Best Obamacare Plans in NYC
Obamacare, also known as the Affordable Care Act (ACA), is a piece of legislation designed to protect consumers from the rising costs of healthcare. It is important to understand the types of plans available to determine which is most suitable for your needs. Bronze and silver plans are best for young and healthy, low-income individuals while gold and platinum plans are typically best for those requiring frequent medical care.
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Best Obamacare Health Insurance Plans in NYC
All plans listed on the Healthcare Marketplace are ACA-qualified. This means that all of the plans you can view on the website are all available under the ACA. The ACA, also known as Obamacare, was signed into law in March of 2010 by President Barack Obama. Obamacare works with private insurance companies to provide essential coverage for more affordable costs and requires participating companies to sort their plans into 4 primary categories.
- Bronze: Best for Young and Healthy People
- Silver: Best for Individuals with Low-Income
- Gold: Best for Comprehensive Coverage
- Platinum: Best for Frequent Medical Needs
Bronze and Silver plans are best for low-income individuals who are young and healthy. Gold and platinum plans are best and most cost-effective for people who need frequent medical care.
Minimum Essential Coverage
The ACA requires that all health insurance plans include 10 essential health benefits. These 10 services must be covered in every state, but the extent of coverage may vary from state to state. These benefits are as follows:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Metal Tier Plans
Obamacare categorizes plans into 4 metal levels: Bronze, Silver, Gold, Platinum. Each level varies in terms of premium and deductible cost but the quality of care remains the same throughout each level. These metal tiers determine the cost-sharing between you and your insurance provider.
Here is a brief overview of each of the 4 metal levels:
| Metal Level | Insurance Pays | You Pay (Deductible) | Monthly premium |
|---|---|---|---|
| Bronze | 60% | 40% | $ |
| Silver | 70% | 30% | $$ |
| Gold | 80% | 20% | $$$ |
| Platinum | 90% | 10% | $$$$ |
In NY, prices may vary depending on which type of plan and which insurance company you choose, but in 2021 the average price for each metal tier plan was as follows:
- Bronze: $430
- Silver: $588
- Gold: $597
- Platinum: $709
Bronze: Best for Young and Healthy People
A bronze plan will cover 60 percent of medical expenses and the patient is responsible for the remaining 40 percent. Out of the 4 metal tiers, Bronze plans offer the lowest monthly premium. However, when it is time to receive care, these plans require the highest out-of-pocket costs. These out-of-pocket, not covered costs are also known as deductibles and can be over thousands of dollars per year.
As such, a Bronze plan would be the most fitting for you if you are in good health but have limited income. If you believe that you will not be in need of frequent medical attention, this plan can be a very cost-effective way to protect you from worst-case scenarios.
Silver: Best for Individuals with Low-Income
A silver plan can also be a good option for healthy, low-income individuals. Although your monthly premium might be slightly higher than the Bronze plan, your deductibles/out-of-pocket costs will be slightly lower.
Especially if your income is anywhere between 100 percent and 250 percent of the federal poverty line, the Silver plan might allow you to qualify for extra savings. For instance, you might qualify for Cost-Sharing Reductions (CSR). CSRs are a government-provided discount to help reduce out-of-pocket costs for low-moderate income families and individuals. CSRs will help to decrease your deductible, co-pay, or co-insurance fees.
Even if you do not qualify for these savings, the Silver plan might be a good choice for you if you are willing to spend slightly more money on your premium to have more of your routine visits covered.
Gold: Best for People who need Comprehensive Coverage
On average, a Gold plan will cover 80 percent of your medical expenses, and the remaining 20 percent will be your responsibility to cover. This means that you will have a comparably high monthly premium but low deductible costs when you receive medical care.
This type of plan is most suited for individuals who need frequent medical services and are willing to spend more money on their monthly premium in return for more comprehensive coverage.
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Platinum: Best for People with Frequent Medical Needs
Platinum plans are the highest level of health insurance plans in NYC under the ACA. Under this plan, 90 percent of your out-of-pocket costs will be covered by your insurance company, however, your monthly premium will be the highest out of all plans. For reference, in 2021, the cost of a platinum plan averaged around $1064 in NYC.
This type of plan is designed for people who need very frequent medical care/services. In these circumstances, this plan would end up being cost-effective because as soon as you meet your deductible, your medical care would be fully covered.
Additional Plan Types
At each metal level, plans can also be categorized into 4 different types of coverage. Before applying to a health insurance plan, it is highly recommended that you understand the different plan options and preview price estimates based on your household size, income, and your own preferences. It’s also important to understand the different types of coverage that are offered.
The following is a brief comparison of these 4 categories. Keep in mind that ACA plans are generally usually HMOs or PPOs.
- Health Maintenance Organizations (HMO)
- Exclusive Provider Organization (EPO)
- Preferred provider organizations (PPO)
- Point of Service Plans (POS)
| Type of Plan | Network flexibility | Cost | Primary care physician? | Referrals for specialists? |
|---|---|---|---|---|
| HMOs: | Must stay in-network, except for emergencies | $ | Required | Yes |
| EPOs: | Must stay in-network, except for emergencies | $$ | Required | No |
| POS: | Out-of-network options are available, but more costly | $$$ | Required | Yes |
| PPOs: | Out-of-network options are available, but more costly | $$$$ | Not required | No |
High-Deductible Health Plans
High deductible health plans (HDHP) have a much higher deductible than traditional insurance. Although the monthly premium fee might be lower, your out-of-pocket medical costs will be much higher. However, HDHPs can be combined with a health savings account (HSA). HSAs allow individuals to save money by allowing individuals to pay for medical services with money free from taxes.
HDHPs can fall under a specific metal tier depending on that tier’s deductible pricing. In 2022, in order for a plan to qualify as an HDHP, the deductible must be at least $1,400 for an individual or $2,800 for a family. Additionally, the out-of-pocket costs in total, can not exceed $7,050 for an individual or $14,100 for a family.
These plans can be helpful for healthy individuals who do not utilize a lot of medical services. It is important to note that although the deductible is high, HDHPs will cover all routine/preventative health services.
Health Insurance Savings
Specific plans can give you specific opportunities to reduce costs. For instance, some plans can be considered High Deductible Health Plans (HDHPs) which will allow you to pair your plan with a health savings account (HSAs). Learn more about how to reduce costs with HSAs by checking out this article about HDHPs.
You might also qualify for a Premium Tax Credit (PTC). PTCs are a refundable tax credit that helps low-moderate income families and individuals afford their health insurance premiums.To see if you might qualify for savings based on your income level, you can check using the Marketplace website.
Alternatives to Obamacare
There are several alternatives to Obamacare. Depending on your income and health status, Obamacare might not be necessarily suited to your needs. In this situation, it can be helpful to explore the different available alternatives to make the most cost-effective decision. Check out our article about the Best Health Insurance Plans to learn more about Obamacare alternatives in NYC.
Catastrophic Plans
Catastrophic plans are not generally grouped with the other four metal plans. Although you can purchase a catastrophic plan under Obamacare, these plans can also be purchased directly from an insurance company, without the official ACA exchange. These plans are similar to Bronze plans in that they have the lowest premiums but also the highest deductible price. Like Bronze Plans, catastrophic plans cater towards young and healthy individuals who do not expect to have high medical costs.
However, it is important to note that to be eligible for a catastrophic plan, you must meet either of the following criteria:
- Under age 30
- Any age but with a hardship exemption (given to individuals who cannot afford typical health insurance due to personal or financial circumstances)
Unlike the silver plan, the catastrophic plan will not allow you to use premium tax credits or tax sharing reductions. As such, if your income level qualifies you for CSR or PTC-related savings, make sure to keep these savings in mind when selecting an affordable health insurance plan.
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Private Plans
Private plans are non-marketplace plans that are not run by the federal government or any state government. These plans can be purchased directly from an insurance company’s website or via an agent or broker. Some private plans can tend to be cheaper than Marketplace/Obamacare plans.
These plans are required to cover the 10 essential health benefits that the ACA requires. However, these plans do not accept individuals with pre-existing health conditions. These plans have the potential to be cost-effective for people with income too high to receive PTCs or CSRs.
Primary Care Membership
Primary Care Memberships, also known as Concierge medicine is a new type of health coverage that has risen to popularity recently. Mira is an example of a primary care membership. Essentially, a patient can pay a monthly or annual membership fee to receive a quick and easy access to medical services such as primary care physicians and urgent care.
It is important to note that the ACA does not recognize these plans as an acceptable alternative insurance plan. As such, in states like NY where insurance is mandatory, individuals who are interested in concierge plans must find another type of approved insurance. However, these plans can still be very helpful and cost-effective as they can function as a supplementary plan to an otherwise low-coverage plan.
Best Obamacare Plans in NYC Frequently Asked Questions (FAQs)
Understanding how to choose the best plan for you or your family is difficult. It is necessary that you carefully examine your possible options and the type of coverage you want to receive. The following questions can help you understand how Obamacare works and whether or not you are eligible.
What is the difference between Medicaid/Medicare and Obamacare?
Medicaid/Medicare are both federally funded insurance programs. Medicaid is an insurance program for low-income individuals under the age of 65. Medicare is an insurance program for people 65 and older, people with disabilities, or people with end-stage kidney disease requiring dialysis or transplant. On the other hand, Obamacare is legislation that regulates private insurance company pricing and coverage. A U.S citizen needs to meet the requirements set by the federal government to qualify for Medicaid or Medicare, whereas any U.S citizen can buy private health insurance through Obamacare.
Do I qualify for Obamacare?
People of all incomes qualify for Obamacare unless they meet the following criteria:
- Your employer offers comprehensive and affordable coverage.
- You have access to coverage via a family member’s employer health insurance plan.
- You are eligible for federally funded health insurance such as Medicaid or Medicare.
- Your income is less than 100% of the federal poverty level.
- Your income is 400% above the federal poverty level.
- You are incarcerated.
How do I enroll in Obamacare?
You can apply and enroll in Obamacare for 2022 in NYC by using the nystateofhealth.ny.gov website. This website can help you quickly compare different health plans and also check if you qualify for any federally funded insurance plans. Through this website, after you create an account, you can apply and enroll in your chosen healthcare plan. If you find yourself in need of more assistance, this website can also help you contact a broker who can help guide you through the application and enrollment process.
Bottom Line
Ultimately, choosing between Obamacare plans be a tough decision to make. As health insurance in NYC can be especially costly, it is essential that you and your family consider all possible options. At the end of the day, having a comprehensive health insurance plan is fundamental to your and your family’s well-being and health.
If you are having trouble choosing an Obamacare plan, Mira can be an incredibly helpful tool in your health coverage. For as little as an average of $25 per month, Mira can supplement your current health insurance or even act as your primary plan. Mira offers affordable physician visits, prescriptions, urgent care, and more. Sign up for Mira today!
Sophie is a 2024 Pharm D. candidate studying pharmacy at Rutgers University, New Brunswick. She has a passion for healthcare and writing and hopes to make meaningful contributions to healthcare transparency and accessibility. In her free time, she likes to take care of her houseplants, cook, and hang out with her cat.
