WATERTOWN — Sticker shock: it’s what some local residents had when they opened letters from their health insurance plans saying premiums may increase by as much as 21 percent.
For those who obtained health insurance coverage for the first time by utilizing New York State of Health, insurance navigators and community advocates are now working with them to educate them about misconceptions of rate increases.
“People are freaking out about it,” said Steve Wood, community health coordinator of Community Health Advocates, a program offered through ACR Health. “People may forget rates generally go up each year. What people are paying will be very different from what the letters are quoting.”
He said that’s because letters come from insurance companies, and a person’s tax credit, which helps alleviate some of the financial burden, is not taken into account. Health insurance companies don’t know first-hand what a person’s tax credit will be, as the state will end up sending a direct tax credit payment to the insurance company.
“One letter I saw was quoting a price of $560, and the guy actually was paying $160 a month,” Mr. Wood said. “We’ve gotten a lot of calls from people.”
Rate increases will take effect in 2015, and although some plans are asking as much as the 21 percent increase, people most likely will not have to pay that hefty amount. Donna Hynes, North Country Prenatal/Perinatal Council insurance program coordinator, said people have the right to challenge their letters and appeal to the state.
The process has been set up through the state Department of Financial Services: Health Bureau, Premium Rate Adjustments.
People who don’t agree with their proposed rate increase can send a letter or comment on their proposed increase to the department at 1 State St., New York, N.Y. 10004, or send an email to firstname.lastname@example.org.
According to an ACR Health news release, emails or letters should include personal information and the name of the insurer, the name of the plan, whether it is individual or group coverage, and the plan’s identification number.
“People have actually been doing that, and it’s nice,” Mrs. Hynes said.
The state Department of Financial Services will make a final decision on approving or modifying rates.
Despite the health insurance rate confusion, Mr. Wood said community health advocates and navigators throughout Jefferson, Lewis and St. Lawrence counties “hear a lot of happy people getting health insurance.”
“I think there’s a big relief you can finally be treated for a chronic condition,” he said.
ACR Health staff has helped about 1,000 north country residents obtain health coverage.
Mrs. Hynes said she does not yet have those statistics available through her agency.
While there have been some “bumps in the road,” the health insurance exchange has worked well for most participants, she said.
“It’s working. It really is,” she said.
Come Nov. 15, she and Mr. Wood said, they expect to see both new and returning clients who may want to adjust coverage during the open enrollment period, which ends Feb. 15.
Anne Marie Snell, director of navigation for the St. Lawrence Health Initiative, said there has been much improvement with the health exchange, and her staff has been “steadily busy” helping people find affordable health coverage.
“We’d also love to assist small businesses through the marketplace,” she said.
“We haven’t seen as much as we’d like. It’s taking the next step, and meeting with a navigator.”
A list of local navigators is at www.nystateofhealth.ny.gov.
Insurance companies are sending letters to people who purchased a plan through the New York State of Health, the health insurance exchange, telling them of possible proposed rate increases for 2015. Here is a look at some information provided by the exchange, also known as the health insurance marketplace, for agencies who have assisted people obtain health coverage:
• Letters sent were required by state insurance law • All plans are required by law to get approval from the state for annual changes in premium rates • Letters do not reflect the advanced premium tax credit used to help pay for coverage • Premiums often change due to reasons such as changes in the price of covered medical services or how often people use services versus what insurance companies expect • There is no maximum percentage increase, but the state will review each request • The letter does not reflect the final price you will pay, only the premium change the health plan is requesting • You do not need to take action through the marketplace at this time • You can appeal to the state
Information provided by New York State of Health