll in Medicaid year round. Now, all pregnant women can enroll in coverage regardless of income or plan type. Learn more about the legislation.
If you are pregnant and in need of coverage, apply online, over the phone, or in-person. Help is available in various languages.
Call: 855-355-5777 or 311 for help to enroll.
LGBTQI Get Covered
Last Updated: December 11, 2015
LGBTQI Week of Action for Health Insurance Enrollment is December 7-11. It's time to get covered!
Learn more about your health insurance options and health care if you are uninsured from our LGBTQI fact sheet.
More LGBTQI New Yorkers are getting covered thanks to the Affordable Care Act. In fact, a recent national survey found that the uninsurance rate among LGB individuals was almost cut in half over the past two years.
Under the Affordable Care Act, plans can't discriminate based on your gender identity or who you love. You can't be denied based on a preexisting condition like HIV or cancer. And now, transgender individuals have better access to care because of New York State rules for private insurance plans and Medicaid to cover transition-related care and services.
If you are uninsured, you can visit the NY State of Health Marketplace to find a plan that's right for you. You can get free help to enroll from someone in your community. There are new plans and new prices this year, including a new affordable option called the Essential Plan. Financial assistance is available.
Visit NY State of Health to explore your options and apply. Open enrollment for health insurance lasts until January 31, 2016. Medicaid and Essential Plan are open for enrollment year-round for those who qualify.
Special note for assistors: Health Care For All New York's LGBT Task Force presented a webinar last year called Best Practices for Enrolling LGBT New Yorkers in NY State of Health Coverage. Learn more and view the webinar slides.
Your Rights to Preventive Care
Last Updated: November 6, 2015
Under the Affordable Care Act, health plans must cover all recommended preventive services, like cancer screenings, without cost-sharing (e.g. copays, coinsurance, deductibles). A new federal FAQ helps explain your rights to some of these preventive services.
Breastfeeding Moms
Health plans must cover services during pregnancy and after birth that promote breastfeeding. These include prenatal and postnatal lactation support, counseling, and equipment rental or purchase. Your plan must:- Cover lactation counseling and the rental or purchase of breastfeeding equipment for the duration of breastfeeding. For example, plans can't cover lactation counseling only in an in-patient setting (hospital).
- Provide you with a list of lactation counselors that are "in-network" (this will usually be found with your plan's online list of in-network providers)
- Cover an out-of-network lactation counselor without cost-sharing, if there is no lactation counselor in-network.
- Cover lactation counseling by any provider working within the scope of their practice (for example, a registered nurse can provide lactation counseling).
Adult Obesity
Health plans must cover preventive and weight management services related to adult obesity. Your plan can't cover only pediatric obesity prevention and weight management.
Colon Cancer Screenings
In addition to colonoscopies, plans must cover related services that are considered integral parts of colonoscopies. For example, plans must cover specialist consultations prior to colonoscopies, pathology exams and polyp biopsies.
General Questions
If you have a Health Republic plan and you questions not related to enrollment through the NY State of Health special consumer helpline, you can call the NY Department of Financial Services consumer help line: 800-342-3736 (Hours: Hours: 8am-8pm M-F; 9am-1pm Saturday).Protecting People from Health Care Discrimination
Last updated: October 8, 2015
An individual shouldn't be denied health care services because she is in a wheelchair. A person who speaks very little English shouldn't be required to have their child interpret sensitive and complex medical information. A transgender person shouldn't be denied care simply because of his or her preferred gender. These are all forms of discrimination in health care.
An important part of the Affordable Care Act called Section 1557 prohibits discrimination on the basis of race, color, national original (including English language proficiency), sex, age, and disability. All health programs that get federal money from the Department of Health and Human Services have to obey Section 1557. This includes doctor's offices that accept Medicare payments, health insurance companies that get federal health insurance subsidies, State health insurance marketplaces, and others.
Now, the federal government is proposing to make nondiscrimination requirements even clearer and stronger, and to add new protections for transgender people. The proposed rule includes protections like:
- Health programs must post notices, in multiple languages, about consumer rights and language and auxiliary assistance.
- Insurance companies can't categorically deny all health services for gender transition services.
- Individuals must be treated consistent with their gender identity (for example, when assigning hospital rooms).
- Individuals can't be denied health care because they need services that are not consistent with their gender (e.g. mammograms for transgender males).
For more information about the proposed rule, including a link to submit comments, visit the website of the Department of Health and Human Services, Office of Civil Rights.
New Health Insurance Protections for Transgender New Yorkers
Last Updated: September 15, 2015
**UPDATE:** Recent changes in New York State and federal private and public insurance policies will help transgender New Yorkers access care.
Private/Commercial Insurance
Private insurance companies in New York may no longer deny medically necessary treatment for gender dysphoria,* if that same treatment would be covered for other conditions. This means that if a person needs treatment related to gender transition (like a mastectomy) an insurance company may not deny that treatment just because the patient is transgender. An insurance company can still review a treatment for medical necessity, as it may do with any benefit. But, if the insurance company denies the treatment they must offer the full set of appeal rights to the consumer. This includes an internal appeal and, if needed, an external appeal with an independent third-party.Medicaid – Public Insurance
As of March 11, 2015, New York's Medicaid program will cover transition-related transgender care and services for the treatment of gender dysphoria.* Covered services include cross-sex hormone therapy and gender reassignment surgery. Medicaid already covered, and will continue to cover counseling services for the treatment of gender dysphoria. Learn more about age limits and other exceptions, see the new Medicaid rule.*Gender dysphoria is a condition when a person's gender at birth is different than who they know to be inside.
**UPDATE:** In June 2015, New York State issued a Medicaid Update with a slight change to the transition-related transgender care regulations. The original March regulation provided a list of services that would not be covered, such as collagen injections, drugs to promote hair growth or loss, and facial bone reconstruction. The Update includes different language that says this list of services may be covered, if a doctor says they are medically necessary and the patient receives prior authorization. You can see the full list of services and read the full update here.
Coverage of Sex-Specific Recommended Preventive Services
The federal government recently clarified that all insurance companies must cover medically appropriate preventive services regardless of a patient's sex at birth, gender identity, or recorded gender. For example, if a provider decides that a pap smear is appropriate for a transgender man who has an intact cervix, the insurance company must cover the service without cost-sharing. The federal government issued this new guidance in the form of a Q&A available online.2016 Health Insurance Rates for New York City
Last Updated: September 15, 2015
On July 31, the Department of Financial Services released approved health insurance premium rates for 2016 plans. The final rates are 30% lower than the average rates insurance companies had requested earlier in the summer. The Department projects this reduction in rates will save consumers more than $430 million this year. The two tables below show requested and approved rate changes for individual/family and small business plans offered through the NY State of Health Marketplace.
2016 Approved Health Insurance Rates for NYC Plans offering coverage through the NY State of Health Marketplace (Individual/Family)
| Health Insurance Company | Requested Average Change | Approved Average Change |
|---|---|---|
| Affinity Health Plan | +6.63% | +6.63% |
| Emblem Health (Health Insurance Plan Of Greater NY) | +13.20% | +10.51% |
| Empire Blue Cross Blue Shield |
+14.50% | +13.20% |
| Fidelis | +4.66% | +4.66% |
| Health Republic | +14.36% | +14.03% |
| Healthfirst | +12.89% | +9.60% |
| Metroplus | -7.00% | -7.00% |
| North Shore-LIJ Care Connect | +4.93% | +4.43% |
| Oscar | +4.54% | +4.54% |
| United Healthcare of NY | +22.00% | +1.65% |
| Wellcare | +4.72% | -3.30% |
2016 Approved Health Insurance Rates for NYC Plans offering coverage through the NY State of Health Marketplace (Small Business)
| Health Insurance Company | Requested Average Change | Approved Average Change |
|---|---|---|
| Capital District Physician's Health Plan (CDPHP) | +16.56% | +16.56% |
| Emblem Health (Health Insurance Plan Of Greater NY) | +29.74% | +29.74% |
| Health Republic | +20.00% | +20.00% |
| Metroplus | -0.81% | -0.81% |
| MVP Health Plan, Inc. | +7.28% | +6.36% |
| North Shore-LIJ Care Connect | +3.27% | +3.27% |
- Is the Internal Revenue Service (IRS) only allowed to give out these subsidies to people who enroll in a marketplace run by a state (like New York)?
- Or, can the IRS also give out these subsidies to people who enroll through the federal health care marketplace?
What did the Court decide?
The Court decided that the IRS can give out health insurance subsidies to any qualified individual who enrolls through a marketplace, no matter whether a state or the federal government runs that marketplace. They agreed that the part of the law that talks about which entity can give out subsidies is confusing. But, upon reading the law as a whole, the Court decided that it was clear that Congress meant for subsidies to be available to everyone who qualifies, not just people getting coverage through state marketplaces.Will this impact my health insurance in New York?
No. That's because New York State operates its own health insurance marketplace called the NY State of Health. This Court decision has made a big difference for about 6.4 million people in other states who had received health insurance subsidies when enrolling through the federal marketplace known as healthcare.gov.Health Insurance Rates for Next Year
Last Updated: June 19, 2015
Health insurance companies recently sent applications to New York State to request raising, lowering, or maintaining health insurance premiums for next year. Every year, the Department of Financial Services reviews these rate proposal applications to decide whether to approve or reduce a rate increase request. Under New York State law, the Department of Financial Services may disapprove or modify an insurance company's request for a premium rate increase if it is "unreasonable, excessive, inadequate, or unfairly discriminatory." The Department considers many factors in its decision, like the cost of health care, history of rate changes, and administrative costs of a company.
Insurance companies are required to send customers a notice when they file their proposed rate application with the Department of Financial Services. Individuals and small businesses can send comments about their plan's rate proposal. Comments must be received 30 days from when the application was posted on the Department of Financial Services website. For most plans comments are due before July 2nd.
Once a final premium has been approved, each insurance company must send a second notice to customers 60 days before the premium change takes effect. The notice includes more specific information about their premiums.
New Health Insurance Protections for Transgender New Yorkers
Last Updated: May 21, 2015
Recent changes in New York State and federal private and public insurance policies will help transgender New Yorkers access care.
Private/Commercial Insurance
Private insurance companies in New York may no longer deny medically necessary treatment for gender dysphoria,* if that same treatment would be covered for other conditions. This means that if a person needs treatment related to gender transition (like a mastectomy) an insurance company mfy not deny that treatment just because the patient is transgender. An insurance company can still review a treatment for medical necessity, as it may do with any benefit. But, if the insurance company denies the treatment they must offer the full set of appeal rights to the consumer. This includes an internal appeal and, if needed, an external appeal with an independent third-party.Medicaid – Public Insurance
As of March 11, 2015, New York's Medicaid program will cover transition-related transgender care and services for the treatment of gender dysphoria.* Covered services include cross-sex hormone therapy and gender reassignment surgery. Medicaid already covered, and will continue to cover counseling services for the treatment of gender dysphoria. For more information about age limits and other exceptions, you can see the new Medicaid rule here.*Gender dysphoria is a condition when a person's gender at birth is different than who they know to be inside.
Coverage of Sex-specific Recommended Preventive Services
The federal government recently clarified that all insurance companies must cover medically appropriate preventive services regardless of a patient's sex at birth, gender identity, or recorded gender. For example, if a provider decides that a pap smear is appropriate for a transgender man who has an intact cervix, the insurance company must cover the service without cost-sharing. The federal government issued this new guidance in the form of a Q&A available online.- Are uninsured
- Attest that you paid the penalty with your 2014 federal income tax return, for not having health insurance in 2014, and
- Were confused or didn't know about open enrollment dates for 2015 coverage, and need another opportunity to enroll in coverage for the remainder of 2015.
The maximum penalty will increase in 2015 and again in 2016. The penalty for those who are uninsured in 2015 and do not have an exemption will be the greater of two percent of income or $325 per adult. That will increase to the greater of two-and-a-half percent of income or $695 per adult in 2016.
This special enrollment period in New York will start on March 1, 2015 and end April 30, 2015.
The IRS has announced relief measures for certain taxpayers who were enrolled in the Marketplace in 2014
Last Updated: March 20, 2015
Who do the relief measures apply to?
The relief applies to taxpayers who meet all four of the following conditions:- Enrolled in a Platinum, Gold, Silver or Bronze QHP through the Marketplace for part or all of 2014
- Received an original 1095-A tax form from NY State of Health
- Subsequently received a corrected 1095-A tax from NY State of Health
- Filed a federal tax return based on the original 1095-A tax return, regardless of whether or not the consumer had already received the corrected 1095-A tax return.
What is the relief?
Taxpayers who meet the four conditions above will not need to amend their tax return with the corrected 1095-A tax form. The IRS will not pursue the collection of any additional taxes from these individuals based on updated information in the corrected 1095-A tax forms.If the relief measures apply to me and I already filed my tax return, could I benefit from amending my tax return?
If you met all four conditions listed above, you are not required to amend your federal income tax return. If you do not amend your federal income tax return, the IRS will not pursue the collection of any additional taxes from these individuals based on updated information in the corrected forms.
However, some taxpayers may benefit from filing an amended return. Whether or not a taxpayer would get a refund or a larger refund, or have to pay less in taxes would depend on that household's circumstances. Revising the federal tax form 8962 that was filed with the federal tax return would indicate if it would be beneficial to amend a federal tax return. Consumers who need assistance with this process should talk to their tax preparer or tax advisor.
The relief measures do **NOT** apply to:
Consumers who received a 1095-A tax form in error from the Marketplace and had not actually enrolled in a Platinum, Gold, Silver or Bronze QHP through the Marketplace in 2014. These consumers will be issued a Voided 1095-A from the Marketplace to indicate that their original 1095-A tax form has been voided. If these consumers filed their federal tax returns based on the original 1095-A form from the Marketplace, they will need to amend their return.
Consumers who were enrolled in a Platinum, Gold, Silver or Bronze QHP through the Marketplace in 2014, but have not yet received their 1095-A from the Marketplace. These consumers should wait for their 1095-A tax form, but should file their federal tax return by April 15. If these consumers have already filed their federal tax return, they will be required to file an amended return once they receive their 1095-A tax form from the Marketplace.
Life Events Special Enrollment Period: February 16, 2015 – October 30, 2015
Last updated: February 25, 2015
What if I missed open enrollment?
After February 15, 2015, you can enroll in a 2015 health insurance plan through the NY State of Health Marketplace if you have an event that qualifies you for a Special Enrollment Period.If you experience certain changes in your circumstances, you may qualify for a special enrollment period. During aIf you qualify for a special enrollment period, you can:
Immediately sign up for new coverage or change your health plan – you don't have to wait until open enrollment.
Special enrollment periods are time-limited:
- If your coverage is through a job, you may only have 30 days from the time of the qualifying
event to make a change. - If you have or are getting insurance on your own, you must act within 60 days of the qualifying event.
Qualifying events that may qualify you for a Special Enrollment Period
- Getting married or divorced
- Having a baby
- Adopting a child or placing a child for adoption or foster care
Losing your current health insurance coverage - Permanently moving outside your plan's coverage area
- Leaving the prison system
- Becoming a citizen or lawful resident
- Being a member of an Indian tribe or an Alaska Native shareholder.
- For people already enrolled in Marketplace coverage:
Having a change in income or household size that affects
eligibility for premium tax credits or cost-sharing reductions
Enrollment Assistance
To find in-person assistance near you, text CoveredNYC to 877877 or call 311. For more information, visit the NY State of Health at nystateofhealth.ny.gov, or call 855-355-5777.News Archives: 2018 | 2017 | 2016 | 2015 | 2014 | 2013