NY State of Health is the #1 Place to Shop Health Insurance
What is the NY State of Health
The NY State of Health (also known as NYSOH) is the official name of the New York State Health Plan Marketplace. The marketplace was created by the Affordable Care Act and is the place where New York’s individuals, families, and small businesses can shop for affordable health insurance.
Under the Affordable Care Act, each state is required to have a health insurance exchange, either operated by the state or by the federal government as well as quasi-state/federal government-run exchanges. New York State opted to establish and operate its exchange.
Since October 2013, NY State of Health customers have been able to shop for and compare different New York health insurance plans from a variety of insurers through the online marketplace.
These health insurance plans are available right here through Vista Health Solutions for you to explore and purchase (as well as non-health insurance marketplace plans).
Health Insurance Carriers on the NYS Health Insurance Exchange
Anthem Blue Cross Blue Shield HealthPlus
Capital District Physicians Health Plan (CDPHP)
Excellus (Excellus Blue Cross Blue Shield offered in Central NY)
EmblemHealth (Health Insurance Plan of Greater New York)
Highmark (Highmark of Northeastern NY and Highmark of Western NY)
United Healthcare of New York, Inc.
Univera ( operating in Western NY)
*Starting January 2024, Highmark will be extending its services to the residents of Schoharie County.
Dental Insurance Carriers on the Exchange
For 2024, the following dental insurance companies will offer Dental Insurance Plans on the exchange.
- Delta Dental
- Anthem Health Choice Dental Blue Cross BlueShield
- Excellus Dental
- Univera Dental
- Guardian
- Solstice
*Healthplex Dental will not offer services in the NYS of Health starting January 2024.
Frequently Asked Questions
Who’s eligible for a plan?
All U.S. citizens or legal permanent residents can purchase insurance through the public health benefits exchange.
How much does the NYS Health insurance plan cost?
Health insurance plans sold through the Exchange have risen steadily since the creation of the NYSOH. Original estimates expected health insurance rates to fall. Unfortunately due to several factors, rates have increased annually. The major factors attributed to the rate increase are
- Less carrier competition in the marketplace
- a greater pool of unhealthy insured
- younger people not signing up for insurance as anticipated
- Congress removing promised risk optimization funding to insureds
Can I buy any other insurance through the Marketplace?
Health insurance and dental insurance are available for purchase.
Doesn’t my employer have to offer me health insurance?
That depends on the size of your employer. Companies employing at least 50 full-time workers, working a minimum of 30 hours per week, are required to offer a health insurance option to their employees.
Companies employing less than 50 full-time workers are exempt from the employer mandate and can choose not to offer their employees health insurance without penalties.
How much are my premiums going to go up this year?
That entirely depends on several factors such as what company you are currently insured with, what health plan you have, and what your expected income is if you’re currently receiving a subsidy
What’s the difference between an exchange plan and going through a private insurer?
When going through a private insurance company, individuals will not receive the possible premium tax credit they might have received had they gone through the exchange. Also, plans previously sold through private insurance companies can be grandfathered in.
How much do I need to pay if I don’t want health insurance?
Under the Affordable Care Act, everyone is mandated to have health insurance coverage.
Since 2019, the ACA’s federal individual mandate penalty has been $0 and that will continue to be the case in 2021. Uninsured people will not face a penalty unless they’re in a state that has its mandate and penalty for non-compliance. However, in 2014 the fee for not having coverage was $95 for an individual or 1% of income, whichever was higher. In 2015 that penalty went up to $325 or 2% of income. Then, in 2016 the penalty increased to $695 or 2.5% of income. From 2017 to 2018, the increase in penalty was tied to an annual cost of living adjustment and based on inflation.
What does the percentage of the federal poverty line mean?
It means your annual total income is measured against that year’s definition of the federal poverty level. This number is used when calculating your premium tax credit.
See where you stand using our health care reform calculators.
How do I calculate my income vs. the percentage of the federal poverty line?
We recommend calculating your income vs the federal poverty
What types of plans does the exchange offer?
The exchange offers insurance plans at four different levels that at least meet the minimum requirements for insurance plans sold under the Affordable Care Act. Those tiered insurance plans are broken down into “Metals”; bronze, silver, gold, and platinum-level insurance plans. The plans are further broken into Healthy NY, HCTC Healthy NY, or Non-Group/Individual HMO/PSO.
When did the marketplace open?
In the summer of 2013, insurance companies began unveiling their plans and offering plans to customers through NYSOH. However, it was on October 1st, 2013 that the first enrollment period opened.
What is Medicaid?
Medicaid is a federally subsidized health insurance program for low-income and disabled individuals who are not insured through their spouse or employer and cannot afford to purchase health insurance.
Each state runs its own Medicaid program, and the eligibility requirements differ from state to state. There is usually a minimum threshold of age and/or income.
What if I already have insurance?
If you are enrolled in a health insurance plan that existed before the Affordable Care Act became law on March 23, 2010, then you can choose to keep that same plan after the rollout of the majority of the ACA provisions on Jan. 1, 2014.
This is called having your insurance plan, “grandfathered in”.
However, not all insurance companies or businesses may choose to grandfather in their plans. For the best information contact your insurance company or your human resource department.
How does this affect my Healthy NY plan?
On January 1st, 2014, Healthy NY ceased to provide care for individuals and solos, but rather only pursued small businesses. Its benefits will match the benefits of a Gold plan which could bring up the price.
Those individuals who were enrolled in a Healthy NY plan on March 23, 2010, when the Affordable Care Act was signed into law are eligible for grandfathered status. Individuals and sole proprietors not eligible for grandfathered status will be moved over to the exchange.
The equivalent health insurance coverage to the Healthy NY plans will be plans sold at the gold level.
Am I going to get a tax break to help pay for my health insurance?
Maybe. If your income falls between 138% and 400% of the Federal Poverty Line (FPL) you will receive credit paid directly to your insurer to help offset the cost of health insurance. It should also be added that these tax credits will only be available to those purchasing health insurance through the health care exchange and those who qualify for the subsidy.
The credit will be set up on a sliding scale so the lower your income the bigger your tax credit.
What is the SHOP Exchange?
The Small Business Health Options Program, or SHOP, is a separate health insurance exchange created as part of the Affordable Care Act exclusively for small businesses. The SHOP exchanges help employers search for affordable insurance plans for their workers and then easily enroll them.
If I get Medicare, how does the exchange affect me?
If you receive Medicare, the exchanges should not affect you at all. You will continue to get your health benefits uninterrupted.
Can I keep my doctor when picking out my new exchange plan?
Doctors are associated with health insurance companies, which are in turn, associated with the marketplace. If a doctor belongs to an insurance company operating on the exchange, and a person joins that insurance company, then they should be able to see that same doctor.
Don’t forget, that you also have the option of grandfathering in your plan if the plan existed before March 23, 2010, when the Affordable Care Act was signed into law.
Many of the health insurance companies in NY are now selling plans both on and off the exchange, marketing to both individuals and small businesses
Individuals: What you need to know about the Affordable Care Act
1. The Employer Mandate
If your business employs at least 50 full-time workers then you are subject to the employer mandate, that is, to provide your workers with health insurance. This plan is called The Employer Shared Responsibility Payment.
Originally the plan was to implement the employer mandate at the same time as the individual mandate. However, in early July 2013, the Obama Administration opted to delay the employer mandate for a year.
According to numbers from the White House, many small businesses have already provided their workers with some form of health insurance. It may also be worth noting that the vast majority of small businesses in the United States employ fewer than 50 full-time workers, and will thus not be subject to the Affordable Care Act’s employer mandate.
If your business does fall into the mandate range, and you do not offer your workers health insurance, you will be subject to a penalty. According to the Congress Research Services, the penalty is, the “Number of full-time employees minus thirty multiplied by 2,000.”
2. SHOP Exchange
New York small businesses with 100 or fewer employees will have access to the state’s Small Business Health Insurance Options Program (SHOP), a health insurance exchange created just for small businesses.
There, businesses can shop for health insurance plans, tailored specifically to their needs. Business owners can then offer a choice of plans and carriers to their employees and pay only one bill directly to the SHOP Exchange for the plans chosen.
in 2014, the federal government announced that it would delay opening the SHOP Exchanges through the marketplace. By 2015, those with 50 or fewer employees had access to SHOP plans, and by 2016, employers with a team of 100 or fewer could use SHOP.
New York is one of the states that operated its own health benefit exchange and launched the SHOP Exchange in 2013 alongside the individual exchange.
3. Tax Credit
Businesses with fewer than 25 employees paying average salaries of less than $56,000 who choose to offer their workers health insurance through the SHOP Exchange will qualify for a tax credit. This tax credit is already in place for small businesses, currently, it covers up to 35% of the cost of health insurance.
In 2014, that number increased to cover up to 50% of costs. However, it’s only available to businesses that provide their employees coverage through the SHOP Exchange.
Businesses can claim a business expense deduction for the amount of the premiums paid that exceed the tax credit. That means those businesses will receive a tax credit and a tax deduction.
4. Affordability is not an option
In New York State, businesses with 50 or more full-time employees are required to provide affordable health insurance. That means the insurance plan must cover at least 60% of medical expenses, and not cost an employee more than 9.83% of their annual income. If a business fails to meet those requirements, it will pay a penalty.
Grandfathered plans are not subject to the affordability requirement.
5. Penalties
If a business of 50 or more full-time employees offers no health insurance then the employer faces an annual penalty of $2,700 times the number of full-time employees minus 30. That amount is scheduled to increase each year with the growth in insurance premiums.
If a business does provide health insurance, but workers still choose to seek coverage at the exchange then the company will face a penalty of $3,860 per worker that goes to the exchange. This number is also pegged to the growth in insurance premiums each year.
If an employer’s plan is unaffordable and/or does not provide minimum value, then the business will face a penalty of $4,060 per worker that goes to the exchange. This number is also pegged to the growth in insurance premiums each year.
Updates for 2024
COVID-19 Public Health Emergency Extension
Due to the COVID-19 Public Health Emergency, the Marketplace extended coverage for individuals under public programs like Medicaid, Essential Plan, and Child Health Plus by an extra 12 months. However, through the Consolidated Appropriations Act of 2023, Congress concluded the PHE continuous enrollment mandate on March 31, 2023. Residents with Medicaid and Essential Plan coverage are required to renew this coming March 2024.
Enhanced Subsidies
Enhanced Tax Credits for Qualified Health Plan coverage will be extended until 2025, and the Marketplace will stay accessible until May 2024 during the “PHE unwind” renewal process. This allows consumers to enroll in a Qualified Health Plan or the NY Essential Plan if they are no longer eligible for Medicaid.