Health care costs in NY State

[MBSC]

Individual
-----------
Catastrophic: $158-$193
Bronze: $320-$370

Moving to New York state for the community rating is on my list of options should the need arise. Healthy persons also have the option of moving to Tennessee. TN continues to allow the sale of low cost underwritten major medical plans through the Farm Bureau. It should be noted that the probability of TN DOI changing FB's designation from "rural health organization" to "health insurance company" is higher than NY changing from community rating.

60 yr old Individual in Knoxville:

$2500 deductible/$3750 MOOP (HSA eligible): $210/month
$5000 deductible/$10,000 MOOP: $150/month

Farm Bureau Health Plans

 

[pablo]

An important note about health care in NY State...COBRA lasts 3 years here, not 18 months. I quit about 18 months ago and I still have 18 months of eligibility left.

 

[copyright1997reloaded]

I agree that if you compare annual premiums to annual costs that community rating is unfair to the young and advantageous to the old. However, over a lifetime it would all even out ... someone would "overpay" when they are young and would "underpay" when they are older.... just like what happens with permanent life insurance... your "overpay" compared to term life insurance rates when you are young and "underpay" when you are older... or another way of thinking of it is that when you are young that you are prepaying to get favorable rates when you are older.

The reason to "join the party" is to have insurance coverage if you are one of the relatively few young people to have a significant health event or accident and to gain access to more affordable health insurance coverage when you are older.



The problem with what you propose is where to draw the line... the ACA draws it in one place (3:1 IIRC) and AHCA would draw it in a different place (5:1 IIRC) vs VT/NY/group at 1:1.

A part of the adverse selection issue is people buying insurance only when they become sick. While I would prefer to mandate coverage it is clear that as a society we are not keen on doing that so the next step would be to deny coverage for existing conditions for a period of time unless someone has had continuous coverage (which AHCA includes as I understand it)... IOW, there is a penalty that could cost you a lot or bankrupt you if you don't continuously carry health insurance coverage... those who are short-sighted or have little to lose will likely decide not to sign up anyway but that is their choice and they will need to live with the consequences.

As a society we have lots of experience with large group coverage and it seems to work ok so I would like to see an approach that creates a huge group with the same approach as group coverage with a couple tweaks as appropriate in the circumstances... and adjust as needed for issues that arise.

So, suppose I am 21 and healthy, but I have no employer provided health care. I'm supposed to pay 3X - 5X rates because someone told me that over my lifetime it will even out? OK, sure that sounds like a good idea. That $600 a month buys me a lot of other things that I need. A car, movies, fun times with my friends. I won't get sick (because I'm invincible), and if I do start to have health problems, I sign up at that point. I don't have tons of money, so what the .... I will let it ride. If I get sick I go to the hospital where they must take me, insurance or not.

It's that simple. Without forcing people to play (which the ACA tries to do but doesn't really succeed at) -OR- by refusing coverage for preexisting conditions/refusing care (which we as a society won't do), the existing structure can't (and won't) work.

Ask yourself this. How many young people would pay social security if given the option to opt out? I am opposed to the ACA (or socialized medicine in general), but if there is to be insurance for all, it should be some sort of minimal, catastrophic care only plan which needs to be funded directly (e.g. by income tax or sales tax). By minimal, I mean minimal - which the ACA certainly is not.

 

[pb4uski]

Actually a 21 year old in my state can buy a high-deductible ACA catastrophic plan for about $240 a month (no subsidy) so perhaps that suits your fancy better.

 

[NameRedacted]

One other thing about health care in NY State worth mentioning that I only found out about today

There is a "Protection from Surprise Bills and Emergency Services" law:

New York’s New “Surprise Bill” Law Rolls out New Health Insurance Protections for Consumers | Families USA

A couple of snippets from that article:

"Consumers who receive emergency services will not have to pay more than their usual in-network cost sharing and/or copayments, regardless of the network status of the providers. The emergency service providers and health insurers will have to negotiate the fees directly."

"Consumers who receive other out-of-network medical services when there were no in-network providers available, or when they did not receive the disclosures required by law, are also protected. Consumers in these circumstances can assign their claims to the out-of-network providers and also pay only their usual in-network cost-sharing. In this situation, too, the bill is then worked out directly between the provider and the health plan."

Until I retired I didn't pay much attention to health care but 'knew' it was more expensive in New York but the more I find out about the rules and regulations in New York the happier I am.

 

[scrabbler1]

One other thing about health care in NY State worth mentioning that I only found out about today

There is a "Protection from Surprise Bills and Emergency Services" law:

New York’s New “Surprise Bill” Law Rolls out New Health Insurance Protections for Consumers | Families USA

A couple of snippets from that article:

"Consumers who receive emergency services will not have to pay more than their usual in-network cost sharing and/or copayments, regardless of the network status of the providers. The emergency service providers and health insurers will have to negotiate the fees directly."

"Consumers who receive other out-of-network medical services when there were no in-network providers available, or when they did not receive the disclosures required by law, are also protected. Consumers in these circumstances can assign their claims to the out-of-network providers and also pay only their usual in-network cost-sharing. In this situation, too, the bill is then worked out directly between the provider and the health plan."

Until I retired I didn't pay much attention to health care but 'knew' it was more expensive in New York but the more I find out about the rules and regulations in New York the happier I am.

Two years ago, when I had my 12-day stint in the hospital, I had gone to the ER first and was later admitted. But the hospital was not in-network. However, because my hospital stay was a result of an ER visit, I was covered as if the hospital was in-network. My insurance company and the hospital had to fight it out (and they did!) over what the IC would pay the hospital, but I was not liable for anything beyond the maximum copay/coinsurance/deductible as stated in my policy (thanks to that law). And I could not be balance-billed, of course (although the hospital tried to bill me for an extra ~$500 which I got them to ignore).

 

[MBSC]

New York also limits Medicare balance billing (excess charges) to 5% for most services instead of the federal limit of 15%.

A New York State law limits the amount that Medicare nonparticipating physicians (physicians who do not accept Medicare assignment) may charge - no more than 5% above Medicare’s approved amount. This limit applies to all services except certain home and office visits for basic medical examinations, (those represented by procedure codes of 99201 to 99215 and 99341 to 99353). For services billed with these procedure code numbers, the federal limit of 15% above Medicare’s approved amount applies. Medicare’s approved amount for health care services and supplies is shown on the beneficiary’s MSN.

Source: https://aging.ny.gov/HealthBenefits/Notebook/Modules/Mod4.pdf

 

[Just_Steve]

And the cost of healthcare in NY may become even cheaper in the near future. Passed in the Assembly now on to the Senate where it only trails by one vote for passage.

"On Wednesday, May 27, the New York State Assembly passed the “New York Health Act” universal health care bill (A. 5062/S. 3525) by a vote of 92 to 52. New York Health would provide universal, comprehensive health care to all New Yorkers without premiums, co-pays, deductibles, or limited provider networks."

https://www.healthcare-now.org/blog/new-york-assembly-passes-universal-healthcare-legislation/

Link to the full bill: New York State Assembly | Bill Search and Legislative Information

 

[Live And Learn]

Oh boy. The thought of moving back to NY is sort of sad but sort of thrilling. I really do miss the museums. I really do NOT miss the winter !!

 

[Fedup]

Actually a 21 year old in my state can buy a high-deductible ACA catastrophic plan for about $240 a month (no subsidy) so perhaps that suits your fancy better.

That seems high. My kid pays $251 for Kaiser plan in HCOL area in CA, non ACA plan. She loves Kaiser.

 

[meierlde]

Did anyone see that in NV they are proposing that you can buy into medicaid? While not the best care, (Ideally they would like to include exchange subsidies). Now this might mean healthcare ala the college clinic many of us recall from college days.

 

[pgiyer]

And the cost of healthcare in NY may become even cheaper in the near future. Passed in the Assembly now on to the Senate where it only trails by one vote for passage.

"On Wednesday, May 27, the New York State Assembly passed the “New York Health Act” universal health care bill (A. 5062/S. 3525) by a vote of 92 to 52. New York Health would provide universal, comprehensive health care to all New Yorkers without premiums, co-pays, deductibles, or limited provider networks."

https://www.healthcare-now.org/blog/new-york-assembly-passes-universal-healthcare-legislation/

Link to the full bill: New York State Assembly | Bill Search and Legislative Information

That link (for the NY State Assembly Bill) does say May 27, but has no year. The accompanying comments are from 2015, and conclude by saying that NY State Senate did not pass the bill. So did all this happen in 2015 and is dead now?

 

[MichaelB]

NY State did announce measures to address coverage in the individual market. Essential health benefits will be required and insurers must continue to offer exchange plans if they want to participate in the Medicaid marketplace.

SYRACUSE, N.Y. -- Any insurers that leave New York's health insurance exchange will be banned from participating in the state's Medicaid program or contracting with any state agencies under regulations Gov. Andrew Cuomo announced today.

Cuomo also will make all insurers who do business on the state's exchange guarantee the 10 essential health benefits required by the federal Affordable Care Act, also known as Obamacare. Cuomo to ban companies from Medicaid if they leave NY health insurance exchange | NewYorkUpstate.com

Requiring insurers to offer individual policies if they want access to the Medicaid market is a smart move. Nevada is doing something similar. Perhaps this is something that other states will follow.

 

[NameRedacted]

I was reading this article about health coverage at the fivethirtyeight web-site:

https://fivethirtyeight.com/features/why-some-conservatives-dont-like-the-house-health-care-bill/

The really interesting part from the point of view of most participants on this board is the map that shows how subsidies might be affected for a 60 year-old couple earning $50,000 on a county by county basis if we switch to the AHCA as it stands.

Amazingly upstate New York comes out pretty well! On the other hand, sadly, Alaska is screwed.

Noticing that the source was the Kaiser Family Foundation led me to this page:

Premiums and Tax Credits Under the Affordable Care Act vs. the American Health Care Act: Interactive Maps | The Henry J. Kaiser Family Foundation

which has a really useful interactive map that allows you to select age and income. You can then point at your specific county and get actual numbers.

Of course, since health care is a moving target the accuracy of these numbers is debatable, but I do think it might help people plan for the future especially those that are maybe thinking of moving when they retire.

 

[GTFan]

Since health care is a moving target right now there is very little info to help ERs plan for the future. All we can do is comment on current legislation and executive action until we see how the sausage has been made.

I find it interesting that all of this is happening behind closed doors right now, with no public input or hearings. I guess we'll see if an attempted ram-through of pork into sausage is the result.