Private Health Insurance New York

As New York residents you have access to affordable and cheap health insurance plans either through the state marketplace or through Medicaid if you qualify for it based on the income. However, residents who are not eligible for employer-sponsored plans or government-sponsored health plans need to shop for affordable private health plans for themselves and their families. Finding the cheap and best health insurance coverage in New York is not an easy task as your choice of the plan mainly depends on the availability of plans in your area and based on your medical and financial situation. While selecting the right plan, you can determine affordability by taking into account the premiums and deductibles for each metal tier.

Vital Statistics about New York Health Insurance

New York being a leader in health reform has enacted several consumer protection regulations.

In 2020, about 273,000 New York residents enrolled in qualified health plans through the state exchange, and another 797,000 residents enrolled in the Essential Plan.

Residents of New York can enroll in health plans through its health insurance marketplace called the NY State of Health, which is a very successful state-based exchange.

New York’s health insurance marketplace has robust insurer participation with fifteen health insurance carriers offering health plans in 2021.

Not all the carriers offer health plans in all counties and some carriers include multiple entities of a single parent company.

For the individual market plans, New York regulators have approved an average rate increase of 1.8% for the plans offered in 2021.

Different Metal-Tiers of Plans available in New York

To choose the best and affordable private health insurance plan, it is essential to compare the prices of all the metal-tiers of plans available in the state. In New York, health insurance is offered at five different metal-tiers, Catastrophic, Bronze, Silver, Gold, and Platinum. A lower metal tier plan with affordable premiums will make more sense to you if you don’t expect significant health or medical expenses. Similarly, Gold and Platinum plans will turn out to be cost-effective for you if you have higher medical costs, as you will be eligible for coinsurance soon after reaching your deductible amount.

New York Health Care Reform Provisions

New York has embraced health care reform much before compared to the rest of the country. Even the rough edges in the New York insurance market have been smoothed by the Affordable Care Act.

The health care reform that applies in the state includes:

IVF coverage – In the 2020 budget, a requirement was included according to which the state-regulated large group health plans have to provide coverage for IVF. This was applicable for large group plans having more than 100 employees. The state even considered the possibilities of requiring individual and small group health plans to cover IVF but that would have been proved costly for the state, so it was not mandated. However, the new budget required individual and small group plans to cover medically necessary fertility preservation.
Contraceptive Coverage – New York has made ACA’s contraceptive coverage mandatory for women and also allows them to obtain up to 12 months of birth control at a time.
Protections from Surprise Billing – Residents of New York have been protected from surprise balance billing through the regulations implemented in 2015.
Higher MLR Standards – health insurance carriers of New York are required to spend at least 82% of premiums on medical costs compared to the federal requirement of 80%.
Regulations to Retain Insurers in the Marketplace – New York in 2017 implemented regulations to prevent health insurance carriers from withdrawing. The insurers that withdrew from the marketplace were not provided state contracts for the Medicaid, CHIP, or Essential Plan programs.
Premium Restrictions – Individual or small group health plans’ premiums cannot vary based on age or tobacco use.

Average Cost of Health Insurance by Metal-tier in New York

To assist you in choosing the best and the most affordable health insurance plans in New York, we are providing you with the average cost of health insurance by Metal-tier in New York.

Finding the Best Health Insurance Coverage in New York

Choosing the best and affordable health insurance plan mainly depend upon the availability of plans in your area along with your medical and financial conditions. While choosing the plan, you can determine affordability by reviewing the premiums and deductibles for each metal tier. However, if you have an emergency fund and you don’t expect significant health and medical expenses, then a lower metal-tier plan with affordable premiums would prove more lucrative for you.