- How can I find a health plan through NY State of Health for myself or for my household member(s)?
Based on the health insurance program that you and/or your household members qualify for, NY State of Health will show you the health plans that you can choose from. We will provide you information about the health plan including the monthly premium (if there is one), metal level (if applicable), type of coverage (i.e., medical or dental), cost sharing such as deductibles or out of pocket costs (if applicable), covered benefits and services, and their quality rating.
- How should I get ready to choose a health plan through NY State of Health?
Think about your coverage needs. Ask yourself these kinds of questions:
What kinds of medical services do I need?
Are there prescription drugs that I have to take?
Are there doctors and other health care providers I prefer?
Do I want to consider the plan’s quality rating?
- Can I search for doctors, hospital, or facility in the health plan's network?
Yes. You can search to see if your current doctors or facilities where you receive health care services are part of a plan's network of providers. Sometimes, the plans that your provider accepts, or the “network” they are in, will change. It is always best to call your doctors, hospitals, other facilities, and the health plans directly before completing the plan selection process. These resources are available to help you:
- Can I change my plan if I am not satisfied with the health plan’s network?
If you are not satisfied with your Qualified Health Plan, you can change plans during the annual renewal period that begins on November 16. To switch plans during other times of the year, you will need to qualify for a Special Enrollment Period.
For the Medicaid Managed Care program, you will have 90 days from the effective date of your health plan enrollment to change your plan for any reason. After 90 days, you will not be able to change your health plan for the rest of the coverage period, unless you have a good reason.
Essential Plan and Child Health Plus program enrollees can change plans at any time.
- Do all my household members need to be in the same health plan?
You decide how to cover your household members. You and your household members may be in the same health plan or different ones. For example, a couple can choose to enroll in the same health plan for simplicity or be in different plans because each person may have different health care needs. The cost of premiums and cost-sharing will vary based on your choice.
- What are the Qualified Health Plan "metal levels"?
NY State of Health offers four major types of Qualified Health Plans: Bronze, Silver, Gold, and Platinum. Each plan type differs in the percentage of health care costs that a plan would pay for an average person. For example, the Bronze level plan will pay for 60% of all health care costs for an average person and individuals that enroll into this plan level will pay for 40% of the costs. Health plans in the Platinum level will cover 90% of the health care costs and the individual will have to pay for the remaining 10%. If you will enroll in a Qualified Health Plan, you decide which metal level is right for you and your household members.
- I hardly ever get sick. Is there a health insurance plan that just provides coverage for major illnesses?
People who are under age 30 and some people who cannot afford to buy a more comprehensive health insurance plan may buy a type of health insurance plan called “catastrophic coverage.” Catastrophic health plans have lower monthly premiums than traditional health insurance plans, but have much higher out-of-pocket costs. If you are over age 30 and want to enroll in catastrophic coverage, you will first need to be approved for the affordability hardship exemption.