Other Ways To Get Health Insurance In New York
Most New Yorkers who arent eligible for Medicare or Medicaid get health insurance through their employer. Employer-sponsored health insurance is usually the most affordable health insurance option, too.
However, besides an employer or the ACA marketplace, there are other ways to get health insurance coverage
- An individual health plan outside of the ACA marketplace. These plans provide additional options to ones found on the marketplace, but they arent eligible for subsidies. If you qualify for subsidies, you may stay with an ACA marketplace plan.
- Catastrophic health insurance is available to people under 30 and those eligible for a hardship exemption. Catastrophic health plans have low premiums and provide similar coverage found in a standard health plan. However, these plans also have high out-of-pocket costs. Catastrophic plans can have individual deductibles up to $8,550 in New York. Members have to pay that amount out of pocket for health care before the plan begins kicking in money to help pay for health care services. The plan picks up all costs once you reach that level. Find out more about catastrophic health plans in New York.
Still not sure about health insurance eligibility? Check out Insurance.coms Health Plan Findertool to explore your health insurance eligibility.
What Types Of Plans Does The Ny State Of Health 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.
Best For Medicare Advantage: Aetna
Aetna
An impressive 36 Aetna Medicare Advantage plans sold in 30 states, plus the District of Columbia, received top NCQA ratings in 2021, with Connecticut and Maine being standouts. In 2020, Aetna Medicare Advantage Prescription Drug plans were made available in 264 new counties across the country, providing millions more Medicare beneficiaries access to an Aetna plan.
The insurer also sells Medicare supplement plans in all 50 states. In addition to these, they also offer a combination dental, vision, and hearing supplemental Medicare product in many states.
In the private arena, Aetna is a large provider of employer-based health insurance. A total of five Aetna plans serving Iowa, Pennsylvania, Wisconsin, and Rhode Island made the top NCQA ranks in 2021, and the 2021 J.D. Power U.S. Commercial Health Plan Study ranked Aetna plans second-highest in Ohio, Maryland, and Virginia. In addition, Aetna’s pricing seems to be lower than many competitors’ pricing.
In November 2018, Aetna became part of CVS Health Company, and synergies between the two are beginning to emerge. For example, Aetna medical plan subscribers with high blood pressure can get a free home monitor at CVS. Chronic disease monitoring may also be available at CVS stores.
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Aetna Group Health Plans
The company does not offer any Platinum plans in New York. Only Gold, Silver and Bronze. Their group health plans include PPO plans, EPO Exclusive Provider Organization) plans, HSA and now their new Aetna Saving Plus plans. Savings Plus plans will have reduced rates and are designed to compete directly with the Oxford Metro plan. All Aetna plans are available everywhere in New York State.
Aetna Open Choice PPO Plan:
Employees can visit any provider, in network or out-of-network, without a referral. But when they stay in network, claims are handled at the lower, contracted rates.
Aetna Open Choice POS 2 Plan:
This plan allows employees to visit any doctor, hospital or facility, in or out of network, with no referrals. But depending on their plan, if they choose a primary care physician and stay in network health care costs will be less.
Aetna Managed Choice Plan:
These plans are a type of health insurance that have contracts with health care providers and medical facilities to provide care for members at reduced costs. Members can select a network PCP to guide their care. Or they can go out of network for a higher cost.
Aetna Open Access Managed Choice Plan:
This plan takes some of the managed out of managed care, while keeping the savings. Members can visit any provider. And while employees are not required to choose a PCP, savings are offered by staying in network.
New York Health Insurance Guide And Resources
In the state of New York, there are 3 main types of health insurance providers:
- Health insurance provided by your employer
- Private health insurance in NY for individuals and families
- Government-assisted health insurance
According to recent statistics, only5% of the population in New York is uninsured. In fact, in a study conducted by US News, it was found that the state of Oregon has the15th best health insurance in the USA. The 3 different types of NY health insurance providers and their numerous health insurance plans ensure that everyone in NY has access to affordable healthcare.
1. Employer-Provided Health Insurance in New York
Nearly half of all residents in New York have employer-provided health insurance, which covers the medical expenses of the employees and their families. This gives them all the basic benefits of a health insurance plan. These include coverage for:
- Emergency service
- Maternity care, delivery, and childcare
- Healthcare for children
2. Private Health Insurance Providers in New York
However, you must keep in mind that most private health insurance providers open their round of applications in the fall. You can apply for the open enrollment between November 1st and December 15th. This is to ensure that as the new year begins, you and your family have insurance from the first day of the year. But due to Covid-19 last year, the deadline for applications was extended until January 31st, 2021.
3. Government Assisted Health Insurance in New York
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Allowing Dependent Coverage Through Age 29
Under the Affordable Care Act, young adults can be covered under their parents’ health insurance plans up to the age of 27. Because of the way insurance is priced in New York, it is preferable for young adults to stay on their parents’ plans until the legal age limit since the additional cost for a dependent is cheaper.
New York also allows health insurance companies to offer an age 29 coverage option. Parents pay a little more for their health insurance in exchange for having their children stay on the family plan until the age of 29.
For example, say your young adult child has passed the age of 27 but does not have a job or sustainable income to pay for their own insurance. In this case, you could pay a small extra premium along with your normal health insurance rate that would allow your coverage to support your son or daughter. To qualify, the young adult must:
- Be unmarried
- Not be insured or eligible for insurance through their employer
- Live, work or reside in New York state or the insurance carrier’s coverage area
Medical Cost Sharing Plans
Medical sharing plans are typically religious-affiliated non-insurance alternatives that pool monthly contributions from thousands of members and payout for medical claims.
Though medical sharing plans are relatively cheaper than insurance plans, they have strict coverage benefits that sometimes exclude pre-existing conditions and diagnoses like cancer and autoimmune diseases.
Instead of paying for your care up front, most sharing plans require you to pay out-of-pocket and submit the claims to the reimbursed.
Alice Stevens, Senior Editor at Best Company, says, â don’t offer the same kind of coverage that Affordable Care Act plans do they can cover more things than some other plan options do. Keep in mind that health care sharing ministries aren’t the same as insurance, expect members to keep a low-risk lifestyle, and are typically associated with religious groups. Before joining, make sure you understand what’s covered.â
Individual monthly premium: $150-$300
- May not cover existing conditions and benefits are not clear what’s covered what’s not.
- Members have to bear the cost upfront and submit claims to be reimbursed
- Reimbursement can take up to 90 days
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How Do I Get Health Insurance
Health insurance gives you better access to medical services, can improve your health, and protects you from paying high out of pocket costs if you get sick. New York State has a health insurance marketplace where you can shop for both public and private health plans called the NY State of Health, or NYSOH. You also have the option to purchase off-marketplace plans offered by various insurance companies. These plans are all subject to the Affordable Care Act rules of minimum essential coverage and other ACA protections. Some important things to consider when choosing a plan are your eligibility, the services and benefits offered by the plan, and the cost of the plan.
Below is a list of health insurance programs offered in New York State. Click on the program to find out more information about your health plan options. If you need assistance choosing a health plan that works best for you, please contact CHA at 888-614-5400.
How To Apply For Medicaid In New York
In the state of New York, Medicaid applicants are separated into 2 different groups: MAGI and non-MAGI applicants. The Medicaid application process is different depending on which group you fall into.
â Pregnant women,
â Children under the age of 19,
â Relatives of parents or caregivers
â Childless adults between the ages of 19 and 64 who are not pregnant and who do not have and do not qualify for Medicare, but who have a certifiable disability,
â Women who are receiving fertility treatments,
â FPBP beneficiaries.
Medicaid applicants who fall under the MAGI applicant category must apply through the New York State Department of Health Marketplace.
Non-MAGI applicants include people in the following groups:
â Medicaid Cancer Treatment Program
â AIDS Health Insurance Program
â Medicaid Savings Program
â Social Security Income recipients
â ADC-related medical needy individuals
â COBRA
â People age 65+ who are not relatives of parents or caregivers
â People who are blind or disabled, but who do not fall into any of the MAGI applicant categories
â Medicaid Buy-In for People with Disabilities
â Residents of Adult Home by LDSS, OMH Residential Care Centers/Community Residences
For non-MAGI applicants, itâs necessary to apply through your local Department of Social Services.
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Humana: Best Health Insurance Company For Seniors
Humana is ranked the fifth largest health insurance provider in the United States, which means that it has a reassuring amount of financial capital behind it. The policies are relatively affordable, though this one only really applies to their HMO plans. But if youre happy with that and dont mind a specific range of pharmacy options, Humana health insurance is well worth considering.
Humanas policies for more elderly customers are especially attractive, as many of their competitors hike up their prices substantially for older customers. The fact that Humana doesnt makes it our top pick for seniors.
New Yorks Medicaid Cancer Treatment Program
New Yorks MCTP services are available to low-income residents with breast, cervical, colorectal, or prostate cancer. Generally, residents must be under 65, meet citizenship requirements, and not be enrolled in qualified coverage at the time of application. The states Department of Health Cancer Services Program oversees the application process.
Income limits vary. For example, the threshold for colorectal and prostate cancer is 250% of the FPL or up to $32,200 for a single adult in 2020.12
Those who qualify get full Medicaid coverage for a specific amount of time tied to the type of cancer. Enrollees must recertify each year if treatment is still needed.
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Types Of Health Coverage
There are multiple types of health insurance plans. Understanding the difference between each plan type can help you select the best provider depending on your needs. Lets take a look at 4 of the most common types of health insurance plans.
Keep in mind that not every health insurance provider offers every type of plan. Some providers only offer 1 plan type, while others offer all 4. Make sure you consult with your plan provider and understand the plans structure before you lock yourself into health insurance.
What About New Federal Assistance For Premiums
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
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Kaiser Permanente: Best Health Insurance Company For Customer Service
Reasons to avoid
Kaiser Permanente stacks up well against its peers, with relatively low premiums easy quotation process, straightforward websites and a well-liked mobile app. The lack of nationwide coverage could be a drawback for some people, even if they live within the coverage area and Kaiser Permanente is definitely one of the more localized health insurance providers.
However, it performs well and has a consistently high level of customer satisfaction, and it is well worth considering for potential customers in those regions and states where it is operational. Kaiser Permanente scored the highest ratings possible in customer satisfaction during the 2017 Health Insurance Plan Study run by JD Power and Associates. Kaiser ranked the highest in six regions, Maryland, South Atlantic, California, Virginia, Northwest and Colorado.
To find out more, why not read our how to choose a health insurance plan guide or take a look at our guide to the best life insurance options.
Get A Health Insurance Quote In New York Ny Today
Health coverage is essential for everyone and every family, giving everyone access to the medical attention, checkups, and coverage they need. Many different factors help determine the rates and coverage of a health insurance plan, but MyRatePlan lets everyone easily and quickly get a quote regarding the best health coverage available in the New York, NY area. Individuals can find this out simply by typing in their ZIP code.
When looking to save money, it’s often tempting to sacrifice large parts of a coverage plan, cutting out parts of the coverage that seem unnecessary. However, this isn’t always the best decision, as everyone should always try to anticipate their future needs. For example, if someone plans on having children, she should make sure to include a maternity package now, rather than waiting to find coverage later. No one should eliminate necessary coverage in order to save money. While many insurance programs can cost a heavy financial burden, the price of out of pocket expense is even greater. Instead, MyRatePlan offers to save individuals money by matching them to the best healthcare coverage plans in the New York, NY area, saving them tons of money, and giving them a free online quote instantly.
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Tips To Save On Health Insurance In New York
There are several factors that affect the cost of your NY health insurance premium. The best private health insurance in NY will decide your monthly premiums based on these compulsory factors:
Your body mass index : Obese and underweight people will have higher premiums
- Tobacco use: If you are habitual to smoking, your premiums will be higher
- Age: Older people and senior citizens will have higher premiums
- Location: People who live in dangerous cities and town have higher premiums
- Cost-sharing reductions: If you qualify for this discount, your premium will be lower
- Applying as a family or individually: Family plans have lower premiums as compared to individual plans
- Pre-existing conditions: People who have pre-existing medical conditions have higher premiums.
- Gender: Women pay a higher premium on their health insurance plans as compared to men
- Insurance and medical history: If your insurance and medical history are satisfactory, you will pay a lower premium.
You can check the best health insurance in NY through the New York health insurance exchangewebsite to find an affordable health insurance plan for you and your family.
What Does Health Insurance Not Cover
Most health insurance plans dont cover the following treatments and therapies:
- Travel vaccinations: Your insurance provider must offer coverage for vaccines that are medically necessary. Boosters, flu shots and immunizations are crucial parts of most health care providers lists of medically necessary treatments. However, vaccines that are only required for international travel may not be covered under your plan.
- Weight loss surgery: There is no federal mandate that requires private health insurance plan providers to offer coverage for bariatric surgery. Do you think someone on your plan might need bariatric surgery in the future? Consult with insurance representatives before you enroll in a plan.
- Cosmetic surgery: No insurance plan provides coverage for procedures that arent medically necessary. This includes injectables, fat reduction surgeries and other types of cosmetic enhancements.
- Dental, vision and hearing coverage: ACA-compliant plans must only provide dental and vision coverage for children. Need dental, vision or hearing protections for adults on your plan? You may be able to purchase an add-on package with your health insurance provider.
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Choosing A Health Plan
To choose the right plan for you and your family, first find out what health plans are available in your county. If you have a doctor you see often, ask that doctor what plans they participate in. Contact the plan to find out what doctors are accepting patients from that plan and ask any other questions you may have. You are entitled to receive certain information about the plan, even if you are not yet enrolled. You may also want to know more about how well the plan provides the services you use most often.
The links below can help you find out what services a managed care plan offers, what managed care organizations are certified in New York and how to pick the best health plan for you and your family.