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N.Y. health exchange data shows preference for low-priced plans

A majority of Western New Yorkers shopping for health insurance through the NY State of Health exchange chose low-priced plans, offered by companies new to the local market, over costlier plans provided by the region’s dominant insurers, the state reported Wednesday.

Health Republic Insurance of New York and Fidelis Care together grabbed 58 percent of the exchange market share here, outperforming BlueCross BlueShield of Western New York, Independent Health and Univera Healthcare, which earned a combined 36 percent.

That market share data is a highlight of a report released Wednesday by the state Health Department that offered new details on who enrolled in coverage through the state insurance exchange during the initial six-month enrollment period, and which plans they selected.

The exchange is a key piece of the federal Affordable Care Act. The measure sought to cover the uninsured, while lowering overall health care spending, but generated controversy.

Enrollment in New York’s exchange opened Oct. 1 and ended April 15, with 960,762 people signing up for Medicaid, Child Health Plus or a private plan.

In Western New York, 55,844 people signed up for coverage through the exchange, including 22,880 who selected a private health plan. The state had periodically provided information on enrollment trends, but it had never released sign-up data broken down by county and by insurer until Wednesday.

Health Republic Insurance drew the largest number of enrollees in this market – and 40 percent of market share – even though it only competed in half the counties here. Fidelis Care was next in the individual market, with 18 percent, followed closely by BlueCross BlueShield and Independent Health.

A nonprofit cooperative headquartered in New York City, Health Republic offered the lowest, across-the-board premiums for individual insurance on the exchange.

“I think historically health insurance has been a price-sensitive purchase. So it’s not surprising that the lower-cost plans did better initially,” said Donald R. Ingalls, vice president for federal and state relations for BlueCross BlueShield.

In Erie County alone, Health Republic signed up nearly 6,100 individuals, or 46 percent of the total. BlueCross BlueShield and Independent Health enrolled 19 percent and 18 percent, respectively.

It’s important to note that insurance purchased through the exchange represents a small portion of the insurance companies’ business. Independent Health, for example, enrolled 3,562 people in individual coverage through the exchange, out of 369,000 members overall.

The vast majority of people get health insurance through an employer or a government plan such as Medicare or Medicaid. For those who don’t, and who didn’t sign up for exchange insurance this year, enrollment through the exchange for coverage that takes effect in 2015 will begin Nov. 15. The state has a goal of enrolling 1.1 million in private health plans through the exchange by the end of 2016.

Insurance officials say that in the enrollment period, shoppers need to look at more than just the sticker price. “Is their doctor in the network? And what kind of customer service does the plan provide? What kind of coverage? What are the benefits overall? And what other value-added benefits are included?” said Nora K. McGuire, Independent Health’s senior vice president and chief marketing officer.

Other highlights of Wednesday’s enrollment report include:

• Statewide, 55 percent of exchange enrollees signed up for Medicaid, and another 7 percent enrolled in Child Health Plus. The other 38 percent enrolled in a private health plan.

• Three-fourths of the 370,604 people who enrolled in a private health plan were eligible for one of the financial subsidies meant to bring down the cost of their insurance. The average tax credit they received was $215 per month.

• 74 percent of people who signed up for coverage through the exchange did so after Jan. 1, and 36 percent did so in March alone as the deadline to enroll in coverage for 2014 loomed.

• 81 percent of people who enrolled through the exchange were uninsured at the time.

• Exchange enrollment roughly followed state population trends, though New York City was slightly overrepresented, and upstate New York was slightly underrepresented. Western New York, for example, has 8 percent of the state’s under-65 population and 6 percent of exchange enrollment.

“It’s the first year. It was kind of a pilot for everybody, and there were a lot of unknowns and uncertainties going into the marketplace,” McGuire said.

• One-quarter of the people who enrolled in a private health plan are ages 55 to 64, and 23 percent are 45 to 54. Combined, they account for nearly half of enrollees in private health plans. One-third of the people who enrolled in a private health plan through the exchange are younger than 35, the demographic coveted by insurers and architects of the marketplace.

The effort to get young people to sign up, Ingalls said, is “a marathon, not a sprint.”