En español | Most New Yorkers are eligible to buy health insurance through New York State of Health, the state’s Affordable Care Act (ACA) marketplace, during open enrollment, which will remain open throughout the duration of the federal public health emergency regarding the COVID-19 pandemic. New York's enrollment period normally runs from Nov. 16 through Dec. 31.
Residents who experience a qualifying life event, such as a marriage, divorce, the birth of a child, a move or the loss of health insurance, may be eligible to buy or change coverage outside the open enrollment period. You might be able to save money on premiums, too, thanks to expanded federal tax credits available through 2022.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the American Rescue Plan of 2021 increased tax credits for insurance premiums and expanded the number of households that qualify for them. Every household that pays more than 8.5 percent of its household income now qualifies for federal tax credits to help it afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $600 per year with the new assistance, the federal government says. As of now, this additional federal financial assistance will be available only through the end of 2022.
Who is eligible?
- Most New Yorkers, including non-U.S. citizens with work or student visas, are eligible to buy health insurance through New York State of Health, regardless of whether they are currently insured. People who are incarcerated are not eligible. Marketplace information is also available in Spanish, Korean and both traditional and simplified Chinese.
- You may also qualify for Medicaid, which offers free or low-cost coverage to low-income people and families, those who live in skilled nursing facilities and people with certain disabilities. Undocumented immigrants and low-income pregnant women may also be eligible for emergency Medicaid, which covers the cost of emergency medical conditions. You can sign up before or up to three months after a medical emergency. If you enroll in advance, you will be covered for the costs of future emergencies for 12 months. Immigrants in New York City have many options for health coverage, depending on their status.
- You and your family members may also be eligible for other subsidized plans through New York State of Health, such as Child Health Plus for those under age 19 who aren’t eligible for Medicaid, or the Essential Plan. These plans aim to fill the coverage gap among families and individuals who do not qualify for Medicaid but cannot afford coverage.
When can I enroll?
- New York State of Health's open enrollment has been extended through at least Mar. 31 due to the COVID-19 pandemic.
- You can enroll anytime outside of open enrollment if you experience a qualifying life event. You only have 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
such as job loss or divorce.
How do I sign up?
You apply for coverage and choose your plan at the same time. You’ll need to pay your first monthly premium for your coverage to begin and to receive your health plan cards. To apply and enroll:
- Online: Go to the New York State of Health website and click “Enroll Today.”
- By phone: Call the New York State of Health customer service center at 855-355-5777 (press 5) Monday through Friday, 8 a.m. – 8 p.m., and Saturdays from 9 a.m. – 1 p.m. If you’re hearing impaired, call 800-662-1220 (TTY enabled).
- In person: Call the New York State of Health customer service center at 855-355-5777 (press 5) to request in-person assistance. Representatives called “assistors” and “navigators” are available to help you and your family understand your options and provide enrollment assistance. They speak over 40 different languages and are available weekdays, evenings and even on weekends. Assistance is free of charge. Use the New York State of Health online search tool to find a navigator in your community.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your household income and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All New York State of Health plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All New York State of Health plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2022. For example, a single 64-year-old filer who earned $51,000 in 2021 could potentially have saved more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
New York State of Health plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays and cover roughly 70 percent of care costs. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
New York State of Health’s comparison tool allows you to estimate costs and benefits of various plans and check whether you might qualify for financial assistance.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to New York State of Health. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.61 percent of your household income for individual coverage.
If you lose your COBRA coverage, you may be able to sign up for a New York State of Health during a 60-day special enrollment window. Try to apply and select your plan through New York State of Health before your COBRA coverage ends to make sure there's no gap in coverage.
Will I need to get a new doctor?
That depends. Major insurance providers, including Empire Blue Cross and UnitedHealthcare of New York, offer New York State of Health plans, but not all doctors accept them. You can talk to your primary care physician or use the New York State of Health’s comparison tool to see whether a certain doctor or practice will accept a marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status.
This guide was updated on April 22.
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