When it comes to health insurance, New York state has always been a trailblazer. The state created an individual New York health insurance market several decades before the enactment of the Affordable Care Act. It has also expanded Medicaid coverage for numerous low-income parents and childless adults before the reforms set by the ACA.

However, the political landscape still offers many proposed changes on the horizon, and this can affect the health insurance situations of millions of residents in the state of New York. If you have questions or issues about your health insurance, please do not hesitate to reach out to us here at HealthQuoteInfo.

Qualified Health Plans

By the end of 2017, about 229,000 residents of the state were able to purchase private individual health plans (Qualified Health Plans or QHPs). The state’s individual health insurance market is quite healthy, as 12 private carriers remain to offer health insurance plans in the individual market through the New York State of Health. These carriers are:

  • Capital District Physicians Health Plan
  • Empire BlueCross and Empire Blue Cross Blue Shield
  • Excellus (Excellus Blue Cross Blue Shield in Central New York and Univera in Western New York)
  • Fidelis Care
  • Health Insurance Plan of Greater New York (EmblemHealth)
  • Healthfirst New York
  • HealthNow New York, Inc. (BlueShield of Northeastern New York, and BlueCross BlueShield of Western New York)
  • Independent Health
  • MetroPlus Health Plan
  • MVP Health Plan, Inc.
  • Oscar Insurance Corporation
  • United Healthcare of New York, Inc.

You can also find the particular health insurance plans that are available for your area through our search bar. Enter your zip code to get the plans that you can choose from to suit the needs of your family.

The Essential Plan

This is formally known as the Basic Health Program. It offers all the ACA-mandated benefits (the “essential benefits”) and it is meant for applicants whose incomes are a little above the Medicaid income ceilings. Legal immigrants in the waiting list for Medicaid can also be eligible. Qualified New Yorkers have incomes that do not exceed up to 200% of the federal poverty level. The premiums and out of pocket costs for these plans are much lower compared to the QHP costs.

For those with income below 138% FPL and are not on Medicaid because they’re on the waiting list, there is no premium to pay for. Enrollees with a household income between 139% and 150% FPL only pay a premium if they want their health plan supplemented by dental and vision coverage. The premium is $20 a month for those whose income is between 150% and 200% FPL.

ESI & Small Business Health Insurance New York

Many employers also choose to offer a group health plan for their employees. This option can make health insurance coverage much more affordable for employees since a large portion of the premium is paid for by the employer. The plan will also be able to offer full coverage to all eligible workers. The COBRA program allows you to maintain that coverage for an additional 18 months to give you more time to secure another health plan.

Medicare

This is the federal program that offers health coverage for the people over 65 years of age. About 84% of the Medicare recipients have qualified due to age alone. However, the program also offers coverage to people with disabilities.

In New York State, there is Original Medicare that includes Part A (hospital insurance) and Part B (medical insurance). The State also has a Medicare Part D that covers prescription drugs as standalone coverage.

New York also offers Medicare Advantage plans, and these offer even more benefits than what you get from Original Medicare. The essential Medicare Parts A and B benefits are automatically included. The only exception is hospice services, and that benefit is part of Original Medicare even if you’re in a Medicare Advantage plan. The Advantage plans cover urgent and emergency care services, and in numerous cases will also provide for dental, vision, hearing, and health and wellness services.

Medicare Advantage plans limit maximum out-of-pocket costs (aside from prescription drugs) to $6,700. However, many plans in this program have much lower maximum out-of-pocket costs.

Medicaid & Low Income Health Insurance New York

Medicaid offers comprehensive health insurance coverage to applicants whose incomes do not exceed 138% FPL. This is the new ceiling under the Medicaid expansion. Children in their first year are eligible if their family income is within 218% FPL. Pregnant women also have an income ceiling of 218% FPL, but they’re counted as two people when computing FPL based on household size. For children ranging in age from one to 18, the family income cannot exceed 149% FPL.

There is no open enrollment period for NY Medicaid, and you can apply at any time of the year.

Child Health Plus

This is the New York’s version of the Children’s Health Insurance Program, and it’s meant for children whose family income slightly exceeds Medicaid requirements. They also should not have any health insurance and they shouldn’t be eligible for the public employees’ state health benefits plan.

For those whose family income is 160% FPL and below, there is no monthly premium. The premium for families with slightly higher incomes can range from $9 to $60 a child per month. Larger families only have to pay for coverage for 3 children, even if their family has more eligible children. For families with incomes that exceed 400% FPL, the full premium will be charged. However, unlike with private insurance plans, there will be no copayments for services with Child Health Plus.

New York Open Enrollment 2019 & New York Obamacare Insurance

The New York Open Enrollment period for health insurance in 2019 will run from November 1st, 2018 to December 15th, 2019.

For all your other questions regarding health insurance in New York, please do not hesitate to give us a call at 1-855-614-5057. We stand ready to guide you so that you can get the health & medical insurance coverage you need and deserve.