TABLE OF CONTENTS
New York has one of the most robust health insurance exchanges in the country, so you have an array of affordable health insurance options. Individuals, families, and small business owners can all find coverage that meets their health care needs and budget.
While most states require you to use HealthCare.gov to enroll in health insurance coverage, New York lets you enroll on its own website. New York State of Health is the official state marketplace website where you purchase plans managed by individual insurance companies called Qualified Health Plans. The website allows individuals, families, and small businesses with 100 or fewer employees to compare and buy health plans online, or you can do it over the phone or in person.
To get started, you must create an online account by providing your name and email address, then accept an email invitation to activate your account. Once activated, you must provide Social Security numbers, birthdates, income information, and details on any available job-related insurance for yourself and other members of your family who will be on your plan. These details help determine what type of insurance you need and whether you qualify for financial help for your health coverage.
When enrolling in a family plan, you must consider the needs of every family member enrolled. Financial assistance is based on your household’s combined income. Family size impacts your premium and deductibles. Enrolling in individual plans is more straightforward because you only have your own health needs and income to consider.
The three primary types of plans offered in New York include:
Before searching for coverage, think about what kinds of medical services you need. All plans on New York’s marketplace must include 10 essential health benefits to guarantee coverage for doctor visits, emergency care, hospital stays, prescription drugs, and more. Preventive care, such as routine screenings, is free. You can also find plans with additional benefits, such as adult vision and dental coverage.
Health insurance plans in New York generally have four major plan levels called metal tiers and include Bronze, Silver, Gold, and Platinum. The higher the tier, the higher your premium, but the lower your cost-sharing.
Insurance plans for families work very similarly to individual plans. The type of plan you choose can have a greater effect on families, especially if someone in your household has a condition that requires ongoing care or a preferred doctor. Depending on how you need to cover your family members, each person may be on the same health plan or on different health plans within the same policy.
You still compare plans on the New York Health Insurance Marketplace, and plans all include 10 essential benefits and are divided into metal tiers. For families, note that required benefits include dental and vision coverage for children.
|Average premiums in New York
|Most affordable Bronze plan
|Most affordable Silver plan
|Most affordable Gold plan
Low-income residents of New York may qualify for Medicaid. Residents whose incomes are too high for Medicaid but too low to afford individual insurance may qualify for an Essential Plan for adults or Child Health Plus for children. There aren’t any set enrollment periods for any of these programs, so you can apply anytime.
Single adults, children, and families with or without children who are New York residents and U.S. citizens or who meet immigration status requirements may qualify for free Medicaid health insurance if their income and household size meet eligibility requirements. Children, pregnant women, and adults under the age of 65 apply for Medicaid through the New York Health Insurance Marketplace, while adults over 65 without minor children and anyone with Medicare or seeking Medicaid due to a disability must apply through New York City’s Human Resources Administration. New Medicaid applicants must submit documents proving citizenship and immigration status.
All children under age 19 who don’t qualify for Medicaid and don’t have other health insurance coverage may qualify for Child Health Plus in New York regardless of immigration status. This free or low-cost health insurance is available to New York residents who meet income eligibility requirements based on household size. Parents or caretaker relatives must apply for Child Health Plus for their children on the New York Health Insurance Marketplace. Required documents for application include proof of identity, citizenship, residency, age, and household income, and, in some cases, immigration status.
New York’s Essential Plan is for adults 19 to 64 who have low incomes but don’t qualify for Medicaid. Applicants must be New York residents, be U.S. citizens or meet immigration status requirements, and meet income eligibility requirements based on household size. Approved participants pay a monthly premium of either $20 or nothing, based on income. Essential Plan covers the same 10 essential benefits as any Qualified Health Plan, and some plans include additional benefits for an additional premium. You can apply on the NY State of Health website, in person, or over the phone at 855-355-5777.
If you qualify for Medicare, you can either get Original Medicare directly through the federal government or sign up for a Medicare Advantage Plan through an insurance provider.
Medicare in New York works the same as in other states because it’s a federal program. Medicare covers adults aged 65 or older or individuals of any age with certain disabilities for 24 months, ALS, or End-Stage Renal Disease.
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
To get help signing up for Medicare, visit your local Social Security office. If you’re within three months of turning 65 and not ready to begin collecting Social Security, sign up using the Medicare only application. Get more information at Medicare.gov or call 800-633-4227 for help. The Health Insurance Information, Counseling and Assistance Program has offices statewide with counselors who can assist you with your application. Call 800-701-0501 to locate the office nearest you.
New York doesn’t allow the sale of short-term health insurance plans in the individual and group health insurance markets and requires all health insurance policies that provide hospital, surgical, or medical coverage to be comprehensive, cover essential health benefits, and be guaranteed renewable. The state’s comprehensive coverage and guaranteed renewability requirements in its insurance laws are independent and can’t be circumvented by federal laws. Therefore, regardless of federal regulatory changes that have loosened short-term health insurance rules, short-term insurance plans are prohibited in New York, and you can’t purchase these plans anywhere in the state.
New York doesn’t require you to have health insurance. Health insurance coverage is mandatory at the federal level, but there’s no longer a tax penalty for not having health insurance.
No, you don’t have to use the New York Health Insurance Marketplace to get insurance. You can also buy plans from an insurance agent/broker/company, but you won’t be eligible for financial help if you don’t go through the marketplace.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t cover pre-existing conditions, mental health care, or pregnancy. Since the federal government and New York don’t consider them health care plans, these plans are unregulated. If you would like to join a faith-based plan, make sure you ask lots of questions before enrolling.
You’re not required to have health insurance to have flexible spending accounts, which are only available through an employer who offers them. You must have a special type of health insurance called a High Deductible Health Plan to open health savings accounts. HSAs and FSAs both allow you to set aside pre-tax money, which can only be used to cover certain health care costs.
New York is one of a few states that require employers to provide short-term disability coverage to employees for off-the-job injuries or illnesses, so you don’t need short-term disability coverage. For unemployed New Yorkers, your previous employer’s disability insurance carrier covers if you’ve been unemployed for less than four weeks. If you’ve been unemployed longer, the Workers’ Compensation Board Special Fund for Disability provides disability benefits, but you can’t collect unemployment benefits and disability benefits at the same time.
Long-term disability coverage isn’t a substitute for health insurance or vice versa. Long term disability coverage replaces part of your paycheck to cover household expenses while you’re out of work due to a long-term injury or illness that wasn’t work-related. You still need health insurance to cover medical expenses. You may receive coverage through your employer, or you can purchase your own policy.
The Essential Plan covers the same 10 benefits that every health insurance plan in New York must cover, including doctor visits, hospital stays, prescriptions, etc. Preventive care like health screenings and annual well visits are still free. You may also receive free vision and dental care or pay an extra premium for these benefits, depending on your income.
Child Health Plus coverage includes: