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New York Health Insurance

new york health insurance

The Affordable Care Act made several major changes to the way health insurance is handled in New York. This law requires all residents to carry health insurance or risk facing a tax penalty. Many aspects of the new law, such as an insurance company’s inability to deny coverage based on pre-existing conditions, began before 2014, but the individual mandate for health insurance was implemented in 2014. 

Coinciding with this insurance mandate was the creation of NY State of Health, the state-run insurance exchange where New York residents can shop for and purchase health insurance policies.

To soften the financial blow of the insurance mandate, 27 states plus Washington, D.C., have expanded Medicaid coverage. New York is one of those states. Now, adults with monthly income of less than $1,273 can qualify for Medicaid coverage. 

As of June 2014, more than 1.3 million people completed applications for health insurance through NY State of Health.

New York health insurance exchange

As part of the Affordable Care Act, each state either established its own health care exchange, partnered with the government to create one, or allowed a federally run exchange. New York’s exchange is not an insurance company in its own right. Instead, it provides a convenient way to shop by comparing multiple insurance providers. 

In order to comply with the ACA, insurance companies participating in the exchange must provide plans that meet certain criteria, such as offering prescription coverage and setting out-of-pocket cost limits.

Policies are divided into tiers – bronze, silver, gold and platinum – depending on the amount the policyholder must pay out of pocket. The gold and platinum policies cost more per month but have lower out-of-pocket costs. 

To participate, after making an account with the exchange, you will be prompted to answer a few questions about your income and family size.

You’ll then be provided a list of ACA-approved plans, and you’ll choose the one that suits your budget. If you qualify for a health insurance subsidy, it will be applied to the premiums for the plan you choose. 

Do I qualify for a New York health insurance subsidy?

Financial assistance is available to some policyholders to help cover the costs of health insurance in New York. To qualify, you must have an income between 100 and 400 percent of the federal poverty level.

This equates to income between $11,490 and $45,960 for an individual and between $23,550 and $94,200 for a family of four. Applicants with a lower income will receive a higher subsidy. Subsidies typically are based on 2013 federal poverty level limits, and Medicaid and CHIP qualification is typically based on 2014 limits.

This subsidy is only available to people purchasing polices through the exchange, not to individuals who obtain health insurance through other sources.

Low-income health care solutions for New Yorkers

For low-income families in New York, Medicaid offers an affordable health care alternative to standard insurance. Medicaid provides coverage for most standard medical procedures, and policyholders will be charged affordable copayments. Through the exchange, families with young children can also enroll in Child Health Plus, a health insurance plan specifically for children in low-income households. 

Health insurance companies participating in NY State of Health

  • Empire Blue Cross Blue Shield (Wellpoint)
  • Health Republic Insurance of New York
  • Fidelis Care
  • EmblemHealth
  • MetroPlus Health Plan
  • MVP Health Plan

New York health and coverage statistics

New York population (2013): 19,651,127
Population 65 and older (2012): 14.1 percent
Life expectancy (2010): 80.5 years
Number of Medicaid beneficiaries (2012): 4,453,900
Number of Medicare beneficiaries (2012): 2,368,800
Estimated number of uninsured residents (2012): 2,270,000

Overall state health ranking: 15

Sources: Kaiser Family Foundation, U.S. Census Bureau, America’s Health Rankings 2014 report. 

New York health insurance resources

New York State Department of Health:

New York State of Health:

New York Medicaid:

Child Health Plus:

New York State Office for the Aging:

Kaiser Family Foundation:

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