Your Health Insurance Coverage Just Evaporated. Now What?

Some 166,000 people who get their health insurance through the New York State Exchange are receiving surprise letters informing them that their coverage through the state’s coop Health Republic will end on November 30th, not December 31st as was previously announced. To stay covered, they need to choose a new plan by November 15th. It will start December 1st.

But plan deductibles and other costs paid towards out-of-pocket maximums generally run through the calendar year, and reset on January 1. What will that mean for Health Republic enrollees who’ve already paid out for 2015 and expect to need more care in December—like pregnant women or cancer patients in the middle of treatment? And will their doctors accept their new plans?

New York State of Health representatives answering the phones for the special hotline for Health Republic’s enrollees (1-855-329-8899) told worried customers that the state Department of Financial Services “is working to ensure that your new plan will not charge you for the amount of deductible you already paid in 2015.” The reassurance fell short of a guarantee, and health insurance trade group representatives questioned how this approach would work.

Exchange customer service representatives told people to keep all evidence of any bills they’ve already paid this year. And, it might be a good idea to select a new plan with a deductible and out-of-pocket maximum similar to the Health Republic plan that disappeared.

Other individuals who need to begin new health insurance coverage towards the end of the year—perhaps due to job loss, moving to a new state, or a qualifying event like getting married—get no such help. They are subject to their plan’s deductible and cost-sharing provisions, up to its stated limits for the calendar year. 

In January, all exchange enrollees, including Health Republic refugees, will start paying towards their 2016 deductible and out-of-pocket costs for any care they receive. 

Cost concerns aside, Health Republic customers also need to figure out which, if any, plans on the exchange are accepted by their current doctors. People who have an ongoing course of treatment, a life-threatening, disabling or degenerative condition or disease, as well as women in their second or third trimester of pregnancy when their new coverage becomes effective, can continue to receive care for up to 60 days (or throughout the course of the pregnancy) with their current providers, even if they are not part of their new plan’s network. They may need to coordinate the continuation of care through exchange representatives at 1-800-342-3736.

Comments and Questions