New York residents have access to private individual market plans and low-income programs such as Marketplace, Essential Plan and Medicaid that offer bronze to platinum plans with different deductibles and cost sharing tiers per county.
Every citizen and permanent United States resident is required to obtain health insurance, whether through their employer, broker, NY State of Health or government assistance programs such as Medicare or Medicaid.
Costs
New York offers one of the nation’s most robust healthcare marketplaces, featuring 12 insurers and providing individuals with options tailored specifically to their needs. Furthermore, government subsidies and tax credits help low-income families afford coverage.
Plans available through the marketplace are divided into four metal tiers that determine how much premium you owe and out-of-pocket expenses that must be covered. The lower your tier level is, the cheaper your premium typically is; Bronze plans tend to cost the least while Gold plans have higher premiums. Under ACA’s regulations, all plans must provide 10 essential benefits while preventive care services are free.
Many adults who purchased private health insurance through the individual market report high levels of anxiety about whether they can afford healthcare. Middle-income households ($50K-$99K/year) tend to feel most financially constrained and may have experienced burdens associated with delaying medical treatments and difficulty paying their bills (see figure 2).
Eligibility
Many New York residents can gain health coverage through the state marketplace. New York State of Health marketplace offers various plans, such as Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO), to suit various customer needs. Most plans cover doctor visits, hospital stays and prescription drugs while some plans offer adult vision or dental benefits as well. During Open Enrollment customers can select the plan which best meets their requirements.
Most residents qualify for Medicaid, the Essential Plan and Child Health Plus; which offer no premiums or copayments to families earning up to 138% of poverty level. Enrollment continues year-round for these public programs.
Some residents may qualify for short-term health plans with lower premiums than ACA-qualified coverage, while others could qualify for the Essential Plan which offers free preventive care and protection against catastrophic costs in every county of New York state. Others New Yorkers could qualify for Medicare which is offered to people aged 65 or over.
Enrollment period
New Yorkers can enroll in Affordable Care Act (Obamacare) health plans during the open enrollment period from November 1 through December 15 each year. Plans must provide 10 essential benefits; prices for bronze and silver plans tend to be most cost-effective for low-income individuals.
New enrollees may receive enhanced tax credits to offset the costs of their plan during COVID-19 public health emergency, though premiums are expected to increase significantly next year and consumers may want to switch.
Individuals can access and enroll coverage through New York State of Health (NYSOH), New York’s health insurance marketplace. Employers with 50 or fewer employees also can gain access to NYSOH for small business health exchange access – especially crucial for New Yorkers who depend on Affordable Care Act subsidies that won’t be available after January 15, 2023.
Tax credits
New York’s State Marketplace provides financial assistance for individuals and families to afford health insurance coverage, including premium tax credits and cost sharing reductions. Families whose income falls within 100-400 percent of federal poverty level (FPL) qualify for tax credits while young adults under 29 can stay on their parents’ plans until 29. Additionally, small businesses offering coverage through SHOP Exchange receive an expense deduction for offering coverage to employees.
Though the COVID-19 spending bill temporarily expanded Obamacare subsidies, it won’t make a noticeable difference to premiums as its system was designed to maintain steady enrollment payments regardless of how insurers raise prices. If extended, this temporary increase will add another $64 billion in inflation with little social benefit; New York should instead pursue policies that replace federal mandate penalties with state mandate penalties while placing limits on individual market insurance premiums and caps.
