Health Insurance in New York: Your Comprehensive Guide

Having a healthcare plan that fits you is crucial today, given growing healthcare expenses. Obtaining a healthcare plan is the only way to be sure your medical expenditures will be paid for should an emergency strike.

Having said that, regarding health insurance plans, all of your alternatives can be very challenging to grasp. This page acts as a road map to help you understand your available alternatives in the State of New York.

Understanding Important Terms

In order to understand health insurance, we first need to grasp key terms. You’ll probably come across some of the following wording when looking for health insurance:

Premiums

The premium—that is, the money you or your organization pays to your health insurance provider to keep coverage—is usually paid monthly. One could see a premium as a kind of subscription charge required to maintain your health insurance.

Deductible

The amount you pay out of cash before your health insurance pays the bills is known as a deductible. Usually, these reset annually, and deductible costs should be considered while choosing health insurance.

Copayment

A co-payment is the set payment you pay for a given prescription drug or healthcare service. One pays a copay right before the service. Healthcare insurance companies vary in the amount of copays they charge for a given service.

Network vs. Out of Network

Your health insurance company employs several doctors contracted to provide you with treatment. 

These doctors go under the moniker “in-network.” You can also visit out-of-network doctors; your insurance company does not contractually deal with that provider. If you see an out-of-network provider, your financial costs will be higher. 

Types of New York State Health Insurance Plans

Plans for Individual and Family Health

If you find yourself not eligible for government-aided programs and not offered work-based health policies, private individual and family health plans are available. The New York State of Health marketplace carries these plans.

You will pay premiums each month to maintain your health insurance.

Employer-based health programs

Your full-time work allows you access to employer-based health policies. These plans direct premiums straight from your wages. You will also lose your health insurance should you lose your work or find that your employment becomes part-time.

Government options 

If you cannot afford to pay for private health insurance, there are several government options available to you. 

Medicare vs. Medicaid 

While both of these programs are run by the government, they vary in who they are for. Medicare is for people aged 65 or older or people with disabilities. This program provides free healthcare for these individuals. 

Medicaid is specifically for low-income families or individuals of any age and can include children. 

What if I don’t qualify for Medicaid but still can’t afford healthcare? 

New York State has a free healthcare option for certain low-income individuals who do not qualify for Medicaid. This is known as The Essential Plan. 

How do I know which plan is right for me? 

There are hundreds of different options for private health insurance- talking to a health insurance broker in New York can help you determine which plan is right for you. 

When speaking to a broker you should consider the healthcare needs of you and your family members. Make sure to compare the options available to you because each one will differ in out-of-pocket costs, deductibles, and copayments. 

Using the New York State of Health Marketplace

The marketplace is the only way for you to buy health insurance or enroll in the Essential Plan in New York State. 

In order to enroll in a health insurance plan first you need to create an account on the New York State of Health Website. From there you will have to input information about you and your family. Then the Marketplace will give you a list of options and their costs. You should compare all of your options and see what works best for you. 

Once you’ve selected your desired insurance, you will then have to enroll by completing the instructions labeled on the Marketplace. 

When can I enroll in healthcare?

Open enrollment takes place from November 1st to January 15th every year. During this period, anyone can enroll for insurance in NYS for the following year. As long as you are enrolled by December 15th, your coverage will start on January 1st. 

Sometimes you face what are known as special enrollment periods. This is when a life event happens such as losing a job or getting married qualifies you to enroll in health insurance any time of the year. It’s important to take advantage of your special enrollment period to ensure you are covered. 

In conclusion

As said before, enrolling in health insurance helps to ensure that, should an emergency strike, you will be covered. From private healthcare plans to government-assisted ones, New York State offers a range of choices that will enable you to ensure you are receiving the required treatment.

If you lack health insurance, you should not hesitate to see what options are available to you.