As state insurance regulations are being aligned with the mandates of the 2010 Patient Protection and Affordable Care Act, significant protections have already been extended to children, who can now remain on their parents insurance policies to age 26 regardless of their status as students or if they have married. Additionally, children may not be excluded from coverage for a pre-existing condition. Currently, adults with pre-existing conditions may access coverage through temporary high risk pools in the individual states, an arrangement that will be supplanted by competitive health care exchanges on January 1, 2014, at which time adults will also gain protection from pre-existing condition exclusion.
General Insurance Regulations
Health policies in New York must carry a guaranteed renewability clause, and there are no elimination riders. Currently, exclusions for pre-existing conditions may only be in place for 12 months, and the look-back period is only six months. Handicapped children may remain on their parents’ health insurance indefinitely, and babies and adopted children are covered for a minimum of 30 days.
Health Care Exchanges
The state of New York is currently studying its options for the implementation of a health care exchange. Since no legislation has been passed at this time, planning and research are being conducted by the New York State Insurance Department and the New York State Department of Health.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in New York is administered by Group Health Incorporated and offers monthly premiums of $361 to $421 for coverage that includes both primary and specialty care as well as benefits for hospital stays and prescriptions. There is no deductible, and the annual out-of-pocket limit is $5950.
Eligibility for Medicaid benefits is determined by income according to a percentage of the Federal Poverty Level, which is the same measurement by which funds are distributed via the Children’s CHIP-funded Medicaid Expansions. In New York, infants are Medicaid eligible at 200% FPL, those ages 1-5 at 133%, and the 6-19 age group at 100%. (This last group may also draw CHIP funds at 133% FPL.)
Pregnant women qualify to draw Medicaid at 200% FPL, parents at 150%, childless adults at 100%, and non-elderly disabled Social Security recipients at 74%.
About 12 percent of the population of New York draws Medicare benefits, with more than 802,000 accessing prescription drug coverage.
The Child Health Plus program protects children under 19 years of age, while Family Health Plus covers the 19-64 age bracket. These benefits go to individuals who do not qualify for Medicaid and those who are not yet drawing Medicare.
The New York Health Insurance Information Counseling and Assistance Program (HIICAP) makes counseling and educational programs available to Medicare beneficiaries.