Signing up for health insurance can be confusing, but it doesn’t have to be. We at Mira compiled a step-by-step guide for signing up for an ACA health plan through the New York marketplace. To get the most realistic prices, we created a profile fitting a single 30-year-old self-employed person with no children seeking health insurance.
Signing Up for an ACA Plan in New York
New York is one of 17 states that operate ACA plans through their state-run health exchange as opposed to the federal government-run marketplace, Healthcare.gov. There are many steps to follow for navigating the NY-state healthcare exchange that we will outline below.
The state of New York’s official health insurance exchange is named the NY State of Health and can be found here. When entering the site, you must create an account by providing an email address and basic information about yourself. The NY State of Health exchange is used primarily by people who do not have health insurance through a job or Medicare.
When is New York’s open enrollment period?
Open enrollment is approaching, spanning November 16th, 2022, through January 31st, 2023. This is when you will want to sign up in New York for an ACA health plan. Also extremely helpful is understanding the key and recurring terms that will appear while searching for a plan. Key terms and their definitions, such as premium, deductible, and much more, can be found in this Mira article.
If you do not sign up for a plan through the NY-state health exchange during their open enrollment period, you may still be eligible to apply during a special enrollment period. You can qualify for special enrollment if you have experienced a qualifying life event.
Step 1 - Have All Relevant Information Ready
You will want to have the following information prepared when applying. This will include the following:
- Your Basic Information
- Social Security Information
- Household Information
- Any existing health insurance coverage
- Household Income
- Children’s Basic Information
- Spouse’s Basic Information
- Home/Mailing Address
- Street Address
- Zip code
- Information About Everyone
- Basic information about everyone applying for coverage under you
- Current Health Coverage Information
- Employer Information
- Health Reimbursement Arrangement Notice (HRA) if applicable
Step 2 - Knowing What You Should Consider When Browsing Plans
You want to consider many things when browsing plans available to you. These include:
- Your monthly budget - How much can you afford to pay each month?
- Plan and Provider Network - Do the health care providers, hospitals, and pharmacies that you prefer fall within the prospective plan’s network?
- How you want to apply - there are many alternative ways to apply instead of using the NY State online marketplace. These include:
- Enrolling over the phone at 1-855-355-5777 (TTY: 1-800-662-1220)
- With the help of training and certified Enrollment Asistor or Broker, at no cost to you.
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Step 3 - Select the Best Option for Your Needs
This involves creating an account and browsing through plans that appear once you input your personal and specific information. On the NY State of Health Marketplace, you will input the information you have gathered in step 2 and generate a list of plan options.
You will want to take your time and look at all plan options, ensuring you understand what is and is not included in each plan. Once you decide on a plan, you will select it and enroll. Your coverage will start when you pay your first premium.
Most plans are organized by metal tiers, which help determine how you and your plan will split the cost of care. Four metal tier categories include Bronze, Silver, Gold, and Platinum. The average premium for individual health insurance in 2022 for the state of New York was as follows: Bronze - $429, Silver - $569, and Gold - $724.
The New York exchange has twelve insurers offering individual health plans that vary from county to county. These twelve insurers are:
- Capital District Physicians Health Plan
- Empire Blue Cross HealthPlus and Empire Blue Cross Blue Shield HealthPlus
- Excellus (Excellus Blue Cross Blue Shield in Central NY and Univera in Western NY)
- Fidelis Care
- Health Insurance Plan of Greater New York (EmblemHealth)
- Highmark (Highmark of Northeastern NY and Highmark of Western NY)
- Independent Health
- MetroPlus Health Plan
- MVP Health Care
- Oscar Insurance Corporation
- United Healthcare of New York, Inc.
For this specific article, we are looking at the most affordable plans for a single 30-year-old self-employed individual with no dependents living in New York. That said, information about “Household” will only include your information as you have no spouse, kids, or dependents to report on.
As a self-employed individual, meaning you have a business that takes in income but does not have any employees, there will be some variation in your ACA plan application. You will have to estimate your net self-employment income for the year you plan to get coverage. This can be challenging with the unpredictability of self-employment. However, this tool helps estimate your self-employment income. Below are some NY state ACA plans available for this profile by metal-tier.
NY-State ACA Plans for a Single Self-Employed Individual by Metal Tier
Metro Plus Health SilverPrime-S1
Metro Plus Health GoldPrime-G1
3 of 5 stars
3 of 5 stars
3 of 5 stars
Source: NY State of Health
Signing Up For An ACA Health Plan Frequently Asked Questions (FAQs)
Consider this additional information when signing up for an ACA health plan in New York as a single self-employed individual.
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Are there any requirements for eligibility to sign up for a New York ACA Plan?
Yes, to be eligible to sign up for a plan in the NY-State Health Exchange, you must:
- 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
- Cannot be applying for coverage of nursing home care or care provided in a Residential Treatment Facility for Children and Youth, Developmental Center, or Intermediate Care Facility for the Developmentally Disabled
Are There Ways To Make An ACA Health Plan More Affordable?
The good news is that if you qualify for any programs that could lower health insurance costs, the marketplace will tell you! After inputting your personal and income information, the marketplace will determine if you qualify for insurance affordability programs. These include Medicaid, Child Health Plus, the Essential Plan, Advance Premium Tax Credits, or Cost-Sharing Reductions.
Can I Use the Federal HealthCare Marketplace instead of New York’s Exchange?
No, if you are a resident of New York, you must use their state-run ACA exchange. If you attempt to sign up or search for plans using Healthcare.gov, it will direct you to the NY-State Healthcare Exchange.
The best thing to do when enrolling in an ACA health plan is to be prepared. The application will require details about you, your family members, and your income. Make your first premium payment, if any, to complete your enrollment and for coverage to begin.
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.