Less Reform For New York Health Insurance

The health care reform is a federal law that will affect the healthcare system across America. However, the changes implemented are not uniform to all the states.

The new law pushes for states to create their own health insurance coverage exchange. The good news is that the government allows states to make their own system that is not limited to the improvements the federal government outlines but even challenges states to go beyond what is asked for.

New York health insurance is off to a good start. One of the major goals of The Patient Protection and Affordable Care Act (PPACA) is to eliminate discrimination in acquiring health insurance plans. New York is one of the few states that have an open enrollment system. This means that when you apply for health care coverage, you do not have to go through physical exams and your premium is not affected by your age, gender, health condition, and occupation.

Some of the provisions in the health care reform are already implemented in the New York health insurance system. Because of this, we are expected to experience fewer changes than other states. Here are some of them:

• Guaranteed coverage – New Yorkers who apply for health insurance coverage are guaranteed coverage (for as long as the necessary documents are in order). You can never be denied a policy due to health conditions, gender, or age.
• Waiting Periods for Pre-existing Condition – Currently, when you have a pre-existing condition and you apply for health insurance in NY, you will not be denied coverage but you will have to undergo what is called a “waiting period” of about 12 months. This is the insurers’ way of ensuring that people don’t buy a policy because they’re already sick. However, by 2014 waiting periods will cease to exist. Under the PPACA no insurer will be allowed to implement a waiting period for people with pre-existing conditions.
• While waiting for 2014, individuals with pre-existing conditions can already acquire health care coverage and not go through waiting periods through the NY Bridge Plan program.
• Coverage for young adults until age 26 – Under the health care reform, providers are required to allow young adults until age 26 to stay under their parent’s policy as dependents. New York has the “Age 29 Law” wherein young adults can stay as a dependent in their parents’ policy until age 29. But there are certain conditions that are different from the Age 26 provision of the law. It is still being discussed with the federal government to see which will work best.
• Adjusted Community Rates – Right now, New Yorkers enjoy the same premium rates regardless of health condition, gender, or age. But the health care reform is suggesting “adjusted community rating” wherein the premium rates will vary depending on a person’s age or whether they smoke tobacco or not. Since the current health policy of the state is better than the one suggested by the reform, the state will most likely be able to keep its current rating requirements.
• Medical-loss ratio – The health care reform mandates insurance providers to spend 80% of premiums on health care for the small group market 85% on the large group market and only 20% on administrative fees. However, the New York health insurance system already spends 82% of health care costs in the small group market and 85% in the large group market.
• No out-of-pocket fees for Preventive care – Under the new health law, insurers are no longer allowed to have members pay a copay, coinsurance, or deductible for preventive care services. As of now, this provision only applies to the coverage of children until age 19.