Essential Plans Now in NY

Nov 20, 2015

  1. RayNY

    RayNY Guru

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    New York
    Starting 1/1/2016, a new "basic" plan, called "Essential", is available on-exchange.

    Overview is, anyone between 138-200%FPL (Medicaid cutoff to 200%, which was formerly the <150% and 150-200% CSR plans) are now forced into the Essential plan with no option to choose a subsidized plan. $0 or $20 premium, individual plans only (Fam of 4=4 plans). No deductible, extremely low co-pays ($0 to a maximum of $150 for inpatient hospital!). Dental and Vision are a $26.45 rider (per plan, of course).

    The carrier reps have no clue what they are, the exchange has no clue how the carriers handle it, and the "community" lines at the carrier also have no clue what it is. I spent an hour on the phone in frustration.

    There is no provider search for dental or vision rider, nor does anyone know what network or process is used.

    It appears they use the same networks as utilized by the carrier on-exchange for other individual product. Again, no one can confirm, but that's where the provider search points.

    It appears they are "Community" plans, akin to CHP, and carry no commission (although no one could confirm, none thought they were commissionable).

    Plan overviews are available here: Plan Benefits and Cost Sharing_1.pdf All plans from all carriers are identical, only different provider networks.

    TL;DR: If a client is under 200%FPL in NY, you're giving them the best plan on the market for next to free and doing it all out of the goodness of your heart.
    RayNY, Nov 20, 2015
  2. gcaros

    gcaros New Member

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    Yes I heardoxford would offer a essential plan they also said was paying commissions. Long story short it's UHC they don't know anything but I am hoping they pay any info is great
    gcaros, Dec 10, 2015