Best Cheap Health Insurance in New York

To help you in finding Health Insurance in New York, we've developed this guide to walk you through the various options for coverage, eligibility requirements and what you need to know. Health Insurance in New York is delivered through a number of different channels with a consumer's eligibility dependent upon their personal circumstances. Under the Affordable Care Act you are required to have some form of health coverage for you and your family. If you are not covered by your employer then your eligibility for the various coverage options will generally depend upon your family makeup and household income. The main options are:

  • New York Health Insurance Exchange: All New Yorkers are permitted the shop on the state run marketplace for coverage. Financial assistance for those shopping on the exchange only applies to those with incomes between 133% and 400% of the Federal Poverty Level and do not have affordable options through their employer.
  • Medicaid: As a state that has expanded Medicaid coverage, Medicaid will cover all households with incomes under 133% of the Federal Povery Level. Plans are generally meant for people between the ages of 19 - 64. In New York, Medicaid coverage is delivered through a health plan provided by a insurance carrier.
  • Child Health Plus: Health plans with reduced premiums that cover children under the age of 19 in households that have incomes that surpass the Medicaid thresholds. The amount the family contributes is based upon the number of children and their income level.

Income Eligibility For Coverage

The following table indicates what type of coverage or assistance you may be eligible for in the state of New York based on family size. Use it to determine where you can get health coverage. In general the New York State Exchange will determine this for you when you apply. If you qualify for Medicaid then you and your child will not qualify for the Child Health Plus plans or the subsidies on the NY State of Health Exchange. Families with household incomes over the maximum thresholds will not qualify for any assistance.

Annual Income Thresholds by Family Size

Family Size

MedicaidChild Health PlusExchange Subsidies

1

(Less Than) $16,105(Less Than) 46,680(Less Than) 46,680

2

21,70863,72063,720

3

27,31180,36080,360

4

32,91397,00097,000

New York Individual Health Insurance Plan Overview

New York has one of the most heavily regulated health insurance markets in the United States. While the Affordable Care Act / Obamacare tightened the rules as to what insurers are permitted to use in pricing your plans, New York's regulations are even more restrictive. Most other states use your age as well as smoking habits in determining your rates, with smokers and older consumers paying more on average.

In New York, insurers are prohibited from using any personal information for calculating premiums, using only where you live as a factor. This means for both individual plans and small business plans all consumers living in a specific location pay the same premiums. This results in younger New York residents paying more for insurance than they would in other states, while older residents pay less than they would otherwise.

For plans covering more than a single individual, health insurance companies will multiply the price they charge for one person by a factor dependent upon the size and makeup of the family. The factors are as follows:

Family Size

Factor

Married

2

Married + Children

2.85

Individual + Children

1.7

Individual

1

This means that a plan that would cost an individual $500 in monthly premiums would cost $1,000 if that person were married, and $1,425 if they were married with kids.

Age 29 Rider Coverage Expansion

Under the Affordable Care Act, young adults can be covered under their parents health insurance plans up until 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 plan until the legal limit since the additional cost is at most 70-85% of the parent's plan. In cases where there are other children, the additional cost is actually 0.

New York improves upon this by having insurance companies offer an Age 29 coverage option which lets parents to pay a little more for their insurance in exchange for having their children stay on their plan until the age of 29. The child does not need to be a financial dependent of the parent. To qualify the young adult must be:

  • Unmarried
  • 29 years or under
  • Not be insured or eligible for insurance through their employer
  • Live, work or reside in New York State or the Insurance Carrier's coverage area

It can make a lot of financial sense to stay on your parent's health insurance plans since the savings afforded can be quite significant.

Individual Marketplace Insurance Companies in NY

Sixteen insurers sell individual marketplace plans on the New York State of Health Insurance Marketplace. Only MVP Health Plans and Health Republic Insurance of New York sell plans across the entire state. The other carriers only offer their plans in select regions. They also do not necessarily have to sell plans in all the counties in a region so choices within a rating area will vary from county to county. In the below table you can find the list of carriers in New York State and the respective areas they serve.

Company

Areas Served

Affinity Health Plan

  • Mid Hudson
  • New York City
  • Long Island

BlueCross BlueShield of Western NY

  • Buffalo

BlueShield of Northeastern NY

  • Albany
  • Buffalo
  • Utica / Watertown

CDCHP

  • Albany
  • Mid-Hudson
  • Syracuse

Empire HealthChoice HMO, Inc

  • Albany
  • Mid-Hudson
  • New York City
  • Utica / Watertown
  • Long Island

Excellus Health Plan

  • Albany
  • Mid-Hudson
  • Rochester
  • Syracuse
  • Utica / Watertown

Health Insurance Plan of Greater New York

  • Albany
  • Mid-Hudson
  • New York City
  • Utica / Watertown
  • Long Island

Health Republic Insurance of New York

All Areas

Healthfirst PHSP

  • New York City
  • Long Island

Independent Health

  • Buffalo

MetroPlus Health Plan

  • New York City

MVP Health Plans

All Areas

North Shore LIJ

  • New York City
  • Long Island

Oscar Insurance Corporation

  • New York City
  • Syracuse

United Healthcare of New York

  • Mid-Hudson
  • New York City

Univera

  • Buffalo

Medicaid Health Insurance Coverage in New York

New York's Medicaid program is the health coverage program designed to help New Yorkers who may not have the financial capacity to pay for medical care. As we mentioned earlier, qualifying for Medicaid is primarily a function of your income and household size. Through the state's adoption of Medicaid expansion most households with Modified Adjusted Gross Income (MAGI) under 138% of FPL are eligible for Medicaid coverage in the state.

While Medicaid is often associated with the poor, one thing most consumer should be aware of is that for most adults, the qualifications only take into account your income. For most people any assets or financial resources that you may have at your disposal are not factored into your eligibility. (Resource limits do apply for those who are blind, disabled or over the age of 65.) This means that you could own a home or have substantial savings in a bank account and still qualify for Medicaid assisted coverage as long as your monthly/annual income do not exceed the qualifying amounts.

The income limits for children and pregnant women are slightly higher than those for adults. Children in a family are eligible for Children's Medicaid if the household income is under 154% of FPL while pregnant women and infants up to the age of are eligible if the household earns less than 223% of FPL. The following table illustrates the maximum monthly income a family can have in order to qualify for the 154 and 223% thresholds.

Family Size

154% of FPL223% of FPL

1

$1,498$2,169

2

$2,019$2,924

3

$2,540$3,678

4

$3,061$4,433

5

$3,582$5,187

6

$4,103$5,942

7

$4,624$6,696

8

$5,145$7,451

How Does Medicaid Coverage Work?

In New York, if you apply for Medicaid you will be asked to select a Health Plan managed by an insurance carrier (United Healthcare, Empire BCBS etc.) These will be the same types of insurance companies that sell individual health insurance policies and small business coverage. Carriers participate in Medicaid assited health plans based upon their coverage areas, so the number of plans and companies you can choose from will depend on where you live.

The plans themselves operate similarly to individual and small business health insurance coverage. Each plan will come with a network of doctors and health care providers that accept the insurance. One thing to note is that the 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. It's important that if you have a physician that you check to make sure that they will be part of the new network.

Unlike Child Health Plus and Individual Health Insurance plans you won't be charged a monthly premium for this coverage.

Child Health Plus Coverage for Children

In New York Child Health Plus is a health care coverage program for children in households that have incomes too high to qualify for Medicaid but under 400% of the Federal Poverty Level. Like Medicaid, Child Health Plus plans are managed by the same types of insurance carriers on the individual and small business market.

Families with children that qualify for Child Health Plus pay a significantly reduced premium for covering their child. The amount a family contributes is based on the size of family and their household income. The contributions per child range from $9 to $60 monthly. For families with multiple children the maximum contribution they will have to make is 3 times the per child premium.

Child Health Plus Income Eligibility 2014

Monthly Income by Family Size

Family Contribution per Child per Month

12345

Free Insurance

$1,555$2,097$2,638$3,179$3,721

$9

$2,159$2,911$3,662$4,413$5,164

$15

$2,432$3,278$4,123$4,969$5,815

$30

$2,918$3,933$4,948$5,963$6,978

$45

$3,404$4,588$5,773$6,957$8,141

$60

$3,890$5,244$6,597$7,950$9,304

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