Orlando Harmon
New York offers a range of health insurance options for its residents, including qualified health plans, Medicaid, and Child Health Plus. The NY State of Health Marketplace is a platform where residents can compare and enroll in various health plans, with Certified Application Counselors available to assist with the process. New York also has the Essential Plan, a free or low-cost insurance option for adults with low incomes who don't qualify for Medicaid. Additionally, short-term health plans are available for those who need temporary coverage, and NYC Care provides affordable medical care for those who don't qualify for or can't afford health insurance.
| Characteristics | Values |
|---|---|
| Name of the health insurance program | New York State of Health |
| Who is it for? | Individuals, families, and small businesses |
| How to apply? | Visit the NY State of Health website to compare and enroll in a plan |
| Cost | Low-cost or free |
| Special Enrollment Period | Yes, for those eligible |
| Types of Assistors | Certified Application Counselors, Marketplace Facilitated Enrollers, and Navigators |
| Types of Plans | Qualified Health Plans, Essential Plan, Child Health Plus, and Medicaid |
| Number of people enrolled in Medicaid | Over 7.5 million (as of December 2023) |
| Other options | NYC Care, Employer or School-Sponsored Plan, Medicare, and short-term health plans |
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What You'll Learn
New York State of Health
The platform offers a range of private health insurance plans from a dozen insurers, following the rules set by the Affordable Care Act. These include covering essential health services and meeting certain standards of cost-sharing. New York State of Health also offers dental insurance plans and broad choices of affordable, comprehensive health insurance plans.
The website provides a plan comparison tool to help individuals, families, and small businesses decide on the right plan for them. It is the only place where employers can take advantage of the Small Business Health Care Tax Credit, if eligible.
New Yorkers can also get help from Certified Application Counselors, Marketplace Facilitated Enrollers, and Navigators, who can assist with understanding coverage options and enrolling in a suitable plan.
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Medicaid
There are several eligibility groups for Medicaid, including low-income adults, pregnant women, children, and disabled individuals. In New York, seniors aged 65 and over can also qualify for long-term care Medicaid. There are three categories of long-term care programs: Institutional/Nursing Home Medicaid, which provides care only in nursing homes; Medicaid Waivers/Home and Community-Based Services (HCBS), which provide services at home, a loved one's home, adult day care, or assisted living; and the third is not specified.
Financial eligibility criteria for Medicaid change annually and vary depending on marital status. Countable assets (or resources) are calculated towards Medicaid's asset limit and include cash, stocks, bonds, investments, vacation homes, and bank accounts. There are also exempt (non-countable) assets, including one's primary home, personal belongings, household items, a vehicle, and burial funds up to $1,500. The program has access to Internal Revenue Service records and will verify all financial information supplied by the applicant.
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Child Health Plus
All children under 19 years of age living in New York State are potentially eligible for Child Health Plus, regardless of their family's income or immigration status. Children Health Plus is a health insurance plan for kids under 19, provided by New York State.
The monthly premium price depends on household income and family size. There is no monthly premium for families with lower incomes, and no annual deductible or co-payments. The amount you pay and your child's eligibility also depend on whether your child has any other health insurance coverage.
Parents or caretaker relatives must apply for Child Health Plus through the NY State of Health Marketplace. Children can apply for coverage at any time during the year. You can enrol your child in Child Health Plus at any time during the year through the NY State of Health website.
You can also speak with a customer service professional by phone, Monday to Friday, 8 am-8 pm, and Saturday, 9 am-1 pm, on 1-855-355-5777. Or, you can chat online with a representative during the same time periods.
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Essential Plan
In New York, access to healthcare is a right. All New Yorkers have health coverage options they can enrol in, regardless of their income or immigration status.
The Essential Plan is a free or low-cost insurance plan for adults with low incomes who don't qualify for Medicaid. It includes comprehensive benefits with $0 monthly premiums and very low-cost sharing. The Essential Plan is offered by NY State of Health, which is a health plan marketplace for individuals, families, and small businesses.
There are three ways to enrol in the Essential Plan:
- Apply through the NY State of Health website
- By phone at 1-855-355-5777 (TTY: 1-800-662-1220)
- With the free help of a trained and certified Enrollment Assistor or Broker
To enrol, you will need the following information for each member of your family:
- Birth dates
- Social security numbers, or for legal immigrants, document numbers
- Employment, income, and health insurance information
It's important to note that you may need to take action each year to renew your health insurance plan.
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Qualified Health Plans
In NYC, access to healthcare is a right. All New Yorkers have health coverage options that they can enrol in, regardless of their income or immigration status.
QHPs are available to individuals who are New York State residents, citizens, lawfully present applicants, and DACA recipients. They are not eligible for Medicaid, the Essential Plan, or Child Health Plus. The monthly premium you pay for a QHP depends on the health plan you choose. You may be eligible for tax credits that can lower your monthly costs. These tax credits are calculated based on your income, household size, and where you live.
You can enrol in a QHP during the annual Open Enrollment Period, which begins on November 1 every year, or during a Special Enrollment Period if you are eligible. This eligibility is determined by a Qualifying Life Event, such as the loss of coverage, marriage, or the birth of a child. Individuals must apply within 60 days of the Qualifying Life Event.
Your cost-sharing, or the amount you pay when you receive health care services (including co-pays, co-insurance, and deductibles), will depend on the health plan you choose. However, once you reach your maximum out-of-pocket (MOOP) cost, the plan will pay 100% of your medical costs.
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Frequently asked questions
The health insurance marketplace in New York is called the New York State of Health Marketplace.
NYC Care is a coverage plan that helps those who don't qualify for or can't afford health insurance to get affordable medical care at New York City's public hospital system, NYC Health + Hospitals.
The NY State of Health Essential Plan is a free or low-cost insurance plan for adults with low incomes who don't qualify for Medicaid.
The Special Enrollment Period is a period during which individuals can apply for a Qualified Health Plan outside of the annual open enrollment window. This is usually triggered by a specific qualifying life event, such as the loss of coverage, marriage, or the birth of a child.
