New Yorkers can purchase affordable health insurance through the state marketplace or through Medicaid if your household income falls below 138% of the federal poverty level.
Find Cheap Health Insurance Quotes in Your Area
For the 2020 plan year, the average monthly cost of health insurance across New York state is $698 which represents a 5% increase from 2019.
To help you find the best coverage, we analyzed Silver health insurance policies available across all counties and found that the IND Destination 65 was the cheapest plan available. However, there are 20 insurers offering health plans in New York, and where you live will determine available companies and policies.
New York individual health insurance plans overview
You can purchase health insurance in New York through the NY State of Health marketplace. Health insurance in New York is one of the most heavily regulated in the United States. While the federal Affordable Care Act limits how insurers can price their policies, New York's regulations are even more restrictive.
For example, most other states allow insurers to charge older people and smokers a higher health insurance premium. But in New York, insurers are prohibited from using any personal information for calculating premiums, using only where you live as a factor. For both individual plans and small-business plans, all consumers living in a specific location pay the same price for health insurance. This means younger New York residents pay more for health coverage than they would in other states, while older residents pay less than they would in other states.
Open enrollment in New York begins Nov. 1 and continues through Jan. 31. If you are a first-time buyer, then you will be able to purchase a health insurance plan once enrollment opens, while people who are renewing a plan can do so beginning Nov. 16. If you buy a health plan before Dec. 15, then your effective coverage will begin Jan. 1. New York's exchange portal also lists brokers who can provide guidance and help you enroll in a health plan.
Cheapest health insurance by metal tier
To help you to compare prices and choose the best policy, we have identified the most affordable health insurance plans available in the state of New York. The plans shown below may not be available in your county but can help you compare costs in that tier.
|Metal tier||Plan marketing name||Deductible||Maximum out-of-pocket||Monthly cost for an adult individual|
|Catastrophic||Fidelis Care Catastrophic||$8,150||$8,150||$143|
|Bronze||MVP Premier Bronze 2||$4,425||$8,150||$348|
|Silver||IND Destination 65||$2,500||$6,400||$480|
|Gold||MVP Premier Plus Gold 2 HDHP||$1,400||$6,750||$592|
|Platinum||Fidelis Care Platinum||$0||$4,000||$721|
Health insurance is offered at five different tier levels in New York: Catastrophic, Bronze, Silver, Gold and Platinum. As you can see above, when the tier level increases, the monthly premium becomes more expensive, while the deductible and out-of-pocket maximum decrease.
Additionally, the price will vary according to the number of people covered. As you can see below, as you add either an adult or dependents to a policy, the monthly premium increases.
Finding the best health insurance coverage in New York
The best health insurance policy for your family will depend on the availability of plans in your area, as well as your medical and financial situation. When deciding on the right type of plan, you should determine affordability by reviewing the premiums and deductibles for each metal tier. Generally, if you have an emergency savings account and don't expect to have significant health or medical expenses, then a lower metal tier plan with more affordable premiums would make more financial sense.
Gold and Platinum plans: Best if you expect high medical costs
Gold and Platinum plans are the highest tier health insurance policies available in New York. These plans often have the most expensive monthly premiums but come with lower deductibles and out-of-pocket maximums. For this reason, Gold and Platinum plans can be the most cost-effective for those with higher medical costs, as you would reach the deductible quickly and can then be eligible for coinsurance. For example, if you require prescriptions drugs that are expensive and need to be refilled every month, an upper-tier health plan could be the right choice.
Silver plans: Best for people with low income or average medical costs
Silver plans are middle-ground policies that fall between Gold and Bronze plans with regard to premiums and out-of-pocket expenses. We would recommend a Silver plan in most situations — but if you are very healthy, Bronze may be best in terms of cost-effectiveness. On the other hand, if you expect a lot of medical expenses, then a Gold plan may better fit your needs.
Silver plans are eligible for cost-sharing reduction (CSR) subsidies in New York if your income falls below 250% of the federal poverty level. If this applies to you, then you would be able to receive discounts on deductibles, coinsurance and copayments.
Bronze and Catastrophic plans: Best for young, healthy individuals
Bronze and Catastrophic tiers have the lowest premiums available on the New York marketplace but also the highest deductibles and cost-sharing. These metal tier plans should only be considered if you have good health and do not expect to have high medical costs.
Bronze plans are available to all consumers, but Catastrophic policies have eligibility requirements. These plans are only available to people under 30 years old or those with a hardship exemption.
Health insurance rate changes in New York by metal tier
Health insurance rates are determined by each insurer and are submitted for approval to the New York state exchange. For 2020, the largest rate increase occurred in Gold plans, which rose in price by an average of $49 per month or 6.29%.
|Metal tier||2019 Premium||2020 Premium||% Change|
Short-term health insurance in New York
Short-term health insurance plans are not available for purchase in New York. Furthermore, New York state prohibits the sale of these insurance plans due to regulations that require all health plans to be guaranteed renewable and cover the minimum essential benefits.
Most short-term plans typically do not cover the essential benefits (maternity, mental health, prescription drugs usually are not covered) and thus are not offered on the New York state health insurance marketplace.
Find Cheap Health Insurance Quotes in Your Area
Age 29 rider coverage expansion
Under the Affordable Care Act, young adults can be covered under their parents' health insurance plans up to the age of 27. Because of the way insurance is priced in New York, it is preferable for young adults to stay on their parents' plans until the legal limit, since the additional cost is at most 70%–85% of the parents' health plan premium.
New York also allows health insurance companies to offer an age 29 coverage option. Parents pay a little more for their health insurance in exchange for having their children stay on the family plan until the age of 29. For example, say your young adult child has passed the age of 27 but does not have a job or sustainable income to pay for their own insurance. In this case, you could pay a small extra premium along with your normal health insurance rate that would allow your coverage to support your son or daughter. To qualify, the young adult must be:
- 29 or younger
- Not insured or eligible for insurance through their employer
- Live, work or reside in New York state or the insurance carrier's coverage area
New York health insurance companies
There are currently 17 insurers that sell individual plans on the New York health insurance marketplace:
- Health First
- Fidelis Care
- MetroPlus Health Plan
- MVP Health Care
- Univera HealthCare
- BlueShield of Northeastern New York
- Blue Cross Blue Shield of Western New York
- Empire Blue Cross
- Empire Blue Cross Blue Shield
- Independent Health
- Solstice Health Insurance Company
- Healthplex Insurance Company
Some of these insurers may not be available depending on where you live. The availability of insurers and health plans changes by county, so your location will directly impact your coverage options.
Medicaid health insurance coverage in New York
New York's Medicaid program is a form of health insurance for those who can't pay for an individual plan. Qualifying for Medicaid is primarily a function of your income and household size. Through the state's expansion of Medicaid, most households with modified adjusted gross incomes (MAGI) under 138% of the federal poverty level (FPL) are eligible for Medicaid coverage in New York.
The income limits for children and pregnant women are slightly higher than those for adults. Children up to the age of 19 are eligible for a special type of Medicaid if the household income is under 154% of the FPL, while pregnant women and infants up to the age of 1 are eligible if the household earns less than 223% of the FPL. The following table illustrates the maximum yearly income a family can have in order to qualify for the Medicaid thresholds in New York.
How does Medicaid coverage work?
If you apply for Medicaid in New York, you will be asked to select a health plan managed by an insurance carrier, such as UnitedHealthcare or Empire BlueCross BlueShield. These insurance companies also sell individual health insurance policies and small-business coverage, and the plans themselves operate similarly. Each Medicaid plan will come with a network of doctors and health care providers that accept the insurance. However, health plans offered as part of the Medicaid program may have a different network of doctors when compared to other plans offered by the same insurance carrier. If you have a physician you prefer, it's important to make sure they are covered in the new network.
Average cost of health insurance by family size
Along with your county of residence, the number of people covered under the health plan will affect the premiums you pay. Below, we have provided the average cost of a Silver health plan for a variety of family sizes. Note that, for a family, the average cost for a Silver policy is $1,659 no matter how many dependents are covered under the health insurance plan.
|Family size||Average monthly cost of health plan|
|Adult and child||$977|
Child Health Plus coverage for children
In New York, Child Health Plus is a health insurance program for children in households that have incomes too high to qualify for Medicaid but are less than 400% of the federal poverty level. Like Medicaid, Child Health Plus plans are managed by the same insurance carriers on the individual and small-business market.
Families with children under the age of 19 who qualify for Child Health Plus pay significantly lower health insurance rates for covering the child. The amount a family contributes is based on the family size and household income, with premiums per child ranging from $9 to $60 per month.
For families with multiple children, the maximum contribution is three times the per-child premium. For example, if you fall into the $9-per-child threshold group, then the maximum you would pay for all your children would be $27, even if you purchase coverage for more than three children.
Maximum monthly income to be eligible for Child Health Plus: By number of children
|Monthly health insurance cost (per child)||1||2||3||4||5|
Health insurance rates and plans for New York were pulled from the New York State of Health insurance marketplace. Using the plan premiums, deductibles and out-of-pocket maximums, we calculated the averages by metal tier, family size and other metrics to produce this report.