How To Qualify For Healthy NY If You Are Self-Employed

Beginning January 1, 2014, Healthy NY has become a program that is only available to New York small businesses.  For alternative self-employed options, you may want to consider a PPO health insurance plan

In the year 2000, the New York State Legislature enacted a program under the Health Care Reform Act of 2000, known as Healthy NY. The main objective behind the Healthy New York Medical Insurance program was to promote access to quality health care by providing comprehensive health insurance to the citizens of New York who needed health insurance the most. The motive behind the creation of Healthy NY was the staggering number of small businesses that couldn’t afford to provide health insurance benefits to their employees.

What makes Healthy NY a viable option is that it’s not a state-run health insurance plan but rather a program mandated by the state of NY in which every Health insurance company must participate. The original intention of the program was to be able to offer it to small businesses that had between 2-49 employees without current health insurance. The obstacle was that the state of New York would not subsidize the actual cost of health insurance. Without a subsidy to work with the only viable option to make it affordable was to remove health care mandates (mandatory coverages) that are built into the community-rated health insurance plans (see the article Factors that affect health insurance rate increases). Without the mandate in place, the Healthy NY program is 35% to 40% less expensive than the average health insurance plan being offered to small businesses (based on the based on the plan design). To avoid confusion and streamline the program, Insurance companies can only offer two plan options. Both plans are identical except for the most expensive option including prescription drug coverage. For a complete listing of benefits please visit www.nyhealthinsurer.com

After the legislature enacted the Healthy NY program and applied it to small businesses, it then made it available to the self-employed and individuals. The same streamlined plans & rates apply to small businesses as well apply to the self-employed. However, qualifying for Healthy NY as self-employed has different requirements. In order to be eligible for the Healthy NY self-employed program you must meet the following criteria:

1. You must live in New York State
2. You must be currently self-employed (or your spouse)
3. You have not had health insurance in effect for the past 12 months or have lost your coverage due to one of the events listed below
   1. loss of employment
   2. death of a family member
   3. change to a new employer
   4. change of residence
   5. discontinuation of a group health plan
   6. termination or cancellation of COBRA coverage
   7. legal separation, divorce or annulment
   8. loss of eligibility for group health insurance coverage
   9. reaching the maximum age for dependent coverage
4. You cannot be eligible for Medicare
5. Your current gross household income meets the income guidelines of the program (listed on your 2005 1040tax form line 37 adjusted gross income)

*When calculating family size include the number of family members in your household and whether they will be included in the Healthy NY policy or not.

Once you determine that you may qualify for Healthy NY, an application needs to be submitted. You should include your most recent 1040 tax form & schedule C. A copy recent utility bill (used to verify your address) or a copy of your driver’s license. For more information or where to get enrollment material please visit www.nyhealthinsurer.com.