New York has one of the most robust health insurance exchanges in the country, so you have an array of affordable options. Individuals, families, and small business owners can all find coverage that meets their health care needs and budget.

What to know about insurance in New York

  • Buying insurance: Any legal resident can purchase individual health insurance plans in New York if you aren’t incarcerated, don’t have affordable employer-based insurance, don’t require nursing home care, and are a U.S. citizen, national, or lawfully present immigrant.
  • Open Enrollment: Open enrollment in New York runs from November 1 to January 31. You can only get health insurance during this period unless you experience a major life change that qualifies you for special enrollment.
  • Special Enrollment: Life-changing events that may qualify for special enrollment periods include getting married, becoming pregnant, giving birth, losing your job, losing your current health insurance, changing your immigration status, or moving.
  • Tax credits: In March 2021, the American Rescue Plan Act increased premium tax credits through New York’s insurance marketplace and ensured subscribers wouldn’t spend more than 8.5% of their income on health insurance.
  • New York State of Health: Health insurance can be purchased on New York State of Health, the state’s official Health Insurance Marketplace, and the only place to get financial assistance to lower your cost of coverage.
  • Non-exchange plans: You can also purchase non-exchange health insurance plans in New York directly from individual insurance companies, but you won’t be eligible for financial assistance.
  • Types of plans: Nearly half of New York residents receive health insurance through an employer. Almost 26% of residents are enrolled in Medicare, 13% receive Medicaid coverage, about 6% have non-group coverage directly through an insurance company, and less than 0.5% are covered under military benefits. About 5% of New Yorkers are uninsured.

How do I enroll in New York's Health Insurance Marketplace?

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.

The following insurance companies offer individual health insurance plans to residents of New York, but some are only available in certain counties:

  • BlueCross BlueShield of Western New York
  • BlueShield of Northeastern New York
  • Capital District Physicians’ Health Plan
  • Emblem Health
  • Empire BlueCross BlueShield HealthPlus
  • Empire BlueCross HealthPlus
  • Excellus BlueCross BlueShield
  • Fidelis Care
  • Healthfirst
  • Independent Health
  • MetroPlus Health Plan
  • MVP Health Care
  • Oscar
  • United HealthCare
  • Univera Healthcare

How do I enroll in New York individual and families insurance?

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:

Insurance for individuals in New York

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 for families in New York

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.

How much does health insurance cost in New York?

Health insurance plans in New York are divided into four metal tiers or cost-sharing levels. Each tier charges a different premium for the coverage offered and splits the cost of care between the plan and beneficiary using a percentage.

Average premiums in New York 2018 2019 2020 2021
Most affordable bronze plan $403 $402 $418 $430
Most affordable silver plan $492 $558 $588 $588
Most affordable gold plan $581 $638 $706 $709

  • Bronze plans have the lowest monthly premiums but the highest annual deductibles. While you may be tempted to get a bronze plan to spend less each month, if you need medical care often, your total out-of-pocket costs may be higher than you realize. These plans pay 60%, and your coinsurance is 40%. In 2021, the average lowest-cost premium for bronze plans was $430 in New York, which hasn’t changed much over the last three years.
  • Silver plans have moderate monthly premiums, but premiums are still higher than bronze plans. However, if you qualify for financial assistance, a silver plan may cost less than bronze. These plans pay 70% of the cost of care while you pay 30%. The average lowest-cost premium for silver plans in New York in 2021 was $588, the same as 2020.
  • Gold plans also have higher monthly premiums and pay 80% of the cost of care while you pay 20%. In 2021, the average lowest-cost monthly premium for gold plans in New York was $709, which wasn’t much more than the $706 noted in 2020. However, this was a hefty increase from the $581 posted in 2018.
  • Platinum plans have the highest monthly premiums but the lowest out-of-pocket costs. These plans pay 90% of the cost of care, and you pay the remaining 10%. If you can afford the premium, these plans are ideal for individuals requiring frequent medical care.

What kind of low-income health insurance is available in New York?

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.

Medicaid in New York

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.

Child Health Plus in New York

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.

Essential Plan in New York

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.

What are New York’s Medicare options for seniors and people with disabilities?

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.

  • Original Medicare includes Part A hospital insurance, which covers inpatient hospital stays, and Part B medical insurance, which pays for outpatient care at a doctor’s office. If you want prescription drug coverage, you must add Part D, a type of supplement plan.
  • You can also purchase Medicare supplement insurance, called Medigap, from insurance providers to cover out-of-pocket expenses, such as deductibles, copays, and coinsurance.
  • Medicare Advantage Plans, called Medicare Part C, also include Parts A and B, but may also include Part D prescription drug coverage and other benefits Original Medicare doesn’t, such as vision, dental, and hearing care, among others.

Eligibility

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.

Enrollment

You’re automatically enrolled in Original Medicare when you turn 65 if you receive Social Security or Railroad Retirement Board Benefits, or at any age after you’ve received disability benefits for 24 months. If you aren’t automatically signed up, you can apply for Medicare during an enrollment period:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • Medicare Advantage open enrollment: You can enroll in Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can enroll, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

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.

Are there short-term health insurance plan options in New York?

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 Insurance FAQs

Does New York require health insurance?

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.

Do I have to use the Health Insurance Marketplace in New York?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in New York?

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.

Do I need health insurance if I have an HSA/FSA?

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.

Do I need short-term disability coverage in New York if I have health insurance?

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.

Do I need long-term disability coverage in New York if I have health insurance?

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.

What does the Essential Plan cover?

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.

What does Child Health Plus cover?

Child Health Plus coverage includes:

  • Dental care
  • Durable medical equipment
  • Emergency care
  • Hospice services
  • Immunizations
  • Inpatient hospital and surgical care
  • Limited speech and hearing services
  • Physical and occupational therapy
  • Prescription and OTC drugs ordered by a doctor
  • Radiation therapy
  • Treatments for injuries and illnesses
  • Therapeutic outpatient services
  • Vision care
  • Well-child visits
author-img
Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

Sources