A.G. Schneiderman Offers Tips to Help Consumers Compare Health Care Plans in Advance of NYS Marketplace Open Enrollment for 2016

Written by Long Island News & PR  |  03. November 2015

New York, NY - October 30, 2015 - Attorney General Eric T. Schneiderman today issued a brochure offering tips to New Yorkers buying health insurance coverage for 2016. The pamphlet, titled “Shopping For Health Insurance Coverage,” is being released in advance of the New York State of Health Marketplace’s open enrollment period starting on November 1, but can be used to evaluate all health insurance options, both on and off the Marketplace.  In 2015, approximately 2.1 million New Yorkers enrolled in a health plan through the New York State of Health Marketplace.

Attorney General Schneiderman encourages consumers to take advantage of this open enrollment period to evaluate how their current health plan has met their needs, to evaluate whether their current health plan will change in a way that impacts the benefits they expect to use, and to consider what other options are available. 
“Health plans are required to make the details of their coverage publicly available so you can make an educated decision about which plan is best for you and your family,” Attorney General Schneiderman said.  “Take the time during open enrollment to compare plans, on and off the Marketplace, and evaluate which plans will work best for you based on your own unique medical needs – including the likelihood of needing significant medical care or using particular medications.  Remember that not all health plans cover all medications, and you may pay more out-of-pocket, or face more barriers to coverage, under some plans compared to others.” 

Open enrollment through New York State of Health begins on November 1, 2015, and New Yorkers seeking coverage effective January 1, 2015 must enroll by December 15.  Remember, however, that coverage is also available off of the Marketplace, and those plans may have different enrollment deadlines. Once open enrollment for the Marketplace begins, you will be able to review all health insurance plans available through the Marketplace, as well as determine what premium subsidy you may be eligible for to reduce the cost of your monthly premiums.

The Attorney General’s brochure offers important information for all New Yorkers shopping for health insurance, whether they are considering purchasing health coverage for the first time, re-enrolling in their existing plan, or switching into a new health plan. Prior to enrolling, take some time to: (1) identify your health needs for the upcoming year; (2) consider your budget; and (3) based on your identified health needs and budget priorities, compare the available plans to evaluate how they satisfy those needs.

As part of this process, the Attorney General’s Office encourages all New Yorkers, when shopping for health insurance, to:

(1) Determine whether a premium subsidy is available through the Marketplace to make coverage more affordable (such subsidies are only available through the Marketplace);

(2) Check and confirm your provider’s participation status within the health plan, using the steps set out brochure;

(3) If you take prescription medications, check whether they are included in the health plan’s formulary, as well as what your out-of-pocket expense will be and whether there any pre-authorization requirements; and

(4) Check what the co-payment or co-insurance will be for any medical services you expect to use during the plan year, such as for physical therapy or mental health services. 

If you have any questions about a health plan’s coverage, including whether your provider is participating, you should call the insurance company directly and take detailed notes, including when you called, with whom you spoke, what you discussed, and what you were advised.

If you encounter inaccurate provider listings once you are enrolled in a plan and cannot access needed care from that provider, or otherwise believe you were given inaccurate information during open enrollment, contact the Health Care Bureau Helpline for assistance: 1-800-428-9071.  For questions about the New York State of Health Marketplace, you can contact the Marketplace directly at 1-855-355-557.

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