A record-breaking 4.3 million New Yorkers enrolled in comprehensive health coverage through NY State of Health for 2018, a total that’s 700,000 higher than the previous year. If you’re new to the Empire State or haven’t bought individual health insurance in the state yet, here’s what you need to know about enrolling in health insurance in New York.
What is NY State of Health?
NY State of Health is New York’s health insurance Marketplace. It was launched in April 2012 and is where New Yorkers can enroll in Affordable Care Act plans. It is also the only place where residents who qualify can reduce their health insurance and health care costs by getting ACA subsidies (premium tax credit and/or cost-sharing reductions).
In addition, the NY State of Health Marketplace is where New Yorkers can enroll in Medicaid, Child Health Plus, and the Essential Plan. (The NY State of Health Essential Plan is a free or low-cost health insurance option for lower-income adults who do not qualify for Medicaid. It is New York’s version of the Affordable Care Act’s optional Basic Health Program. The only other state with this program is Minnesota.)
New York State of Health also operates a Small Business Marketplace with SHOP certified plans for small business owners with 100 or fewer employees.
How is NY State of Health related to HealthCare.gov?
Residents of most states use HealthCare.gov to enroll in and manage their ACA health insurance plans. NY State of Health is the New York version of HealthCare.gov. Residents of New York who are U.S. citizens or otherwise lawfully present and are not incarcerated are eligible to shop for health coverage through the NY Marketplace.
All plans offered by NY State of Health and HealthCare.gov have to include essential health benefits and other ACA consumer protections such as guaranteed and nondiscriminatory coverage for those with pre-existing conditions. Both Marketplaces use the same metal tier levels to categorize plans and the same eligibility requirements for ACA subsidies.
How is NY State of Health related to HealthSherpa?
HealthSherpa is a hybrid, privately-run alternative. It offers all the same plans, prices, and subsidies as HealthCare.gov, and it offers all the qualified health plans available on NY State of Health at the same prices and with the same subsidies. HealthSherpa can also help eligible New Yorkers enroll in the Essential Plan.
Plus, HealthSherpa has a Consumer Advocate team who can help you choose a plan, walk you through the application process, and answer any questions before and/or after you enroll.
How do you enroll in health insurance in New York?
You can enroll in Medicaid, Child Health Plus, or the Essential Plan at any time of the year by applying on the New York State of Health website or by calling (855) 355-5777.
For ACA individual health insurance in New York, you typically need to enroll during Open Enrollment. NY State of Health had its 2018 Open Enrollment Period between November 1, 2017 and January 31, 2018. You can still enroll, however, if you qualify for a Special Enrollment Period. To be eligible, you need to experience a Qualifying Life Event. (In New York, this also includes pregnancy that’s been certified by a healthcare provider. New York is the first state to add pregnancy to the list of qualifying life events.) Should you qualify, you’ll have 60 days from the date of your qualifying life event to enroll in a plan. If you enroll during the first half of the month, your coverage will typically start on the first day of the next month. If it’s after the 15th, the start date is usually the first day of the second month.
If it’s Open Enrollment or if you think you’re eligible for an SEP, you can enroll by calling the NY State of Health phone number or by applying either online or in-person. You can also enroll via HealthSherpa’s website or by calling the HealthSherpa Consumer Advocate team at (855) 772-2663.
If you’re interested in private health insurance outside of the New York State of Health Marketplace, that’s an option. too. However, it’s important to know that no financial assistance will be available in that case.