Health Insurance Options for New Yorkers

Having health insurance is essential for protecting yourself and your family from high medical costs. New York offers several options for obtaining health coverage, whether you're self-employed, between jobs, or looking for alternatives to employer coverage.

NY State of Health Marketplace

NY State of Health is New York's official health plan marketplace. It's the only place where you can qualify for financial assistance to lower your monthly premiums and out-of-pocket costs based on your income.

• Open Enrollment: November 1 through January 31 each year
• Special Enrollment: Available if you have a qualifying life event (job loss, marriage, birth of child, moving)
• Financial Assistance: Tax credits and subsidies may be available based on household income

Types of Health Insurance Plans

HMO (Health Maintenance Organization)

HMO plans require you to choose a primary care physician and get referrals to see specialists. You typically must use providers within the plan's network. HMOs often have lower premiums and predictable copays.

PPO (Preferred Provider Organization)

PPO plans offer more flexibility in choosing healthcare providers. You can see specialists without referrals and use out-of-network providers (at a higher cost). PPOs typically have higher premiums but more choice.

EPO (Exclusive Provider Organization)

EPO plans combine features of HMOs and PPOs. You don't need referrals for specialists, but you must stay within the network except for emergencies.

HDHP (High Deductible Health Plan)

HDHPs have lower premiums but higher deductibles. They can be paired with a Health Savings Account (HSA) that lets you save pre-tax money for medical expenses. Good for healthy individuals who want lower monthly costs.

Understanding Plan Metal Tiers

Marketplace plans are categorized by metal tiers that indicate how costs are shared:

• Bronze: Lowest premiums, highest out-of-pocket costs. Plan pays about 60% of costs.
• Silver: Moderate premiums and costs. Plan pays about 70% of costs. Eligible for extra savings.
• Gold: Higher premiums, lower out-of-pocket costs. Plan pays about 80% of costs.
• Platinum: Highest premiums, lowest out-of-pocket costs. Plan pays about 90% of costs.

Other Coverage Options

• Employer Coverage: If available, often the most cost-effective option
• COBRA: Continue employer coverage temporarily after leaving a job (expensive but no gap in coverage)
• Medicaid: Free or low-cost coverage for eligible low-income individuals and families
• Child Health Plus: Free or low-cost coverage for children under 19 in NY

Get Help Finding Coverage

Navigating health insurance options can be confusing. The Steele Agency can help you understand your options and find a health insurance plan that fits your needs and budget. Contact us for assistance with your health insurance questions.