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Medicaid drives 33 percent increase in New York State’s health exchange enrollment

Enrollment in New York State’s health insurance exchange rose by one-third this year as more residents signed up for Medicaid and also a new, low-cost plan for those not eligible for Medicaid, according to the latest report from the state Health Department.

The health insurance exchange enrolled 2.8 million people as of Jan. 31, with 69 percent enrolled through the jointly-funded state and federal health insurance program for low-income people and others who need assistance.

But less than 11 percent enrolled in a qualified health plan – the department’s name for private health insurance – as hundreds of thousands of people signed up for the state’s low-cost, no-frills Essential Plan that drew 14 percent of enrollees.

In the eight counties of Western New York, membership on the NY State of Health exchange rose 28 percent this year.

“I think there’s more people recognizing the need to have coverage,” said Nora McGuire, senior vice president and chief marketing officer at Independent Health.

This year marked the third enrollment period for the insurance exchange, which opened Oct. 1, 2013. It provides coverage for people who don’t get insurance through their employer or through Medicare.

The exchange is a key piece of the federal Affordable Care Act, which sought to cover the uninsured and lower overall health care spending.

About 961,000 New Yorkers enrolled during the first sign-up period, which ended April 15, 2014. During the second enrollment period, from Nov. 15, 2014 to Feb. 28, 2015, more than 2.1 million signed up.

The report offers the first detailed breakdown of enrollment for 2016.

•Enrollment rose 33 percent, an increase of about 700,000 people.

That’s slower growth than in 2015, when enrollment grew by 1.1 million.

The number of uninsured New Yorkers has fallen by 850,000 since 2013, when people could get health insurance through the exchange, according to the state Health Department.

The percentage of New York State residents without health insurance fell from 10 percent in 2013 to 5 percent in September 2015, according to the Centers for Disease Control and Prevention.

“The uninsured rate is at an all-time low,” said Tom Sass, director of consumer markets for BlueCross BlueShield of Western New York.

• Statewide, more than two-thirds of those signing up for coverage did so through Medicaid.

“It’s a little surprising to me that Medicaid is such a high percentage,” said Donald R. Ingalls, BlueCross BlueShield’s vice president of state and federal relations.

He offered one possible reason for the high rate. People seeking to enroll in the exchange may find out during the sign-up process that they qualify for Medicaid.

In Western New York, 71 percent of those enrolled in the exchange did so through Medicaid; 11 percent signed up through a qualified health plan; 10 percent signed up through the Essential Plan; and 8 percent signed up through Child Health Plus.

Total enrollment in the region rose from 117,330 to 150,493.

• Across the state, 272,000 people enrolled in a qualified health plan in 2016, down from 415,000 in 2015.

One of every five are new enrollees, and about half received a premium tax credit – averaging $170 per month – or some other financial assistance that reduced the cost.

Health Department officials previously set a goal of enrolling 615,000 people in a qualified health plan by the end of this year.

• The Essential Plan drew 14 percent of enrollees in its first year.

The program is aimed at people who earn too much to qualify for Medicaid, but don’t earn much beyond that, or who are ineligible for Medicaid due to their immigration status. If people are deemed to qualify during the application process, they are automatically enrolled in an Essential Plan. NY State of Health sets the rates for the Essential Plan, but the plans are sold by insurers and the insurers manage their members’ needs after the enrollment process, Sass said.

Fidelis Care, which has a large operation in Getzville, has 38 percent of the Essential Plan market in the eight counties of Western New York. Independent Health, which only offers Essential Plans in Erie and Niagara counties, has 27 percent of the market.

“It’s kind of between Medicaid and the qualified health plan,” Independent Health’s McGuire said.

• This is the first year consumers didn’t have Health Republic Insurance as an option. The nonprofit co-op, which was shut down by state and federal regulators last year, had the largest share of the exchange market in the region, with 43 percent, in 2015.

This year, Fidelis Care had 36 percent of individual enrollment in qualified health plans in Western New York, followed by BlueCross BlueShield of Western New York, 32 percent; Independent Health, 27 percent; MVP Health Care, 2 percent; and Univera Healthcare, just under 2 percent.

Each of the top three performers in the region increased market share by at least 10 percent, as Health Republic’s former customers sought replacement coverage.

“There were other choices available in Western New York,” Ingalls said.


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