ALBANY, N.Y. (AP) -- New York has taken several steps to establish a statewide health insurance exchange in 2014 intended to extend coverage to the uninsured and reduce costs for individuals, small businesses and local governments.
The New York Health Benefit Exchange, a federally required and subsidized marketplace for buyers, was established by Democratic Gov. Andrew Cuomo by executive order last April after a legislative proposal ran into opposition in the Republican-controlled state Senate.
New York has an estimated 2.7 million uninsured among roughly 19 million residents. Danielle Holahan, director of policy and planning for the Health Department's exchange, said their analysis indicates they will enroll about 1.1 million people.
Individuals and small businesses purchasing coverage through the exchange can tap up to $2.6 billion in federal tax credits and subsidies annually, according to the executive order. The state has already indicated to federal officials it will be ready to begin taking applications in October 2013 for coverage starting Jan. 1, 2014.
The department last month chose as the exchange benchmark the largest small group plan in the state. An outside analysis showed Oxford EPO provides comprehensive coverage while minimizing costs to individuals and small groups. "We felt that really balanced desire for comprehensive benefits and affordability," Holahan said.
Coverages in that plan include up to 200 days per year in a skilled nursing care facility, up to 210 days of hospice care, up to 60 physical therapy visits and 60 occupational therapy visits per condition, up to 30 inpatient days annually for mental health treatment and yearly vision screening, according to a state summary. Dental services are not covered. Elective abortions are covered, subject to benefit limits and may be excluded based on religion.
Other insurers that participate in the exchange will have to match coverage. Premiums and deductibles haven't been set yet. "It applies to all non-grandfathered plans for individual and small group markets inside and outside the exchange," Holahan said.
Under the federal mandate, tax credits will offset premium payments with subsidies covering out-of-pocket medical costs like co-payments, up to certain thresholds. The credits work on a sliding scale based on a percentage of income. For example, individuals with income up to 149 percent of the federal poverty level will pay no more than 4 percent of their income for premiums.
The 2012 poverty guideline ranges from $11,170 for a one-person household to $23,050 for a household of four.
Those with incomes at 300 to 400 percent of the poverty level will pay no more than 9.5 percent for premiums. For a household of four, that's an income level up to $92,200.
According to a Kaiser Foundation price calculator, a 26-year-old earning $30,000 a year with no employer health plan could be required to pay up to $2,509 in premiums for coverage.
New York already provides most of the expanded Medicaid coverage required by the federal law, officials said.