NY State of Health: Official Marketplace for Affordable Health Insurance Plans
What is the NY State of Health
NY State of Health (NYSOH) is the official Health Plan Marketplace of New York State. The exchange 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 an insurance exchange, either operated by the state or by the federal government as well as quasi-state/federal government-run exchanges. NY State opted to establish and operate its own 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.
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)
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 Companies 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 NY Marketplace plan?
All legal permanent residents and U.S. citizens residing in New York State are eligible to purchase insurance through the NY Exchange.
How much do plans cost on the NY State of Health Marketplace?
It depends on your household income, as you may be eligible for a tax credit or subsidy which can substantially reduce your premium and out-of-pocket costs. The easiest way to estimate what you can expect to pay is by using our quoting tool above.
Can I buy any other insurance through the Exchange?
Health and dental insurance are the only available insurance options for purchase.
Doesn’t my employer have to offer me health benefits?
That depends on the size of your employer. Companies that have at least 50 full-time employees, working a minimum of 30 hours per week, are required to offer a health option to their employees.
Companies employing less than 50 full-time workers are not required to offer their employees insurance.
How much are my premiums going to go up this year?
That depends on several factors such as what company you’re currently insured with, what plan you have, and what your expected income is if you’re currently receiving a subsidy or tax credit.
What’s the difference between an NY State of health Marketplace plan and going through a private insurer?
An individual purchasing a healthcare policy through a private insurance company will not receive the possible premium tax credit they may be entitled to, if they had gone through the NY state of health.
How much do I need to pay if I don’t want a plan?
Nothing. Since 2019, the penalty for not having a plan has been removed and that will continue to be the case throughout 2025.
What does the percentage of the federal poverty level mean?
It means your total annual income is measured against that year’s definition of the federal poverty level. This number is used to figure out if you meet the criteria for a premium tax credit or subsidy.
See where you stand using our health care reform calculators.
How do I calculate my income as a percentage of the federal poverty line?
To calculate your income as a percentage of the federal poverty line (FPL) for New York State in 2025, please use the following chart.
New York State Poverty Guidelines for 2025
Persons in household Poverty guideline
1 $15,060
2 $20,440
3 $25,820
4 $31,200
5 $36,580
6 $41,960
7 $47,340
8 $52,720
For families/households with more than 8 persons, add $5,380 for each additional person.
1)Locate the Federal poverty line based on your household Size
2)Divide your actual income by the FPL
3)Multiply that by 100
Here is an example:
1)Let’s say you’re actual annual household income is $60,000 and you have 4 people in your household. based on the chart above, the FPL for four people is $31,200. Take your actual income and divide it by the FPL $60,000/$31,200 = 1.92
2)Multiply that by 100 and you get 100 x 1.92 = 192%
Your income is 192% of the FPL.
So how does that information help you? Well, we know that in NY State, Free health insurance and subsidized medical coverage is based on incomes of 138% to 400% of the FPL. So, if your income falls within that level, you probably will be approved for free or subsidized insurance.
What types of plans does NYSOH offer?
The NY exchange offers Tiered “Metal” insurance plans broken down into bronze, silver, gold, and platinum, that meet the minimum requirements for insurance plans sold under the Affordable Care Act. Additionally, the exchange has a free health insurance plan for eligible individuals
When did the Exchange open?
In the summer of 2013, insurance companies began offering plans to customers through NYSOH. However, it was on October 1st, 2013, that the first enrollment period opened.
What if I already have insurance?
If you are enrolled in a 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 firms may choose to grandfather in their plans. For the best information contact your insurance company or your human resource department.
Am I going to get a tax break to help pay for my medical policy?
Maybe. If your income falls between 138% and 400% of the Federal Poverty Line (FPL) you will receive tax credits that are paid directly to your insurer, to help offset the cost of the coverage. It should also be noted that these tax credits will only be available to those purchasing a plan through the NYSOH, and those who qualify for the subsidy.
The tax credit (or subsidy) will be set up on a sliding scale so the lower your income the bigger your tax credit.
What is the NY SHOP Exchange?
The Small Business Health Options Program, or SHOP, is a separate 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 a New York Medicare Plan, 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 insurance companies, which are in turn, associated with the Exchange. 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
What happens if I have an NY Exchange plan, and I move out of state?
You will not be able to continue your current plan, and here are the steps you need to take. Contact the NY Exchange and inform them of the move, they will stop your insurance. Contact your new resident state health exchange and apply for a plan. Since a move is considered an acceptable life event, you can start a new plan on the date of your new residency without having a gap in your benefits
What does it mean to have a qualifying life event?
A qualifying life event is when you have a significant life-changing event that allows you to Enroll or change your on-exchange policy outside of the allowable enrollment period known as open enrollment. The most common life events are:
A loss of coverage, though not as a result of not paying your monthly premium
Moving permanently to or from New York State
Marriage or domestic partnership
Legal separation or divorce
Becoming pregnant
Having a baby, adopting or placing a child into foster care
Becoming a United States Citizen or a legal permanent resident
Becoming eligible (or ineligible) for financial help in paying for your insurance
With all of the above examples, you normally have 60 days to notify the NY exchange regarding the life-changing event.
When is the NY State of Health Open Enrollment Period?
Open enrollment for individuals without a health policy and no eligible life event starts on November 1st, 2024, and ends on January 31st, 2025. For those with an existing policy through the NY Exchange, open enrollment begins on November 15th and also ends on January 31st, 2025. For both those with and without health plans, the earliest start date is Jan 1st, 2025.
Small Businesses: What you need to know about the Affordable Care Act
1. 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), an exchange created just for small businesses.
There, companies can shop for NY Group health insurance plans, tailored specifically to their needs. Company 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.
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.
2. Tax Credit
In 2024, organizations with fewer than 25 employees paying average salaries of less than $56,000 who choose to offer their workers’ benefits through the SHOP Exchange will qualify for a tax credit. This tax credit is already in place for small companies, currently, it covers up to 35% of the cost.
In 2014, that number increased to cover up to 50% of costs. However, it’s only available to companies that provide their employees coverage through the SHOP Exchange.
Companies can claim an expense deduction for the amount of the premiums paid that exceed the tax credit. That means those firms will receive a tax credit and a tax deduction.
3. Affordability is not an option
In New York State, companies with 50 or more full-time employees are required to provide affordable coverage. 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 an entity fails to meet those requirements, it will pay a penalty.
Grandfathered plans are not subject to the affordability requirement.
4. Penalties
If a company of 50 or more full-time employees offers no medical coverage, 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 company does provide a medical plan, 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 2025
ALL METAL PLANS have reduced their cost sharing for the following services:
Diabetes care for most services now has a $0 copay.
Pregnancy and postpartum care now have a $0 out-of-pocket when applied to the following:
Services during pregnancy and up to one year after giving birth, except for hospital services. It includes prescription drugs, mental health and substance use benefits, lab and x-ray services, prenatal testing, doctor’s visits, and some specialist visits. Specialist visits can treat conditions like hypertension, asthma, and urinary tract infections.
It does not apply to the following:
Ambulance services, inpatient services, emergency hospital care, or delivery services by a physician, nurse, or midwife
SILVER PLANS – Starting January 1, if your income is between 250% and 400% of the Federal Poverty Level (FPL), you will be eligible for additional cost-sharing savings. These savings are substantial, and if you’re earning up to 350% of FPL, this can potentially save you an average of $3,500 annually on out-of-pocket costs.
The Cost-Sharing Reduction (CSR) benefit reduces out-of-pocket expenses, co-pays, deductibles, and the maximum out-of-pocket limit when receiving healthcare services. However, these savings are only available if you’re enrolled in a Silver plan. You will not receive these savings if you enroll in any other metal level plan besides Silver.
The following table highlights the cost savings when using the Silver Supreme and the Silver Enhanced vs, a standard Bronze plan
| Cost Sharing for Health Care Services | Silver Supreme | Silver Enhanced | Bronze |
|---|---|---|---|
| Annual Deductible | $350 | $1,855 | $3,800 |
| Preventive Care | Free | Free | Free |
| Primary Care Physician Visit | $15 | $30 | $50 |
| Specialist Visit | $35 | $65 | $75 |
| Inpatient Hospital Stay per admission | $250 | $1,500 | $1,500 |
| Mental health/Substance use Outpatient Visit | $15 | $30 | $50 |
| Mental Health and Substance Use Inpatient Visit per admission | $250 | $1,500 | $1,500 |
| Emergency Room | $75 | $275 | $500 |
| Urgent Care | $50 | $70 | $75 |
| Physical Therapy, Speech Therapy, Occupational Therapy | $25 | $30 | $50 |
Please use the following Silver CSR Reduction Chart for complete details.
Updates for 2024
COVID-19 Public Health Emergency Extension
Because of the COVID-19 Public Health Emergency, NYSOH extended benefits for Medicaid, Essential Plan, and Child Health Plus by 12 months. However, Congress ended this extension on March 31, 2023, which required Residents with Medicaid and Essential Plan to renew by March 2024.
Enhanced Subsidies
Enhanced Tax Credits for Qualified Plans will be extended until 2025, and the NYSOH will stay accessible until May 2024 during the “PHE unwind” renewal process. This allows consumers to enroll in a Qualified Plan or the NY Essential Plan if they are no longer eligible for Medicaid.