Extra Cost-Savings Through NY State of Health in 2025

Great news! NY State of Health is providing new cost savings to consumers in 2025.  Accessing the health care services you need will be more affordable than ever. Click below to learn more about:

• 2025 Cost Savings for Qualified Health Plans
   
• 2025 Cost Savings for the Essential Plan

2025 Cost Savings in Qualified Health Plans

There are four levels of Qualified Health Plans, organized by “metal level.”  Each level has different cost sharing. Cost-sharing is the amount you pay when you get care.  It includes deductibles, copayments, and coinsurance.  In 2025, all metal level plans have been upgraded – especially the Silver plan!  

Bronze, Silver ,Gold and Platinum Plans benefits now include*:

• $0 out-of-pocket costs for most services for diabetes.  

  This applies to non-hospital-based preventive diabetes-related services, medical care, supplies, tests, and prescription drugs.  

• $0 out-of-pocket costs for most pregnancy and postpartum health services.  

  This includes services during pregnancy and up to one year after postpartum.  It applies to everything except for hospital services.  This can include prescription drugs, mental health/substance use benefits, lab/x-ray services, prenatal testing, doctor’s visits, and some specialist visits.  Specialist visits can include treatment for health conditions like hypertension, asthma, and urinary tract infections.

This benefit does not apply to ambulance services, all inpatient services, emergency care in a hospital, and delivery services by a physician, nurse or midwife.

Silver plan benefits now include*:  

• the diabetes and pregnancy and postpartum benefits listed above,  
  PLUS 
   
• Cost-Sharing Reductions (CSR).  CSR Silver plans offer more savings than Standard Silver plans. They discount your cost-sharing payments. Cost-sharing includes deductibles, copayments, and coinsurance.  
   
  • Expanded eligibility for Silver Supreme CSR plans:  Consumers with incomes up to 350% of the Federal Poverty Level (FPL) are now eligible for this plan.  These are New Yorkers who earn up to $52,710 a year as an individual, or up to $109,200 as a family of four, who are eligible for a Qualified Health Plan with Advance Premium Tax Credit (APTC). 
     
    • Silver Supreme plans have a $350 individual deductible and a $700 family deductible. 
       
    • For more information on copay amounts, please see chart below. Copay amounts are listed under the Silver Supreme column.
       
  • Expanded eligibility for Silver Enhanced CSR plans:  Consumers with incomes above 350% up to 400% of FPL are now eligible for this plan.  These are New Yorkers who earn between $52,710 and $60,240 in a year as individual, or between $109,200 and $124,800 as a family of four, who may be eligible for a Qualified Health Plan with Advance Premium Tax Credit (APTC).
     
    • Silver Enhanced plans have a $1,855 individual deductible and a $3,710 family deductible.  
       
    • For more information on copay amounts, please see chart below or the Qualified Health Plans Fact Sheet here. Copay amounts are listed under the Silver Enhanced column. 

*All 2025 Standard Silver plans allow one visit to primary care provider or specialist that are not subject to the deductible, co payments are applicable for these visits. This includes behavioral health outpatient visits.
 

For a complete list of copay amounts, please click here. Copay amounts will be listed under the Silver 73 column for Silver Enhanced or the Silver 87 column for Silver Supreme.   
 

2025 Cost Savings in the Essential Plan

The Essential Plan is a health plan for New Yorkers who qualify, with $0 monthly premiums.  Consumers with incomes up to 250% of the FPL are now eligible for this program. It covers doctor’s visits, hospital care, screenings, prescription medicine, dental and vision benefits, and more.  There is no deductible.  Cost sharing is low.  Now, in 2025, cost sharing is even lower!

Essential Plan benefits now include: 

• $0 out-of-pocket costs for pregnancy and postpartum services.  There has been added coverage for eight doula visits.  All copays are removed during pregnancy and postpartum up to one year. 
   

• $0 out-of-pocket costs for certain services for diabetes.  

  This applies to non-hospital-based preventive diabetes-related services, medical care, supplies, tests and prescription drugs.  

  *These benefits are available to all Qualified Health Plan consumers in all metal levels. Benefits are not available with Catastrophic plans.  

  *For high-deductible health plans, consumers must satisfy the minimum deductible amount required for high deductible plans under the Internal Revenue Code.  For maternal health, there is an exception for certain preventive services.   
   

Diabetes Cost-Sharing Reduction Initiative: Essential Plan and Qualified Health Plans
Items and services are subject to change based on updated recommendations/guidance.
 

Prescription Drugs

Prescription Drugs for the Treatment of diabetes on the Plan's formulary or when the Prescription Drug is obtained through the formulary exception process will have cost-sharing waived.