What the Healthy NY Change Means To Me?

Healthy NY has recently announced that beginning January 1st of next year, the NY health insurance program will no longer be offering traditional HMO plans (health maintenance organization). New enrollees can only choose between HDHP (high deductible health plans) with drug coverage or HDHP without drug coverage. HMO plans have been the popular choice over the years across most, if not all countries.

The reason for the change is that in the past three years, Healthy NY’s enrollees have been increasing and consequently, claims have also increased. However, the program’s budget has not increased. It has come to a point when the funding has been insufficient to cover claims, particularly from the HMO plans.

The announcement has stirred confusion among Healthy New York members. They are wondering how this will affect them. Existing members will not be affected by this change. Only new members with effectivity dates of January 1, 2012, and onwards will be affected by this option change. Below are detailed examples that should clarify frequently asked questions.

If you are currently covered under an HMO plan, you don’t have to change your plan to an HDHP come January 1, 2012. If your renewal date falls after January 1, 2012, you can still keep your HMO policy provided that you do not change your health plan provider. When you transfer to a new provider, you are considered a new enrollee therefore you will be subject to the rules regarding new members. Upon renewal if you plan to change your HMO plan to one with a prescription or if you want to drop the prescription coverage, you may do so. This will not require you to change to an HDHP.

Adding or removing dependents or adding or removing employees in group plans will not disqualify you from keeping your HMO plan.

If you recently had a Healthy NY HMO plan that lapsed and you are looking to re-enroll, you would have to re-enroll but with an HDHP. You can no longer re-enroll your previous HMO plan.

If you have an HDHP and you want to switch to an HMO, you can. But the effectivity date should be on or before January 1st, 2012.

In general, existing members will only be affected by the announcement if, upon renewal, they change to a new health insurance coverage provider; if their previous Healthy NY plan has lapsed and they want to renew it, or if they currently have an HDHP and they want to change to an HMO.