A Conversation with MetroPlus President and CEO Arnold Saperstein

HHC’s own health plan is offering the most affordable coverage on the state’s health exchange and attracting more “young invincibles” than expected

	Arnold Saperstein, MD

The federal Affordable Care Act (ACA) requiring health insurance to be offered to all U.S. citizens and legal residents in state or federally managed marketplaces took effect Oct. 1st. HHC’s own MetroPlus Health Plan is offering enrollment to new subscribers on the state health insurance exchange at https://nystateofhealth.ny.gov. The new plans are called MetroPlus Health Plan Market Plus. Here, Arnold Saperstein, MD, President and CEO of MetroPlus, talks about the organization’s early experience in the new exchange.

Q: How many people have shopped for new health insurance on the State health benefit exchange so far, and how many have chosen MetroPlus?

A: As of the fourth week in November, the state reported that more than 275,000 people statewide had completed the full application and nearly 76,000 had enrolled in the NYS exchange. Of the 76,000 enrollees, there were 35,000 Medicaid and about 41,000 signed up for the non-Medicaid Qualified Health Plans. MetroPlus has received 4,200 new enrollees in their non-Medicaid Qualified Health Plans to date. The state will not be releasing each plans Medicaid enrollment until later in December.

Q: Were there any surprises?

A: Absolutely. We were surprised we actually got a lot of “young invincibles.” These are young, healthier people who are needed in the ACA to offset the cost of carrying older customers who generally have more health needs and typically generate more costs to the healthcare system. More than 73% of all the new customers we got are under age 50 and about 47% were under age 35.

Q: Why is that surprising? And to what do you credit that result?

A: Though the numbers are still coming in slowly, early reports indicate a different trend. Most of those who have applied for health coverage in the federal and other state exchanges were older people with health problems and an immediate need for healthcare services. Fortunately for us, our rates on the state exchange are the lowest in three of the four available tiers and we provide quality, comprehensive services that are very attractive. I think young people who see the value of having health insurance but may not have a lot of health care needs now are naturally attracted to the most affordable option.

Q: Beyond affordable rates, what else makes the MetroPlus Health Plans attractive?

A: Because we are a subsidiary of HHC, we have a tremendous ability to work together with all primary care physicians, nurses and specialists from 11 public hospitals in New York City, HHC nursing homes, and dozens of community-based clinics to help manage care for our customers. Our interests are aligned with a focus on prevention, early detection and coordinated care across any health service -- for the young and for the old. We have specialty case management programs for chronic diseases like asthma and HIV. And, we have a culture of caring for our customers, where dollars are second and patient outcomes are first.

Q: Can you give an example of what a person would have to pay for a MetroPlus plan on the exchange?

A: Sure. Let’s use the example of a 28-year-old male with an annual salary of $40,000. In this case, an individual “Silver” MetroPlus policy would cost about $311 per month after the eligible monthly tax credit. That would include coverage for primary and specialty visits as outlined in our benefit packages. A family of four earning $75,000 can select a Silver plan with MetroPlus for $576 per month after the tax credit.

Q: Tell us more about the children's dental coverage.

A: It is a standard service included in the family plans. Checkups and cleanings are included, with copays that vary by product for children under 19. But we also have an option for adults who want dental. In fact, it includes both dental and vision at an additional, but low, extra fee in all four tiers. For example, that same 28-yr old male making $40,000 a year can get full vision and dental included in a MetroPlus Silver plan.

Q: What are your projections for the first year of enrollment from the health exchange?

A: We have about 422,000 members right now and expect to attract another 40,000 through the exchange during the first year.

Q:: How will you be prepared to serve these additional members and meet their healthcare needs?

A: We have a lot of experience in meeting the needs of a growing membership base, so we know how to quickly bring on board additional customer service representatives, to provide the quality service that has earned us the #1 overall quality and customer satisfaction rating in the state for seven of the last eight years.

Q:: Is the state health exchange the only way an individual or family can purchase insurance with MetroPlus?

A: No. MetroPlus offers low or no-cost health insurance to eligible people living in Manhattan, Brooklyn, Queens and the Bronx, including special plans for patients who are eligible for Medicaid and Medicare, patients who need long-term care services, and HIV patients. We also offer MetroPlus Gold for HHC employees.

For more information about MetroPlus, visit www.metroplus.org.

December 2013