NY State of Health: Official Marketplace for Affordable Health Insurance Plans

NY State of Health (NYSOH)

NY State of Health (NYSOH) is New York State’s official Health Plan Marketplace. Created by the Affordable Care Act, it’s where individuals, families, and small businesses can find affordable health insurance.

Why NYSOH

Under the Affordable Care Act, every state must have an insurance exchange. States can run their own or let the federal government handle it. New York chose to run its own exchange.

Since 2013

Since October 2013, nystateofhealth has allowed customers to shop for and compare various New York health insurance plans online.

 

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)

Fidelis Care

EmblemHealth

Healthfirst

Highmark (Highmark of Northeastern NY and Highmark of Western NY)

Independent Health

MetroPlus

MVP Healthcare

Oscar Insurance Corporation

United Healthcare of New York, Inc.

Univera ( operating in Western NY)

 

Dental Companies on the Exchange

For 2025, 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

 

Frequently Asked Questions 

 

Who’s eligible for a NY Marketplace plan?

All legal permanent residents and U.S. citizens living in New York State can buy insurance through the NY Exchange.

How much do plans cost on the NY State of Health Marketplace?

It depends on your household income. You might qualify for a tax credit or subsidy to lower your premium and out-of-pocket costs. Use our quoting tool to estimate your costs.

Can I buy any other insurance through the Exchange?

Only health and dental insurance are available for purchase.

Doesn’t my employer have to offer me health benefits?

It depends on the size of your employer. Companies with at least 50 full-time employees (working 30+ hours per week) must offer health insurance. Smaller companies are not required to provide insurance.

How much will my premiums go up this year?

It depends on factors like your current insurance company, plan, and expected income if you’re receiving a subsidy or tax credit.

What’s the difference between an NY State of Health Marketplace plan and a private insurer?

Buying a policy through a private insurance company means you won’t get the premium tax credit you might be eligible for through the NY State of Health.

How much do I need to pay if I don’t want a plan?

Nothing. Since 2019, there’s no penalty for not having a plan, and this will continue through 2025.

What does the percentage of the federal poverty level mean?

It means your total annual income is compared to the federal poverty level for that year. This helps determine if you qualify 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

1)Locate the Federal poverty line based on your household Size

2)Divide your actual income by the FPL

3)Multiply that by 100

 

 Example:

1)Let’s say your 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. Divide your actual income and divide it by the FPL:

$60,000/$31,200 = 1.92

2)Multiply that by 100 to get the percentage:

100 x 1.92 = 192%

Your income is 192% of the FPL.

How does this help you?

In New York State, free health insurance and subsidized medical coverage are available for incomes between 138% and 400% of the FPL. If your income falls within this range, you may qualify for free or subsidized insurance.

 

What types of plans does NYSOH offer?

The NY exchange offers tiered “Metal” insurance plans: bronze, silver, gold, and platinum. These plans meet the minimum requirements of the Affordable Care Act. Additionally, there’s a free health insurance plan for eligible individuals.

When did the Exchange open?

In the summer of 2013, insurance companies began offering plans through the nystateofhealth. The first enrollment period opened on October 1st, 2013.

What if I already have insurance?

If you have a plan that existed before the Affordable Care Act (ACA) became law on March 23, 2010, you can keep it after the ACA provisions rolled out on January 1, 2014. This is called having your plan “grandfathered in.”

However, not all insurance companies or employers may choose to grandfather in their plans. For the best information, contact your insurance company or human resources department.

Am I going to get a tax break to help pay for my medical policy?

Maybe. If your income is between 138% and 400% of the Federal Poverty Line (FPL), you will receive tax credits paid directly to your insurer to help offset the cost of coverage. These tax credits are only available to those purchasing a plan through NYSOH and who qualify for the subsidy.

The tax credit (or subsidy) is 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 (SHOP) is a separate exchange created by the Affordable Care Act for small businesses. SHOP helps employers find affordable insurance plans for their workers and enroll them easily.

If I get a New York Medicare Plan, how does the exchange affect me?

If you receive Medicare, the exchanges won’t affect you. You’ll continue to get your health benefits without interruption.

Can I keep my doctor when picking out my new exchange plan?

Doctors are associated with insurance companies, which are linked to the Exchange. If your doctor is with an insurance company on the exchange, and you join that company, you should be able to keep seeing your doctor.

Remember, you can also keep your plan if it existed before March 23, 2010, when the Affordable Care Act was signed into law.

Many health insurance companies in NY now sell plans both on and off the exchange, targeting individuals and small businesses.

What happens if I have an NY Exchange plan, and I move out of state?

You won’t be able to keep your current plan. Here’s what you need to do:

1. Contact the NY Exchange and inform them of your move. They will stop your insurance.
2. Contact the health exchange in your new state and apply for a plan. Since moving is considered a life event, you can start a new plan on the date of your new residency without any gap in your benefits.

What does it mean to have a qualifying life event?

A qualifying life event is a significant life change that allows you to enroll or change your on-exchange policy outside of the open enrollment period. Common life events include:

• Loss of coverage (not due to non-payment)
• 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 U.S. citizen or legal permanent resident
• Becoming eligible (or ineligible) for financial help with your insurance

For all these events, you usually have 60 days to notify the NY exchange about the life change.

When is the NY State of Health Open Enrollment Period?

• For individuals without a health policy and no eligible life event: November 1, 2024, to January 31, 2025.
• For those with an existing policy through the NY Exchange: November 15, 2024, to January 31, 2025.

For both groups, the earliest start date is January 1, 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 can access the state’s Small Business Health Insurance Options Program (SHOP). This exchange is designed specifically for small businesses. Companies can shop for NY Group health insurance plans tailored to their needs. Employers can offer a choice of plans and carriers to their employees and pay only one bill directly to the SHOP Exchange for the chosen plans. New York launched the SHOP Exchange in 2013 alongside the individual exchange.

2. Tax Credit

In 2025, organizations with fewer than 25 employees paying average salaries of less than $56,000 can qualify for a tax credit if they offer benefits through the SHOP Exchange. This tax credit covers up to 35% of the cost and increased to 50% in 2014. It’s only available to companies providing coverage through the SHOP Exchange. Companies can also claim an expense deduction for the amount of premiums paid that exceed the tax credit, receiving both 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 must provide affordable coverage. 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 company fails to meet these requirements, it will pay a penalty. Grandfathered plans are not subject to this requirement.

4. Penalties

• If a company with 50 or more full-time employees offers no medical coverage, it faces an annual penalty of $2,700 times the number of full-time employees minus 30. This amount increases each year with the growth in insurance premiums.
• If a company provides a medical plan, but workers still seek coverage at the exchange, the company faces 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, the business faces 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.