Navigating New York's Medical Insurance: A Comprehensive Guide For Residents

If you need health insurance, GetCoveredNYC Specialists are here to help you navigate the process. You can get medical insurance in New York by enrolling in a Qualified Health Plan on the NY State of Health Marketplace for individuals with middle or low income who are not eligible for Medicaid. You may be eligible for financial assistance to help pay for one of these plans. Enrollment for these plans is only available during the annual open enrollment period or during a special enrollment period. You can also get medical insurance through an employer or school-sponsored plan, or through Medicaid.

NY State of Health Essential Plan: Free or low-cost insurance plan for adults with low incomes

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.

To be eligible for the Essential Plan, you must be:

• An adult who is 19-64 years of age
• A New York State resident
• Lawfully present in the U.S.
• Meeting income eligibility requirements

The Essential Plan offers comprehensive benefits with $0 monthly premiums and very low-cost sharing. It covers free preventive care like routine exams and screenings, dental and vision, inpatient and outpatient hospital care, prescription drugs, and more.

Individuals can enroll in the Essential Plan at any time during the year through NY State of Health. You can enroll at any time if you qualify for Medicaid, Child Health Plus, or the Essential Plan.

GetCoveredNYC can help you navigate the process and enroll in a plan that works for you. Specialists speak over a dozen languages and are here to make healthcare easy for you. You can contact GetCoveredNYC to get started.

Qualified Health Plans: Private insurance plans available on the NY State of Health Marketplace

Qualified Health Plans are private health insurance plans that are available on the NY State of Health Marketplace for individuals with middle or low income who are not eligible for Medicaid. You may be eligible for financial assistance to help pay for one of these plans. Enrollment for these plans is only available during the annual open enrollment period or during a special enrollment period (November 1 to January 31) or during a special enrollment period (February 1 to October 31). You may be eligible for a special enrollment period if you recently had a change in your family, income, or health insurance coverage.

The NY State of Health Marketplace is your one-stop-shop to shop and compare health insurance. The Marketplace is offering new plan options with significant savings. Financial help is available to make these more affordable.

Qualified Health Plans follow the rules set by the Affordable Care Act, which include covering essential health services and meeting certain standards of cost sharing.

Certified Application Counselors, Marketplace Facilitated Enrollers, and Navigators are types of Assistors that can help New Yorkers apply for health insurance.

If you need health insurance, GetCoveredNYC Specialists are here to help you navigate the process. Contact GetCoveredNYC to get started!

NYC Care: Health insurance for those who don't qualify for other plans

If you don't qualify for or can't afford health insurance, you can get NYC Care. NYC Care is a health insurance program for New Yorkers who don't qualify for other plans.

To be eligible for NYC Care, you must be a resident of New York City, have a low income, and not qualify for other health coverage. You can apply for NYC Care online or in person at a Community Health Worker office.

The application process for NYC Care is straightforward. You will need to provide proof of identity, income, and residency. You will also need to answer a few questions about your health coverage and insurance history. Once you have submitted your application, you will be notified within 30 days whether you are eligible for NYC Care.

If you are eligible for NYC Care, you will be enrolled in a plan that meets your needs. You will be responsible for paying a monthly premium based on your income. You will also be responsible for paying any deductibles and co-pays that may apply.

NYC Care offers a range of benefits, including coverage for doctor visits, hospital stays, prescription drugs, and vision and dental care. You will also have access to preventive care and mental health services.

Child Health Plus: New York State's health insurance plan for kids under 19

New York State has a health insurance plan for kids, called Child Health Plus. The monthly premium price depends on household income and family size. There is no monthly premium for families with lower incomes. Child Health Plus has no annual deductible and no co-payments. You can enroll your child in Child Health Plus at any time during the year through NY State of Health. Instructions on how to enroll are available here.

To be eligible for either Children's Medicaid or Child Health Plus, children must be under the age of 19 and be residents of New York State. Whether a child qualifies for Children's Medicaid or Child Health Plus depends on gross family income. Children who are not eligible for Medicaid can enroll in Child Health Plus if they don't already have health insurance and are not eligible for coverage under the public employees' state health benefits plan.

Children can qualify for the plan—sponsored by New York State—regardless of family income or immigration status. Child Health Plus provides no- or low-cost healthcare coverage for children under 19 who aren’t eligible for Medicaid. Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Child Health Plus covers dental care and exams—including braces if they are medically necessary. You can enroll by requesting a call and our sales team will call you within one business day. You can also visit the NY State of Health website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

Medicaid: Public health insurance for people with low incomes

Medicaid is a public health insurance program for people with low incomes. Depending on how much money you make, you might qualify for Medicaid. If you qualify for Medicaid, Child Health Plus, or the Essential Plan, you can enroll at any time. You can enroll in a Qualified Health Plan during a Special Enrollment Period, if you are eligible. Contact us for help! Make a plan to stay covered! Log in here to review your application and renew your health insurance coverage.

Qualified Health Plans are private health insurance plans that are available on the NY State of Health Marketplace for individuals with middle or low income who are not eligible for Medicaid. You may be eligible for financial assistance to help pay for one of these plans. Enrollment for these plans is only available during the annual open enrollment period or during a special enrollment period (November 1 to January 31) or during a special enrollment period (February 1 to October 31). You may be eligible for a special enrollment period if you recently had a change in your family, income, or health insurance coverage.

If you need health insurance, GetCoveredNYC Specialists are here to help you navigate the process. Contact GetCoveredNYC to get started! NY State of Health Essential Plan: this is a free or low-cost insurance plan for adults with low incomes who don't qualify for Medicaid. Qualified Health Plans: Qualified Health Plans are available on the NY State of Health Marketplace and directly from insurance companies. These private insurance plans follow the rules set by the Affordable Care Act, which include covering essential health services and meeting certain standards of cost sharing. Financial help is available to make these more affordable. NYC Care: If you don't qualify for or can't afford health insurance, you can get NYC Care.

Child Health Plus: This is New York State's health insurance plan for kids under 19. Depending on your family's income, your child may be eligible to join either Children's Medicaid or Child Health Plus. How much you have to pay for this affordable plan also depends on your income. Employer or School-Sponsored Plan: Many employers offer health insurance to employees, often at a reduced rate. Talk to your HR department about your options. If you're a student, you might be able to get health insurance through your college or university.

Frequently asked questions