About 16% of the population of New York does not have health insurance coverage, this comes down to about 2.7 million residents under the age of 65 who do not have health insurance. The main reason for not having insurance is the high cost of health insurance plans, most people can not afford them. Because of this taxpayers as well as insured people shoulder the cost of paying for the uninsured. Establishment of state based health insurance exchange will provide a much needed boost to curtail the number of uninsured individuals in the state of New York. The exchange is going to starting accepting application for enrollment starting oct 1, 2013.

Expected Enrollment In New York Health Exchange:

The exchange will offer individual as well as small business exchange programs also know as SHOP exchange, to let individuals and small business buy health insurance. According to Urban Institute,  44% of the enrollment is expected in SHOP program vs 56% in the individual exchange program.

New York Health Exchange Projected Total Enrollment

It is also expected, that approximately 41% of of the enrollment in the individual exchange will be from people who earn 138-200% of federal poverty level (FPL).
Also 40% enrollment will be done by small business where employees earn above 40% of FPL. Following figure shows the break down of enrollee by income.

 New York Health Exchange Enrollment By Income

Those who enroll in individual exchange, a whopping 44% of enrollee will be of between age of 25-44 and 39% of enrollee will be between age of 45-64 in SHOP exchange.Following figure shows the break down of enrollee by age.

New York Health Exchange Enrollment By Age

Individual and SHOP Exchange Plan Details:

The SHOP exchange program will initially offer insurance for small businesses with between 2-50 employees in 2014 and by 2016 this will be raised to 100
employees.There is a benchmark plan which needs to be offered in each of the 4 types of qualified health plan, so that its easy to compare plans from different insurance providers. Additional non standard plans may be offered with the requirement that each should include coverage of minimum essential health benefits.

SHOP Exchange Administrative Advantage For Small Businesses:

The New York health exchange will provide employers with a single monthly bill which will include the breakdown of employee and employer contribution towards each QHP. It will be the responsibility of the employers to collection any health plan premiums from their employees. Exchange will take care of collecting payments from employer and will pay insurance providers directly. Employers may be eligible for small business insurance tax credits if they qualify.

An employer who wants to offer health insurance plans from exchange will have following available via exchange:

  • Ability to select one or more Qualified Health Plan (QHP) from a one or more insurance provider.
  • Ability for employees to select employer selected QHPs
  • The QHPs can also be offered via insurance broker, which is what most of the small businesses use in New York
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