Best New York Health Insurance Plans
Due to its wealth and variety of resources, New York is nicknamed as the Empire State. The state ranks 4th in terms of population and 27th in terms of area. As per the stet health ranking, New York is in the 19th spot, which means that the state has to certainly improve in terms of health of its residents.
New York being a progressive state has long ago embraced health care reform compared to other states. Some of the rough edges of the New York insurance market has been smoothed out by the Affordable Care Act and with the Obamacare implementation the state has continuously improved upon its residents health. Residents of New York can purchase health insurance in New York through the NY state of Health marketplace. Health insurance is heavily regulated in New York compared to other U.S. states. Though the federal Affordable Care Act has posed a limitations on insurance carrier for the setting of their policies prices but New York’s regulations are even more restrictive.
In most of the U.S. states, insurance companies are allowed to charge higher premiums to older people and smokers but in New York insurance companies are prohibited to calculate premiums based on any personal information. Insurance carriers can only take into account the area in which one is living to calculate the premium amount.
Highlights and Updates of New York Health Insurance Market
- The state operates its own health exchange NY State of Health
- Open enrollment for 2020 coverage in New York run from November 1, 2019 to January 31, 2020.
- The state is rightly regarded as the health reformer, as it has enacted several consumer protection regulations.
- The sale of short-term plans is not permitted in the state.
- Since 2013, the uninsured rate in the state has dropped 47%.
- For offering health coverage in 2020, there are 12 insurers offering coverage through the state exchange.
- There is an average health premium rate increase of 6.8% for 2020.
- The New York’s state-based exchange has robust insurer participation.
Individual & Family Health Insurance Plans in New-York
New York residents can purchase individuals and family health insurance plans offered by private insurance companies or through the state-run exchange. All the legal New York residents can buy healthcare coverage through the state exchange or by applying online or by calling in person. All the qualifying individuals and family health insurance plans in New York offers the ten standardized essential benefits common in every state and currently the state has mandated the certain benefits that exceed ACA requirements such as diabetes care management, blood products and services, dialysis, durable medical equipment, ambulance services, home health care services, infertility treatment, skilled nursing facility, second medical opinion for cancer diagnosis along with few others.
All insurance companies participating in the federal or a state healthcare exchange in New York should offer at least Silver and Gold plans, as all the qualifying plans available in the state are designated by the ACA to be one of four metal plans. Individual and family health insurance plans in New York can be bought only during open enrollment. Individual and family health plans available in New York are:
Preferred Provider Organization or PPO plans are perfect for individuals who want freedom in choosing health care provider as well as medical facility for their healthcare needs. The PPO plans are greatly popular among the individuals, as it allows them visit the in-network physician of their choice and these plans also refrain them from obtaining referral from a primary care physician for visiting a specialist. In-network healthcare services in PPO plans are covered at a higher benefit level compared to out-of-network services. However, members of the PPO plans have to pay an annual deductible to pay before the insurance companies start providing coverage. Members also might have to pay co-payment or pay a certain percentage of the total medical expenses of their medical bills.
Health Maintenance Organization is among the cheapest health insurance that prove to be good choice for individuals and families who are on a tight budget and don’t have many medical issues. These individual plans also come with low premiums, deductibles and fixed copays for doctor visits. In the HMO plan, members are required to choose a primary care physician, who will look after their health when required and will also provide referral before seeing a specialist. Since, all health care services ate obtained through the primary care provider, members should carefully select their PCP to whom they can trust.
High Deductible Health Plans with HSA
High Deductible Health Plan work with a health Savings Account because members of this plan need to ensure that they have sufficient funds to pay for their medical expenses when they need it. HSA is a tax-favored savings account, which is used in conjunction with a high deductible HSA-compatible health plan to make healthcare more affordable and to save for the retirement. The members of this plan has to initially pay for their medical expenses until they reach their deductible. This plan is ideal for individuals who wish to have plans with lower monthly premiums and such plans suit to individuals who are usually healthy and do not require to see a physician regularly. This plan ensures that people have coverage for any major medical emergency but they will not require to pay high premium even when they do not need it.
A Point of Service plan come with the combined features of both HMO and PPO plans whose benefits vary depending on whether the plan’s member receive health care in or out of the health insurance company’s network of providers. In the POS plans members are responsible for co-payments, coinsurance and an annual deductible and they may receive health care from non-network providers by paying higher out-of-pocket costs. The POS plans are best for individuals who are willing to abide by the plan’s rules and manage your healthcare through a primary care physician. This plan will be also perfect for the individuals, if their favorite doctors are in the plan’s network.
Exclusive Provider Organization or EPO health plans are designed especially for individuals who wish to receive health care services at a much lower negotiated rate compared to HMO or PPO plans. In the EPO plans members do not have to obtain a referral to visit a specialist. All the members of the EPO plans are encouraged to visit the doctors and hospitals within the EPO network, and they are not allowed to go outside the network for care because there are no out-of-network benefits.
Dental Plans in New York
Dental insurance plans in New York provide immediate coverage for most preventive cleanings and check-ups and for some serious dental procedures, members have to meet deductibles and they are also responsible to pay their percentage of cost to receive benefit form their insurance carrier. Some of the dental plans in New York also have out-of-pocket maximum that protect members from high cost dental care throughout the year. New York dental insurance plans are categorized as either Indemnity or managed-care plans:
Indemnity dental plans in New York offer a wide selection of dental care providers. The members of the dental plan have to pay up front and they can later claim reimbursement from their insurance carrier, as they pay for the covered dental services only after receiving the bill.
Managed-care Dental Plans
Managed care dental plans maintain a networks of dentists, who agree to participate in a network to provide dental services for patients at pre-negotiated rates and usually they submit the claim to the dental insurance company on behalf of the members of the plan. With managed-care dental plans, members have less paperwork and lower out-of-pocket costs though they have a limited choice of dentists.
Vision Insurance Plans in New York
Vision insurance plans are designed for individuals and families keeping in mind that routine vision care is not covered under health plan so vision insurance plans are offered by private health insurance companies in New York that help to offset the costs of routine checkups as well as of the prescribed vision correction wear. In absence of vision plan, people often avoid routine eye exams, which act as a preventive measure to ensure the overall health of the eye. There are two types of vision plans in New York, Vision Insurance Plan and Vision Discount Plan.
Short-term Health Plans in New York
In New York, short-term health insurance plans are not available for purchase. The state has prohibited the sale of short-term insurance plans due to regulations that require all health plans to cover the minimum essential benefits and also to be guaranteed renewable. Since, short-term plans do not provide coverage for the essential benefits so these plans are not available in state health insurance marketplace. The sale of the short-term plans is not allowed to protect the health insurance risk pool for everyone, as it restricts healthy people from opting for the lesser benefits plans instead of beneficial health insurance.
Health Insurance Carriers of New York
Following health insurance companies are offering coverage for 2020 plans in new York.
- Capital District Physicians Health Plan
- Health Plus HP (Empire BlueCross and Empire Blue Cross Blue Shield)
- Excellus (Excellus Blue Cross Blue Shield in Central New York and Univera in Western New York)
- Fidelis Care (New York Quality Health Care Corp.)
- Health Insurance Plan of Greater New York (EmblemHealth)
- Healthfirst New York
- HealthNow New York, Inc. (BlueShield of Northeastern New York, and BlueCross BlueShield of Western New York)
- Independent Health
- MetroPlus Health Plan
- MVP Health Plan, Inc.
- Oscar Insurance Corporation
- United Healthcare of New York, Inc
FAQ on New York Health Insurance
The individual mandate law that requires you to have health insurance does not apply anymore leaving a few of the states that still have an individual mandate at the state level. New York does not have an individual mandate that means you do not have to pay a tax penalty for not having health insurance. However, you are still advised to obtain health insurance as it provides you financial protection in the case of medical emergencies.
For the 2021 health plan coverage, the open enrollment in New York will run from November 1, 2020, to December 15, 2020. Outside the open enrollment period, residents will need a qualifying event in order to enroll in health coverage or make changes to their existing plans. Open enrollment for 2020 coverage ended on February 7, 2020, but due to the COVID-19 pandemic, the state quickly moved to open a special enrolment period to give people an opportunity to obtain coverage. Since then the enrollment window has been extended five times and is currently open through September 15, 2020.
The average monthly health insurance premium cost for the 2020 plan across the New York state is $698 which is a 5% increase from the previous year 2019.
After analyzing health insurance plans across all the counties it was discovered that IND Destination 65 is the cheapest plan available in New York. However, the best health plan depends on the availability of plans in an area, along with your medical and financial situation. While choosing a cheap and affordable plan you should review the premiums and deductible for each metal tier. If you don’t have major health issues and don’t expect to have significant health or medical expenses, then you can opt for a lower metal tier plan having more affordable premiums.
The state of New York is among a few states that do not allow the sale of short-term health insurance in the state. So all the residents of the state do not have access to short-term health plans in New York.
Medicaid and CHIP are both government programs that help low-income people obtain health insurance within their budget. Thus, if you make less than 133% of the federal poverty line, then you will qualify for government assistance. Besides, pregnant, disabled, and medically needy people who make over 133% of the FPL should also apply for these programs because they may qualify for the coverage.