The Empire State offers several health insurance options to fit your budget. You can qualify for help with Marketplace plans or coverage through low-income programs.
New York Health Insurance Overview
Nearly 2.1 million New Yorkers had no health insurance in 2013 when the Affordable Care Act (ACA or Obamacare) was implemented. This number dropped to more than half at 1 million uninsured residents by 2018.
New York’s expansion of Medicaid in 2013 contributed to more residents getting health insurance.1 The ACA allowed states to expand eligibility to childless adults who earn up to 138% of the federal poverty level. As of 2019, more than 3.5 million New Yorkers gained coverage under Medicaid expansion.2
Other options for low-income residents include New York’s Essential Plan, which offers coverage through private companies outside of the Marketplace. Residents can also get health plans through the Marketplace. These policies qualify for tax credits that can reduce your monthly premium.
We cover more detail about New York’s health insurance options below.
Buying New York Health Insurance for Individuals, Families, and Self-Employed Individuals
The Empire State offers affordable private health insurance for individuals and families. If you’re self-employed with no employees, you qualify as an individual. You can buy coverage through the Marketplace called New York State of Health. Plans are available in all four metal levels: bronze, silver, gold, and platinum.3 These are known as Qualified Health Plans.
Each metal plan pays a percentage of your covered healthcare costs ranging from 60% to 90%. For instance, bronze pays 60% and is usually the lowest-cost plan. Platinum pays 90% and is the most expensive plan.
All plans provide comprehensive coverage that includes essential health benefits, such as hospitalization, maternity care, prescription drug coverage, and free preventive services.
New York Health Insurance Marketplace
New York State of Health is a one-stop-shop to apply for private health insurance. You can also find out if you qualify for ACA subsidies and check eligibility for low-income health insurance programs. New York’s low-income programs include Medicaid, Child Health Plus, and the Essential Plan.
New York’s open enrollment period (OEP) for ACA-qualified health plans began on November 1, 2019, and ended on January 31, 2020. According to the New York State Department of Health, more than 200,000 residents signed up during the first 41 days of the OEP.4
The next enrollment period for the 2021 plan year starts on November 1, 2020. If you qualify for Medicaid, Child Health Plus, or the Essential Plan, you can enroll at any time.6
Health Insurance Companies in New York
New York has a robust Marketplace with 12 companies offering coverage for 2021. Most residents have at least four plans in their county. The following companies offer Qualified Health Plans for individuals and families:
- Capital District Physicians Health Plan
- EmblemHealth (Health Insurance Plan of Greater New York)
- Excellus Health Plan
- Fidelis (New York Quality Healthcare Corp.)
- Healthfirst PHSP
- HealthNow New York
- HealthPlus HP, LLC (Formerly Empire)
- Independent Health Benefits Corporation
- MetroPlus Health Plan
- MVP Health Plan
- Oscar Insurance Corporation
- UnitedHealth of New York
New York Health Insurance Costs
New York Marketplace premiums for 2020 have an average rate increase of 6.8%.7 Below are the average monthly premiums from 2019 to 2020.
- Average lowest-cost bronze premium: $402 in 2019 | $418 in 2020
- Average lowest-cost silver premium: $558 in 2019 | $588 in 2020
- Average lowest-cost gold premium: $638 in 2019 | $706 in 2020
For 2021, the state approved increases of 1.8% for individual plans, or a bump of $11 for the average unsubsidized plan.8
Financial Help With Marketplace Plans in New York
The federal government provides financial assistance based on your income and household size. You can receive help through premium tax credits, cost-sharing reductions, or both when you enroll through the Marketplace.
- Premium Tax Credits (Subsidies): This lowers your monthly premium on any metal plan. A single New Yorker earning between $12,760 and 51,040 in 2020 can qualify.9 This number represents 100% to 400% of the federal poverty level (FPL). In 2019, more than half of New York enrollees received subsidies.10 The average subsidy was $325.
- Cost-Sharing Reductions (CSRs): This lowers your out-of-pocket costs only on silver plans. You must earn up to 250% of the FPL to qualify, or $43,100 for a family of two. Just 13% of New York enrollees got CSRs in 2019.11
New York Health Insurance Programs for Low-Income Residents
New York offers several programs for low-income adults and children, including those mentioned below.
New York Medicaid
Medicaid in New York is available to low-income residents, which include:
- Children under 19
- Pregnant women
- Parents and caretakers of minor children Childless adults 19 to 64 who qualify under Medicaid expansion
- Individuals 65 and older
- Individuals with certain types of cancers
- Blind individuals and those with disabilities
New York’s Medicaid Cancer Treatment Program (MCTP)
New York’s MCTP services are available to low-income residents with breast, cervical, colorectal, or prostate cancer. Generally, residents must be under 65, meet citizenship requirements, and not be enrolled in qualified coverage at the time of application. The state’s Department of Health Cancer Services Program oversees the application process.
Income limits vary. For example, the threshold for colorectal and prostate cancer is 250% of the FPL or up to $31,900 for a single adult in 2020.15
Those who qualify get full Medicaid coverage for a specific amount of time tied to the type of cancer. Enrollees must recertify each year if treatment is still needed.
New York Children’s Health Insurance Program (CHIP)
CHIP is called Child Health Plus in New York. It’s available to uninsured children under 19 who don’t qualify for Medicaid. About 682,000 children are enrolled as of October 2019.16 Families can apply for the program through the New York State of Health Marketplace.
Children must be New York residents from low-income households to qualify. Some families get Child Health Plus for free, while others pay a small monthly premium.
For example, a family of three earning at or below $2,843 per month (as of 2019) can get coverage with no monthly premiums. If the same family made up to $3,947 per month, they would pay a $9 monthly premium per child or a maximum of $27 for all covered children. There are no copayments, regardless of income.
New York Essential Health Plan
The ACA allows states to set up a Basic Health Program (BHP) that contracts with plans outside of the Marketplace.17 The Essential Plan is New York’s version of a BHP. It’s available to low-income New Yorkers who don’t qualify for Medicaid or CHIP. You can enroll through the Marketplace year-round.
A single adult earning up to $24,980 (as of 2019) can qualify. The income limit increases to $33,820 for a family of two.
Monthly premiums per person can be as low as $20. Another advantage is no deductibles. These plans cover 100% of your care from day one.
The Essential Plan includes the same health benefits found in Qualified Health Plans on the Marketplace. These include doctor visits, drug coverage, and free preventive care.
Medicare for New York Seniors and Younger Adults With Disabilities
Medicare is a federal health insurance program generally for people 65 and older. But younger adults with disabilities and certain illnesses also qualify.
New York has the fourth-highest number of Medicare recipients in the country. More than 3.6 million residents enrolled as of 2018.
Roughly 6 in 10 enrollees have Original Medicare from the federal government. The rest have private Medicare Advantage plans. Both options provide Part A hospital and Part B medical insurance. But Medicare Advantage offers extra benefits, such as Part D prescription drug coverage.
Private companies also sell individual Part D drug plans, which are often paired with Original Medicare. Nearly 1.5 million New Yorkers have a separate Part D plan as of 2018.
Original Medicare enrollees can also add a Medicare Supplement plan, known as Medigap. New York, like most states, offers 10 standard Medigap plans. Policies help pay for covered out-of-pocket expenses, including copayments, coinsurance, and deductibles. Many policies also pay for qualified emergency care you receive in a foreign country.
Can I Get Short-Term Health Insurance in New York?
No. New York prohibits the sale of health plans that don’t provide comprehensive coverage or essential health benefits. This ban includes short-term health plans, which don’t count as qualified coverage under the Affordable Care Act (ACA).
States that follow federal rules for short-term health insurance offer coverage for up to 364 days with renewals up to 36 months. Short-term plans are used to fill temporary gaps in coverage, such as when you’re in between jobs or waiting for new benefits to start.
Short-term health plans are usually cheaper than ACA-qualified insurance. But if you’re concerned about cost, you can use the New York State of Health Marketplace to see if you qualify for Medicaid or the Essential Plan. These programs provide coverage beyond what a short-term plan would offer.