NYS Essential Plan from 200% to 250% FPL officially approved

[jim584672]

Starting April 1st the $0 Essential Plan will be expanded to incomes between 200 ($30,120) and 250 ($37,650) percent of the FPL.

https://www.cms.gov/files/document/new-york-section-1332-waiver-fact-sheet.pdf

"March 1, 2024
The U.S. Department of Health and Human Services and the U.S. Department of the Treasury (collectively, “the Departments”) approved New York’s application for a State Innovation Waiver under the Affordable Care Act (ACA) (referred to as a “section 1332 waiver”) for five years, from April 2024 through December (PY) 2028."
https://www.cms.gov/files/document/new-york-section-1332-waiver-fact-sheet.pdf

Info page: https://info.nystateofhealth.ny.gov/1332

EP Benefits and Cost Sharing is available at:
https://info.nystateofhealth.ny.gov/sites/default/files/Attachment%20G%20-%20EP%20Benefits%20and%20Cost-Sharing_Revised%206%2020%202023.pdf

 

[jim584672]

New flyers just came out:

https://info.nystateofhealth.ny.gov...ntial Plan Fact Sheet - English expansion.pdf

https://info.nystateofhealth.ny.gov...At a Glance Card - English 2024 expansion.pdf

 

[MichaelB]

Looks like a good option for lower and middle income earners.

 

[scrabbler1]

Jim, I recall you mentioned this in another thread we posted in a few months ago (thank you for the tip). I did some advanced research work on this back in late December and into January, mainly about finding specific participating insurance companies who have my 4 main doctors in their network. (My current IC offers no Essential Plans.) I found 2 companies.

I also checked to see that my main pharmacy and lab (both popular national chains) are in there, and they are. I also checked their drug formularies, mainly for 2 costly drugs I take. In their January lists, one wasn't there. But in the March list, that one is now there. I have been using manufacturers discount coupons the last few years for both to reduce the current copays further, but I felt a little uneasy about relying on that as my sole means of getting a discount if the plans themselves didn't include them.

I just received the official letter from the NYSOH telling me about this changeover effective 4/1/2024. I do need to have everything in place with the new plan because April is a busy month for me visiting doctors and other medical service providers.

It will be nice seeing my HI premium drop to zero.

 

[GenXguy]

Starting April 1st the $0 Essential Plan will be expanded to incomes between 200 ($30,120) and 250 ($37,650) percent of the FPL.

https://www.cms.gov/files/document/new-york-section-1332-waiver-fact-sheet.pdf

"March 1, 2024
The U.S. Department of Health and Human Services and the U.S. Department of the Treasury (collectively, “the Departments”) approved New York’s application for a State Innovation Waiver under the Affordable Care Act (ACA) (referred to as a “section 1332 waiver”) for five years, from April 2024 through December (PY) 2028."
https://www.cms.gov/files/document/new-york-section-1332-waiver-fact-sheet.pdf

Info page: https://info.nystateofhealth.ny.gov/1332

EP Benefits and Cost Sharing is available at:
https://info.nystateofhealth.ny.gov...nefits and Cost-Sharing_Revised 6 20 2023.pdf

You picked a good state for you. You really know how to work the system for the benefits.

 

[jim584672]

It will be nice seeing my HI premium drop to zero.

Glad to hear it looks like it will work out for you.

 

[scrabbler1]

Glad to hear it looks like it will work out for you.

With help from a NYSOH phone rep last week (it has been rare I talked to adept ones there), I was able to change my online application so it would trigger a NY Essential Plan from my desired company. Then, 2 days ago, a phone rep from my new IC called me and gave me a CS # and membership # I can use on April 1st if I hadn't received an ID card by then (I'm supposed to get it next week).

No monthly premium notice, as I can ignore the April one from my existing IC.

 

[jim584672]

With help from a NYSOH phone rep last week (it has been rare I talked to adept ones there), I was able to change my online application so it would trigger a NY Essential Plan from my desired company. Then, 2 days ago, a phone rep from my new IC called me and gave me a CS # and membership # I can use on April 1st if I hadn't received an ID card by then (I'm supposed to get it next week).

No monthly premium notice, as I can ignore the April one from my existing IC.

No more premiums! I noticed the EPs have a gym membership reimbursement if you visit the gym 50 times within a six-month period.

 

[scrabbler1]

With help from a NYSOH phone rep last week (it has been rare I talked to adept ones there), I was able to change my online application so it would trigger a NY Essential Plan from my desired company. Then, 2 days ago, a phone rep from my new IC called me and gave me a CS # and membership # I can use on April 1st if I hadn't received an ID card by then (I'm supposed to get it next week).

No monthly premium notice, as I can ignore the April one from my existing IC.

In the "nothing is as simple as it seems" department, after not receiving any new membership materials including the ID card yet, I called my new IC to ask why. This rep told me the process of sending me new materials and the ID card had not begun, contradicting what I was told last week. So, I won't be getting anything by Monday.

However, I did sign up for an online account which works fine. But when I tried to print out my new ID card, it told me I can't do that yet because I am not a member. The phone rep confirmed this. So, I will have to print out the new ID card Monday morning before my 8:30 AM appointment. I'll have time, as long as there are no further glitches.

Not a good start.....

 

[jim584672]

Long-awaited Essential Plan expansion launches

https://www.politico.com/newsletter...ed-essential-plan-expansion-launches-00149899

Interesting part of the article, NYS will expand cost-sharing subsidies up to 400% FPL next year.

"New York plans to implement cost-sharing subsidies for enrollees in qualified health plans earning up to 400 percent of the federal poverty line starting next year, New York State of Health Executive Director Danielle Holahan said in an interview."

 

[hornet99]

Long-awaited Essential Plan expansion launches

https://www.politico.com/newsletter...ed-essential-plan-expansion-launches-00149899

Interesting part of the article, NYS will expand cost-sharing subsidies up to 400% FPL next year.

"New York plans to implement cost-sharing subsidies for enrollees in qualified health plans earning up to 400 percent of the federal poverty line starting next year, New York State of Health Executive Director Danielle Holahan said in an interview."

I thought NYS already offered cost-sharing subsidies (up to 400%) on qualified health plans, in the form is premium subsidies?

The detail will be interesting here, as there's a pretty big difference in cost between NY Essential Plans vs. QHPs (i.e. standard Obamacare subsidized plans).

 

[jim584672]

I thought NYS already offered cost-sharing subsidies (up to 400%) on qualified health plans, in the form is premium subsidies?

The detail will be interesting here, as there's a pretty big difference in cost between NY Essential Plans vs. QHPs (i.e. standard Obamacare subsidized plans).

NY adds no additional PTCs for plans right now. The cost-sharing reductions are only for Silver plans 250% and under (part of the original ACA formulation). To extend CSRs to 400% would be a first. Not enough details to know if it will be additional PTC help or CSR help.