Best ACA Plans in New York for 2023
Open Enrollment is right around the corner, and numerous plans exist. For the State of New York, there is a specific portal you will use to browse and select an Affordable Care Act (ACA) plan. The plans available to you are specific to you and your background. When choosing a health insurance plan, it is best to compare plans based on what’s included, your monthly premium and deductibles, and any financial help you might be eligible for.
What are the best Plans for the NY-State Healthcare Exchange?
For this specific article, we are looking at the most affordable plans for a single 30-year-old female who does not smoke and is not on disability. She makes an annual average income of $70,000 and lives in New York. Individuals and families with incomes between 200% and 250% of the Federal Poverty Level (FPL) can get help with their deductibles, copays, and coinsurance. For this profile, her income is at 543% of the FPL. This does not qualify her for a lot of help. Her income is not between $24,980 - $31,225 for an individual, which is 200% - 250% of the FPL.
The table below lists all available insurance plans in 2023 for the profile listed above. It outlines the plan name and carrier, the monthly premium, and the deductible amount. After using the NY-State Healthcare Exchange estimated financial help calculator, a $174 tax credit was estimated. However, it is essential to remember that this is just an estimate of your financial help and that your actual Advanced Premium Tax Credit will be determined when you apply for coverage. The table includes bronze, silver, gold, and platinum plans and does not include catastrophic plans. For this profile and financial help estimate, remember that the $174 tax subsidy is being applied to the listed monthly premium.
NY-State Health Exchange ACA Plans by Monthly Premium
Plan | Monthly Premium | Deductible Amount |
|---|---|---|
MetroPlus Health BronzePlus-B1 (HMO) | $353.30 | $4,700.00 |
Healthfirst Bronze Leaf, Bronze (HMO) | $375.88 | $4,700.00 |
Fidelis Care Silver, Silver (HMO) | $384.34 | $4,700.00 |
Fidelis Care Bronze (HMO) | $389.89 | $6,100.00 |
Fidelis Care Bronze HSA (HMO) | $474.38 | $4,700.00 |
Empire HealthPlus Gatekeeper X (HMO) | $520.75 | $4,700.00 |
Oscar Bronze Classic (HMO) | $536.41 | $4,700.00 |
EmblemHealth Bronze ST (PPO) | $758.67 | $4,700.00 |
Metro Plus Health SilverPlus-S1 (HMO) | $516.02 | $1,750.00 |
HealthFirst Silver Leaf (HMO) | $551.12 | $1,750.00 |
Empire HealthPlus Gatekeeper X, Silver (HMO) | $560.96 | $1,750.00 |
Oscar Silver Classic (HMO) | $702.00 | $1,750.00 |
MetroPlusHealth GoldPlus-G1 | $730.78 | $1,750.00 |
United HealthCare Compass Bronze (EPO) | $687.30 | $600.00 |
EmblemHealth, Silver (PPO) | $775.86 | $1,750.00 |
United HealthCare Compass Silver ST (EPO) | $1,039.87 | $1,750.00 |
HealthFirst Gold Leaf (HMO) | $713.81 | $600.00 |
Fidelis Care Gold (HMO) | $765.03 | $600.00 |
Empire HealthPlus Gatekeeper X, Gold (HMO) | $921.08 | $600.00 |
EmblemHealth Gold (PPO) | $948.63 | $600.00 |
MetroPlusHealth PlatinumPlus-P1 (HMO) | $860.51 | $0.00 |
Oscar Gold Classic (HMO) | $987.04 | $600.00 |
UnitedHealthcare Compass Gold (EPO) | $1,285.58 | $600.00 |
HealthFirst Platinum Leaf (HMO) | $943.47 | $0.00 |
Empire HealthPlus Gatekeeper X, Platinum (HMO) | $1,157.45 | $0.00 |
HealthFirst Platinum Leaf (HMO) | $943.47 | $0.00 |
EmblemHealth Platinum (PPO) | $1,184.84 | $0.00 |
Oscar Platinum Classic (HMO) | $1,229.81 | $0.00 |
United HealthCare Compass Platinum (EPO) | $1,594.45 | $0.00 |
What should I consider when picking a health plan?
There are many things to consider when selecting an ACA health plan on the NY state health exchange. Some significant factors to consider are your current and future health needs, your financial situation, how much you can afford, and if you frequently travel.
Your Health Needs
When browsing plans, you'll want to evaluate your current health needs and any preferences for providers, facilities, and pharmacies you might have. Do the healthcare providers, hospitals, and pharmacies that you prefer fall within the prospective plan's network?
Additionally, if you require prescription medications, you'll want to ensure that these will be covered under your new plan. Each insurer has a list of medicines covered by their plan, usually found on their website. You should list your current medication and compare it to the plan's list to ensure your prescriptions are covered and understand all potential out-of-pocket costs.
Your Financial Situation
Your financial situation depends on how much you can pay out of pocket. The following are the basic categories of plans by metal tier that you can select within the health exchange. These plans vary based on monthly premiums and are suited to various living situations.
ACA Plan Breakdown & Cost Sharing
Metal Tier | Monthly Premium | Insurance Pays | You Pay | Best For |
|---|---|---|---|---|
Bronze | $ | 60% | 40% | A good option for youngand healthy individuals. |
Silver | $$ | 70% | 30% | Good option for healthy, low-income individuals. |
Gold | $$$ | 80% | 10% | Best for people who will need comprehensive coverage |
Platinum | $$$$ | 90% | 10% | Best for people with frequent medical needs |
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How Much You Can Afford
You have your health needs and budget figured out. Now you can select the health plan that will best meet your needs. You’ll likely choose those plans that cover your health needs by their premium or deductible. The average premium expenses for ACA plans in New York are as follows:
Average Marketplace Premium for New York by Metal Tier, 2018-2023
State | 2023 Average Lowest-Cost Bronze Premium | 2023 Average Lowest-Cost Silver Premium | 2023 Average Lowest-Cost Gold Premium |
|---|---|---|---|
| New York | $484 | $619 | $799 |
Source: KFF
You might also want to consider offsetting a high deductible health plan (HDHP) with a service like Mira. HDHPs have a higher deductible than the average insurance plan, where monthly premiums are much lower. An HDHP, in 2023, is any plan with a deductible of at least $1,500 for an individual or $3,000 for a family. HDHPs are recommended for healthy people with infrequent medical needs and those experiencing illness. You may consider pairing it with a Mira membership. Mira offers an affordable alternative to health insurance, and there is no deductible to be met.
If You Frequently Travel
If you travel a lot and need coverage during this time, you may want to purchase an additional add-on in the health exchange, such as a preferred provider organization (PPO). PPOs give you access to out-of-network coverage and allow you to see specialists without a referral. These plans do often come with a high premium and vary per state.
What happens if you can’t afford any plan on the exchange?
Only four states and DC will impose a tax penalty on those who do not have health insurance, and New York is not one of the four. There is no penalty for not having enrolled in a health insurance plan for New York. However, having health coverage is extremely important, and you may qualify for assistance with paying for your health insurance.
How to enroll in an ACA plan?
Signing up for an ACA health plan in New York’s health exchange can be confusing. When entering the site, you must create an account by providing an email address and basic information about yourself. You can take three simple steps to browse, decide upon, and enroll in a health plan. These are as follows:
- Have All Relevant Information Ready
- Know What You Should Consider When Browsing Plans
- Select the Best Option for Your Needs
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ACA Health Plans in New York State Frequently Asked Questions (FAQs)
Below are some frequently asked questions about health insurance in New York we gathered for you.
What health insurance terms should I understand during this enrollment period?
There are many health insurance terms to know and understand during this enrollment period. Mira compiled a list of 10+ good words, including Health Savings Accounts, deductibles, Benefit Periods, premiums, and many more.
What requirements do I need to meet to be eligible in New York?
Yes, to be eligible to sign up for a plan in the NY-State Health Exchange, you:
- Must live in New York
- Must be a U.S. citizen, national or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid or the Essential Plan based on your income)
- Cannot be currently incarcerated
What are the benefits that my plan is required to provide?
Affordable Care Act health insurance plans are required to provide ten essential benefits, known as minimum essential coverage. Any plan on the ACA exchange must include benefits about:
- Outpatient care
- Emergency care
- Inpatient care/hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use services
- Prescription drugs
- Rehabilitation services and devices
- Laboratory services
- Preventive care and chronic disease services
- Pediatric care
When is the special enrollment period?
The Special Enrollment Period (SEP) refers to the “time outside the yearly Open Enrollment Period when you can sign up for health insurance.” You must qualify for SEP by having experienced a qualifying event(s). These include events such as:
- losing health coverage
- moving
- getting married
- having a baby, or adopting a child,
- your household income is below a certain amount (150% of FPL)
Bottom Line
There are many ACA plans on the New York State Health Exchange. These vary by metal tier, coverage types, and premium and deductible amounts. Choosing the best plan for you is a process that takes time, but it does not need to be complicated. Considering your financial situation, healthcare needs, and other factors will help you choose the most affordable yet comprehensive health plan.
An alternative to individual health insurance plans is health memberships such as Mira. If you struggle to find affordable yet high-quality health coverage in New York, you may want to consider Mira. For as little as $45 a month, Mira members get access to low-cost virtual and urgent care, up to 80 percent off select medications, and same-day lab testing. Additionally, a Mira care team member will work with you to find an affordable provider in your area. Sign up for Mira today and get covered today!
Kendra Bean is from Maui, Hawaiʻi. She is currently enrolled at the University of Hawaiʻi at Mānoa, specializing in Epidemiology. She is passionate about improving health literacy and access to care, specifically in rural areas.
