In January, more than 350,000 New Yorkers began paying $20 a month or less for comprehensive health insurance with no deductibles and low copayments, for a type of coverage made possible by the federal health law. Minnesota has similar coverage in place through the same option, with more than 125,000 enrollees.
The two states are using a provision of the health law to create what’s called a “basic health program” for people with limited means. For low-income consumers, these plans are a better buy than marketplace plans — even when those plans have a premium tax credit and cost-sharing subsidies.
“Even though marketplace subsidies are incredibly generous, at 175 to 200 percent of poverty, [some people] don’t have an extra $100 a month to spend on health insurance,” said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, an advocacy group.
The basic health option is generally aimed at people just above the Medicaid cutoff, with incomes up to 200 percent of the federal poverty level ($23,540 for an individual), who would otherwise qualify for subsidized coverage on the health insurance marketplaces. Low-income legal immigrants who aren’t eligible for Medicaid because they haven’t been in the country for five years, however, also can join.
Like marketplace plans, basic health program plans have to cover the 10 essential health benefits, and have to be at least as affordable as those plans. The states contract with plans to run the program. To fund it, the federal government pays states 95 percent of the amount it would have paid marketplace insurers in premium tax credit and cost-sharing subsidies for those consumers.
The coverage is significantly more affordable than the alternative subsidized marketplace plans.
In New York’s Essential Plan, as the state’s version is called, someone with an income of $23,540 would pay a monthly premium of $20 for a plan with no deductible and $15 copayments for primary care doctor visits. Maximum out-of-pocket spending for the year would be capped at $2,000. (People with lower incomes would generally have no premiums, no copayments for doctor visits and maximum
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