Key Fixes to NY Commercial Payer Exchange to Ease New Enrollment

April 27, 2020 - New York’s off-exchange insurance market needs revamping in light of the coronavirus pandemic, as more residents and immigrants face job loss and fall off their employer-sponsored health plans, according to a new report from the United Hospital Fund (UHF).

The latest unemployment claims figures from the Department of Labor, published on April 23, indicate that a total of 26 million Americans have lost their jobs since the initial coronavirus outbreak. And with that spike in unemployment naturally comes an increase in the number of individuals seeking a new health insurance plan, as many are losing access to their employer-sponsored coverage.

In New York, the search for new healthcare coverage is easier said than done, according to the new UHF report, because the insurance exchanges can be challenging to navigate. Specifically, New York’s off-exchange market, or insurance market intended for individuals seeking to purchase insurance directly from a commercial payer, is outdated and hard to navigate.

New York developed the off-exchange marketplace following the passage of the Affordable Care Act to provide consumers with another option for purchasing insurance directly from a payer. This came as an alternative for the New York State of Health (NYSOH) marketplace, which is the state marketplace enabled as a part of the ACA.

This off-exchange market was intended for individuals who do not qualify for government subsidies under the ACA, such as immigrants who do not qualify for the government marketplace.

However, the off-exchange marketplace has limited tools to help consumers shop for insurance plans, and have certain regulations that make it impossible for undocumented immigrants to purchase a plan that is not in any way subsidized or provided through the government.

This is a problem, considering the strain the novel coronavirus outbreak has put on consumer access to health plans and the fear patients have that they may contract the virus and incur astronomical medical costs.

“Undocumented New Yorkers made up about a third of New York’s uninsured population before the pandemic struck, and most have incomes that make them ineligible for the limited programs available, such as Emergency Medicaid,” said Peter Newell, director of UHF’s Health Insurance Project and the author of the report.

“Given the rapid spread of coronavirus infection and the significant costs of treating the disease, on top of the Trump Administration’s immigration policies, some families might be interested in enrolling in off-exchange coverage now, despite the high cost of unsubsidized coverage,” Newell added.

There are a number of improvements that could make the New York off-exchanges more accessible for traditionally underserved patient populations, the UHF report recommended.

Foremost, the off-exchange marketplace could replace Social Security numbers with other types of identification and documentation during the application process. Alternatives include taxpayer identification numbers, tax and utility bills, or residential leases.

Next, the off-exchange marketplace may include some resources that were required for individual commercial insurance purchasing prior to the ACA. These resources may include county-by-county information about off-exchange plan availability, available products, health plan websites, toll-free assistance hotlines, health plan retail locations, and non-English language services.

The off-exchange marketplace may also consider including information about different coverage or benefit options, including child-only plans, dental plans, and vision coverage.

Finally, UHF recommended the off-exchange marketplace conduct consumer outreach and education about who is eligible to shop on the marketplace. Specifically, UHF said the off-exchange marketplace should emphasize that all New York residents, not just those who meet the “lawfully present” requirements elucidated in the NYSOH marketplace, are eligible to shop on the off-exchange.

These measures may make it easier for individuals to shop for commercial insurance, a key goal as more lose access to employer-sponsored plans at the hands of the pandemic.

To its credit, New York has taken steps to preserve access to insurance plan coverage as COVID-19 grips the nation, Newell acknowledged. The considerations listed in the UHF is just another step forward in ensuring patients have access to coverage.

“New York moved quickly to roll back Medicaid eligibility provisions that might lead to involuntary disenrollment and to reopen the NYSOH marketplace for business during the pandemic,” Newell concluded. “Eliminating off-exchange enrollment barriers seems like a logical next step.”