Questions about Benefits

All health plans offered by NY State of Health are licensed and approved by New York State. These plans include Qualified Health Plans. In NY State of Health, New Yorkers can also apply for public programs such as Medicaid, Child Health Plus, and the Essential Plan. If you qualify for one of these programs, you can sign up right away through NY State of Health. 

Yes. No matter which program you are eligible for, you can choose from different health plan options in the county where you live. We provide you with all the facts about each plan. You can look at the plan’s coverage for anticipated medical services, their network of providers, their formulary of covered prescription drugs and their quality rating. This helps you choose a plan that is best for you and your family.  

Qualified Health Plans offered in NY State of Health fall into categories called metal tiers. The metal tiers are bronze, silver, gold and platinum, and are associated with an actuarial value. Actuarial value is the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, the consumer would be responsible for, on average, 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy. Platinum provides the highest level of coverage, followed by gold, silver and bronze.