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. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, the New York State of Health enrollment window is open through the end of 2021.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands 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 only be available in 2021 and 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?
- Anytime through the end of 2021
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 new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save 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.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for an almost $0/month premium health coverage option, thanks to the American Rescue Plan. If, however, you're already enrolled in a marketplace plan, you can update your application to apply this additional subsidy moving forward. You'll also be able to claim the additional subsidies for the months during which you were eligible when you file your 2021 federal income tax return. This extra financial help will expire at the end of 2021.
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 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you should be receiving a temporary COBRA premium subsidy that covers 100 percent of your monthly premium cost. This premium assistance, made possible through the American Rescue Plan, runs through the end of September or the end of your last month of COBRA eligibility, whichever comes first.
If you’re on COBRA, you may want to sign up for a marketplace plan that starts as soon as your COBRA coverage ends. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker.
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, published on June 22, was updated on July 19 with additional resources for non-English speakers.