The best health insurance policy depends on your health needs, the availability of plans in your area, and how much you can spend on coverage. Understanding the cost of premiums and deductibles for each metal tier and alternatives to health insurance can help you figure out the best options to get coverage. This article breaks down the best health insurance plans in NYC for different people, depending on the coverage need.
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Best Health Insurance Plans in NYC
The average individual private health insurance plan costs around $440 monthly for coverage, while the average family plan pays nearly $1,168 per month. Still, comparatively, rural areas pay the highest premiums compared to urban areas, such as New York City. However, the specific amount you’ll pay depends on several factors, including your location, the people on your plan, and your deductible.
New York’s Open Enrollment Period lasts between Monday, November 1, 2021, through Saturday, January 15, 2022, unless you qualify for a Special Enrollment Period such as moving, getting married, having a baby, or job loss. In the state of New York, residents can get health coverage through employer-sponsored health programs, individual or family plans, or government-assisted programs. Below is a breakdown of New York’s enrollment in these various health insurance plan types.
|Insurance Type||Percent Enrollment|
Metal Tier Plans: Best for Comprehensive Coverage in NYC
If you can financially manage unsuspecting emergencies, but do not anticipate significant health or medical expenses, then a lower metal tier plan with more affordable premiums may be most cost-effective. Consider the average monthly premiums for the metal tier plans in New York.
|Plan Type||Average Monthly Premium|
To help you determine which metal tier plan is right for you, you will want to consider your age and medical needs. Gold and platinum plans have lower deductibles but higher monthly premiums, while silver and bronze plans have higher deductibles and lower monthly premiums. Catastrophic plans are also an option for individuals under 30 years of age.
Gold and Platinum Plans: Best for Frequent Medical Care
Gold and platinum plans have the lowest deductibles but the highest premiums. These plans are cost-effective for those that anticipate greater medical expenses because the insurance company pays a greater percentage of the total medical expenses. With a platinum plan, the insurance company pays 90 percent of the member’s health care expenses while the member pays only 10 percent, on average. For Gold plans, insurance pays 80 percent while the member pays 20 percent.
Silver Plans: Best for Moderate Medical Care
Silver plans offer moderate monthly premiums and moderate costs when you need care. The deductibles are typically lower than bronze plans and are a good choice if you qualify for “extra savings” such as cost-sharing reductions. These are also a good choice if you are willing to pay a higher monthly premium than a Bronze plan for more routine services covered. With Silver plans, the insurance company typically pays 70 percent of the member’s medical expenses while the member pays 30 percent.
Bronze and Catastrophic Plans: Best for Young, Healthy Individuals
Bronze and catastrophic plans have high deductibles and low monthly premiums. According to the Department of Health, bronze plans are a good choice if you want a low-cost way to protect yourself from worst-case medical scenarios. Typically, these plans are cost-effective for young, healthy individuals, as the insurance company pays 60 percent of medical costs and the member pays 40 percent.
Catastrophic plans are available to individuals under 30 years of age, but people of any age with a hardship exemption or affordability exemption. When applying to the Healthcare Marketplace, individuals will also see Catastrophic plans listed as potential options, if eligible. Catastrophic plans cover the same essential health benefits and preventative services as marketplace plans, as well as three primary care visits per year. The Department of Health suggests that if you qualify for a premium tax credit based on your income, a Bronze or Silver plan is likely to be a better value.
Federal Insurance Programs: Best for Low-Income Comprehensive Healthcare in NYC
Paying for a non-group health insurance plan as an individual or for your family with assistance from an employer can be unaffordable for many. Luckily there are federal and state health programs to help make health insurance more affordable. Eligibility often depends on income level compared to family size, but you may also be eligible for tax reductions based on the plan you choose.
NY Medicaid: Best for Low-Income Families
Medicaid is a public health insurance program funded by the state and federal government for individuals and families below 138 percent of the federal poverty level (FPL). Eligible populations include children, pregnant women, single individuals, families, and individuals certiﬁed blind or certiﬁed disabled. Pregnant women and infants are eligible for Medicaid for those less than 223 percent of the federal poverty level. Nearly 20.2 million New York residents have Medicaid or roughly 6.2 million enrollees.
You can apply for medication through the New York Marketplace, or by calling the Medicaid Helpline at (800) 541-2831. The chart below shows the income you can receive annually to retain and qualify for Medicaid in the state of New York. Income levels and eligibility depend on family size.
|Family Size||Income Level|
Source: New York Department of Health
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Child Health Plus: Best for Children Without Insurance
The Children’s Health Insurance Program (CHIP) is called Child Health Plus in New York. Child Health Plus is available to children who are without insurance and under 19 years of age who do not qualify for Medicaid coverage. As of April 2021, nearly 600,000 children are enrolled in this plan. To qualify, children must be New York residents from low-income households, although some families get Child Health Plus for free,
NY Essential Health Plan: Best for Those Not Eligible for Medicaid
The Affordable Care Act (ACA) allows states to set up a Basic Health Program (BHP) that contracts with plans outside the Marketplace. In New York, the Basic Health Plan is called The Essential Plan, available to low-income New Yorker residents who don’t qualify for Medicaid or CHIP. You can enroll through the Marketplace year-round and potentially qualify for $0 monthly premiums and no deductibles. These plans offer the same health benefits found in Qualified Health Plans, such as doctor visits, drug coverage, and preventative care coverage.
Cost-Sharing Reductions: Best for Savings on Silver Plans
If you enroll in a Silver plan through the New York Marketplace, you may be eligible for cost-sharing reductions. Cost-sharing reductions lower how much you pay when you receive health care services. They can lower your deductibles, co-payments, co-insurance, and overall out-of-pocket spending. Individuals and families with incomes between 100% to 250% of the Federal Poverty Level (FPL) help reduce the cost of doctor or other health care service expenses.
Premium Tax Credits: Best for Marketplace Savings
Depending on family size and income, you may be eligible for premium tax credits. When you apply for health insurance through the Marketplace, you are expected to estimate your annual income for that term year. You may qualify for a premium tax credit toward your monthly health insurance premium based on your income information. If you have used more than your credit allowed by the end of the year, you will have to pay back that difference, but if you used less, you would receive that difference.
Alternatives to Health Insurance: Best for Low-Cost Basic Health Coverage in NYC
The high costs associated with health insurance are driving companies to consider new health coverage options. Some options can be paired with insurance plans or as a stand-alone option to help offset the cost of out-of-network care or uncovered services. Consider these low-cost options to further drive down your annual healthcare expenditure.
Care Membership Plan: Best for Basic and Supplemental Coverage
A care membership plan such as Mira can help you save thousands of dollars on your health care expenses each year. Mira offers up to 80 percent discounted rates on over 1,000 prescriptions and lab screenings. Mira also provides affordable access to primary care, urgent care, and behavioral health services through its member portal.
Concierge Medical Plans: Best for Primary Care Savings
New York City offers a wide array of concierge medical plans, a model in which a patient pays a monthly, bi-annual, or annual fee to their physicians to create affordable health options for small businesses, self-employed. With these models, patients may pay a copayment but no charge for a specialist in the event of a referral. These facilities typically offer shorter wait times, and patients can normally reach a doctor quickly by phone or text and make an appointment the same day. Some concierge medical practices even make house calls.
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Medical Cost-Sharing Programs: Best for Those Religiously-Motivated
Cost-sharing programs, often considered Faith-Based programs, are a medical cost-sharing option. Faith-based programs are not considered health insurance, as they are not governed by the ACA but are designed to meet similar health needs that Marketplace plans offer. The core concepts are typically shared religious beliefs. You may be required to engage in a certain number of monthly meetings or promise not to engage in specific lifestyle behavior. New York has a robust network of faith-based plans.
Health Insurance for NYC Frequently Asked Questions (FAQs)
When shopping for health coverage and potential alternatives, you will want to understand whether the health insurance plan will meet your medical and financial needs. Consider the following answered questions when picking the plan that is best for you and your family.
What does health insurance cover?
Qualified health insurance plans under the ACA and sold on the healthcare Marketplace help cover essential health benefits. Essential health benefits are minimum requirements and do not include dental and vision care or weight management services. Specific services covered in each broad benefit category can vary based on your state’s requirements. Still, the following are the essential health benefits ACA health plans are required to help cover:
- Outpatient care
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental and behavioral health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
What does health insurance not cover?
While health insurance offers comprehensive coverage to many healthcare services, plans typically only provide essential coverage and minimum requirements. Additional health services not covered by insurance providers include:
- Dental services
- Vision services
- Hearing aids
- Uncovered prescription drugs
- Acupuncture and alternative therapies
- Weight loss programs and surgery
- Cosmetic surgery
- Infertility treatment
- Sterilization reversal
- Private nursing
- Travel vaccines
Can I Get Short-Term Health Insurance in New York?
New York prohibits the sale of health plans that do not provide comprehensive coverage or essential health benefits. This ban includes short-term health plans, which don’t count as qualified coverage under the Affordable Care Act (ACA). Individual and group health plans sold in New York must be guaranteed renewable. Often healthcare plans in most states do not provide coverage for some of the essential health benefits.
How long can a child remain on a parent’s health insurance plan?
Under the Affordable Care Act, young adults can be covered under their parents' health insurance plans up to 26. New York allows health insurance companies to provide health insurance to a child on parent’s plans up to age 29 - also called the “Age 29” law. Coverage for these individuals on another subscriber’s (parent’s) plan comes with an increased charge.
Health insurance can be a considerable expense, but understanding the plan types can help you and your family pick a plan that makes the most sense for your medical and financial needs. Low-income health insurance options exist in NYC, but you may want to consider alternative options if you are looking to offset more of your healthcare costs.
Mira offers affordable rates on thousands of prescriptions and preventative lab screenings. Mira has also expanded its services by adding virtual primary care and telebehavioral health, in addition to its affordable access to urgent care. Whether Mira covers your care or not, the customer service team will find you the best rates in your area to drive down your annual healthcare expenditure. Try Mira today!