New York’s Amended State Innovation Waiver Will Save 117,000 New Yorkers Over $300 Million in Out-of-Pocket Costs in 2025
Waiver Reduces Deductibles, Copayments for Moderate-Income New Yorkers, Individuals with Diabetes, and Pregnant or Postpartum People
Open Enrollment for 2025 Begins November 1, 2024
ALBANY, N.Y. (October 2, 2024) – The State Department of Health’s NY State of Health, the State’s official health plan Marketplace, today announced that the U.S. Department of Health and Human Services and the U.S. Department of the Treasury approved New York’s State Innovation Waiver amendment, cutting an estimated $307 million in out-of-pocket costs annually for over 117,000 New Yorkers.
The waiver’s amendment approval comes at a critical time for New Yorkers making their care choices for 2025. The Open Enrollment Period begins November 1 and ends January 31. If an individual enrolls by December 15, then coverage will start January 1, 2025. Otherwise, coverage will begin February 1, 2025. In addition, beginning October 1, consumers can browse 2025 plan options on the Marketplace to prepare for Open Enrollment. The waiver amendment approval is effective from January 1, 2025, through December 31, 2028.
“This is a significant milestone in ensuring New Yorkers have access to high-quality health care when needed,” State Health Commissioner Dr. James McDonald said. “I want to thank Governor Hochul for her steadfast support of innovative healthcare initiatives that address health disparities in all communities and protect New Yorkers from excessive out-of-pocket costs that hinder many from accessing quality care.”
“We are thrilled that the approval and implementation of the 1332 waiver will provide more New Yorkers with enhanced options for their care,” Executive Director of the NY State of Health Marketplace Danielle Holahan said. “As New Yorkers decide on their 2025 coverage during the Open Enrollment Period, the amended waiver will result in significant savings for the consumer and will allow us to lower costs for Qualified Health Plan populations meaningfully.”
“This administration has been focused every day on improving health care for all New Yorkers, including waiving cost sharing for insulin and improving access to mental health services,” Department of Financial Services Superintendent Adrienne Harris said. “The expanded health care insurance subsides for low-income New Yorkers approved by CMS will make insurance more affordable and ensure all New Yorkers receive the health care they deserve.”
The approved waiver amendment provides cost-sharing subsidies for enrollees with diabetes, who are pregnant or in their 12-month postpartum period, and all individuals and families with incomes up to 400 percent of the Federal Poverty Line (FPL) or $60,240 for an individual and $124,800 for a family of four.
On March 1, 2024, the federal government approved New York’s Essential Plan (EP) expansion waiver for populations with incomes 250 percent of FPL who would otherwise be ineligible for the Essential Plan. Over 1.5 million low-income consumers are enrolled in EP coverage. Under the amended waiver, New York will extend cost-sharing subsidies to Qualified Health Plan program enrollees starting in 2025.
New York State’s application for the 1332 waiver was approved by the U.S. Department of Health and Human Services and the US Department of the Treasury on March 4, 2024.
In addition to the affordability improvements projected to result from New York’s initially approved waiver, the estimated savings for Qualified Health Plan enrollees approved under this amendment will result in aggregate savings of $307 million in 2025 and $1.3 billion from 2025-2028 for an estimated annual average of 117,687 enrollees. At an individual level, the amendment will result in estimated annual savings of:
- $3,500 for 80,000 consumers with income between 250-350 percent of FPL.
- $730 for 20,000 consumers with income between 350-400 percent of FPL.
- $1,600 for 17,000 consumers with diabetes.
- $2,800 for 1,600 consumers who are pregnant or postpartum.
- An estimated 5,000 consumers will benefit from more than one cost-sharing subsidy.
More information about the cost-sharing initiatives for 2025 can be found here.
NY State of Health Marketplace is a one-stop shop platform that allows New Yorkers seeking coverage to compare and buy insurance. Consumers can enroll by:
- Visiting nystateofhealth.ny.gov.
- Calling the NY State of Health Customer Service Center at 1-855-355-5777.
- Requesting free personalized help from a Certified Enrollment Assistor info.nystateofhealth.ny.gov/findassistor.
The Marketplace offers an array of tools that make comparing and buying insurance easy:
- Compare Plans and Estimate Cost Calculator.
- Comprehensive list of plans by county.
- Search for Certified Enrollment Assistors in your community.
- Web Chat is available to help consumers complete their applications.
In New York State, over 6.6 million individuals have enrolled in the NY State of Health Marketplace, including 1.5 million Essential Plan enrollees and nearly 230,000 Qualified Health Plan enrollees, 145,000 benefitting from enhanced tax credits. These enhanced premium tax credits, initially authorized under the American Rescue Plan Act of 2021, have led to record enrollments in Qualified Health Plans and have provided critical funding for New York’s State Innovation Waiver.
Due to expire at the end of 2025, these tax credits are essential to keeping Marketplace health insurance coverage affordable in New York and provide New Yorkers with additional incentives to take advantage of lowered health care coverage. For more information on the benefits to New Yorkers of these tax credits, see the Congressional District fact sheets: 2024 Congressional District Report.pdf (ny.gov)
NY State of Health is also announcing the health and dental insurance plans that will be offered through the Marketplace for the 2025 coverage year. New Yorkers looking for affordable and comprehensive health insurance can experience the ease of a one-stop shopping experience by comparing Qualified Health plan options to prepare for the 2025 Open Enrollment Period, which begins on November 1, 2024.
Qualified Health Plans
Consumers can enroll (starting November 1, 2024) or renew (starting November 16, 2024) in a 2025 Qualified Health Plan, and are encouraged to enroll before December 15, 2024, for coverage starting January 1, 2025. All Qualified Health Plans cover preventive care, such as routine doctor visits and screenings, and pre-existing conditions at no additional cost.
Essential Plan, Medicaid and Child Health Plus
The Essential Plan, Medicaid and Child Health Plus are open for enrollment year-round. All these programs offer comprehensive benefits, including vision and dental benefits for all enrollees with no monthly premium, no deductible, and low-cost sharing.
Small Business Marketplace
Eligible small employers can lower the cost of offering employee coverage with the federal Small Business Healthcare Tax Credit when purchasing Small Business Marketplace-certified plans approved through NY State of Health. There are currently more than 18,900 employers signed on with the Small Business Marketplace (SBM). Employers can only access small employer tax credits by completing a short application at nystateofhealth.ny.gov/employer.
In 2025, Oscar Insurance Corporation will no longer offer plans on the SBM. Consumers in the counties served by these insurers will continue to have a choice of two or more insurers offering SBM-certified plans.
Dental Plans
Dental coverage is available for adults and families in certain Qualified Heath Plans or through a stand-alone dental plan (SADP) on the individual Marketplace. New for 2025, there will be no waiting periods permitted for dental services other than for orthodontia for on-exchange SADPs.
More information on 2025 Plans can be found here.
More Information on Plans by County can be found here.
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About The NY State of Health Marketplace
New York opened the State Department of Health’s NY State of Health, the State’s official health plan Marketplace, in October 2013. The Marketplace’s one-stop health insurance shopping experience offers high-quality, comprehensive health plans. NY State of Health, a division of the New York State Department of Health, is the only place where consumers can qualify for help paying for coverage through premium discounts or tax credits. Eligible New Yorkers can also enroll in Medicaid, Child Health Plus and the Essential Plan through the Marketplace all year. For more information about the NY State of Health Marketplace, visit https://nystateofhealth.ny.gov/ or call Customer Service at 1-855-355-5777, TTY: 1-800-662-1220, or find an enrollment assistant.
Contact: New York State Department of Health
518-474-2043 x. 2