4 Types of Plans Available On The NY State of Health Marketplace
The NY State of Health is an organized marketplace designed to help people shop for and enroll in health insurance coverage. It provides a variety of health plan options that cater to different needs and budgets. For those seeking coverage in 2024, it is crucial to understand the differentiated plan types available on the marketplace to make an informed choice.
Qualified Health Plans (QHPs) are comprehensive health insurance policies that cover a set of Essential Health Benefits. In 2024, there will be twelve health insurers offering QHPs in the individual market. These plans are categorized into metal tiers—Platinum, Gold, Silver, Bronze, and Catastrophic—each representing a level of coverage and associated costs.
The Essential Plan (EP) is designed for lower-income individuals who do not qualify for Medicaid and need affordable coverage. As of 2024, twelve insurers are providing Essential Plans with coverage variation available in different counties.
Small Business Marketplace (SHOP) is tailored for small businesses seeking to provide health insurance to their employees. There are seven insurers offering options in the SBM, with over 1,700 policies to choose from.
Lastly, Stand Alone Dental Plans (SADPs) offer dental-only coverage, separate from health insurance, with options both for individuals and families. Dental plans comply with pediatric dental coverage essential health benefits and may also offer adult dental coverage.
II. When Can I Enroll Into An ACA Health Plan in NY?
Navigating the open enrollment window is critical to securing health insurance coverage for the 2024 plan year. Here are the dates New Yorkers need to mark on their calendars:
Open Enrollment Period
The window to enroll in a plan runs from November 16, 2023, through to May 31, 2024. During this time, individuals can enroll in a Qualified Health Plan (QHP) or change their QHP selection.
Coverage Start Dates by Enrollment Periods
Depending on when you complete your enrollment, coverage start dates are as follows:
| Enrollment Period | Coverage Start Date |
|---|---|
| Oct 16 - Nov 15, 2023 | December 1, 2023 |
| Nov 16 - Dec 15, 2023 | January 1, 2024 |
| Dec 16, 2023 - Jan 15, 2024 | February 1, 2024 |
| Jan 16 - Feb 15, 2024 | March 1, 2024 |
| Feb 16 - March 15, 2024 | April 1, 2024 |
| March 16 - April 15, 2024 | May 1, 2024 |
| April 16 - May 15, 2024 | June 1, 2024 |
| May 16 - May 31, 2024 | July 1, 2024 |
Additional Enrollment Details
For residents needing immediate coverage due to special circumstances or life events, specific Special Enrollment Periods (SEPs) may also be available outside of the stated Open Enrollment dates. New Yorkers are encouraged to apply as early as possible within the Open Enrollment period -- this not only ensures coverage starts earlier but also provides adequate time for any potential application processing. This extended Open Enrollment Period (OEP) is under the marketplace's exceptional circumstance SEP authority due to the Public Health Emergency unwind.
III. Qualified Health Plan Options in 2024
In the individual market, New Yorkers can choose from plans offered by 12 different health insurers for their Qualified Health Plans (QHPs). In a notable expansion for 2024, Highmark is set to extend its coverage into Schoharie County, providing more options for residents there. Depending on the county, consumers will have between two (2) to seven (7) insurer options to choose from. Most counties offer at least four (4) different insurers, presenting a variety of choices for coverage.
How Much Do QHPs Cost for One Person in NY?
| Individual plan tier | 2023 Monthly Premium | 2024 Monthly Premium | Increase | Lowest | Highest | Count of Plans |
|---|---|---|---|---|---|---|
| Catastrophic | $359 | $418 | 16.3% | $268 | $693 | 6 |
| Bronze | $706 | $800 | 13.4% | $619 | $1,312 | 18 |
| Silver | $945 | $1,069 | 13.1% | $805 | $1,704 | 18 |
| Gold | $1,112 | $1,260 | 13.3% | $984 | $2,053 | 16 |
| Platinum | $1,355 | $1,544 | 13.9% | $1,173 | $2,487 | 14 |
| Grand Total | $953 | $1,082 | 13.5% | $268 | $2,487 | 72 |
How Much Do QHPs Cost for A Family in NY?
| Family Plans | 2023 Monthly Premium | 2024 Monthly Premium | Increase | Lowest | Highest |
|---|---|---|---|---|---|
| Catastrophic | $1,024 | $1,191 | 16.3% | $763 | $1,974 |
| Bronze | $1,898 | $2,237 | 17.9% | $1,764 | $3,738 |
| Silver | $2,976 | $2,854 | -4.1% | $2,197 | $4,855 |
| Gold | $2,445 | $3,378 | 38.2% | $2,788 | $5,850 |
| Platinum | $3,708 | $4,221 | 13.9% | $3,344 | $7,088 |
| Grand Total | $2,588 | $3,020 | 16.7% | $763 | $7,088 |
Standard Product Must-Knows:
Essential Health Benefits (EHB): Each standard QHP is required to include EHBs, which cover a set of 10 categories, such as outpatient care, emergency services, hospitalization, maternity and newborn care, mental health services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services.
Cost Comparisons for Deductibles and Maximum Out-of-Pocket (MOOP):
| Metal Level | Deductible 2023 | Deductible 2024 | Max Out of Pocket 2023 | Max Out of Pocket 2024 |
|---|---|---|---|---|
| Platinum | $0 | $0 | $2,000 | $2,000 |
| Gold | $600 | $600 | $4,750 | $5,900 |
| Silver | $1,750 | $2,100 | $9,100 | $9,450 |
| Silver (>200 -<250 FPL) | $1,625 | $1,925 | $7,250 | $7,550 |
| Silver (>150 -<200 FPL) | $250 | $275 | $2,800 | $3,150 |
| Silver (>100 -<150 FPL) | $0 | $0 | $1,000 | $1,000 |
| Bronze | $4,700 | $4,600 | $8,700 | $9,450 |
| Catastrophic | $9,100 | $9,450 | $9,100 | $9,450 |
Non-Standard Products:
Number of insurers offering non-standard products: 10 insurers will provide various non-standard QHPs, which may include benefits not found in standard products. These non-standard QHPs could offer supplementary benefits such as Adult/Family Dental coverage, Adult/Family Vision coverage, Telemedicine services, and even Acupuncture, which are tailored to meet diverse consumer needs.
IV. Essential Plans for 2024
There are 12 insurers confirmed to offer Essential Plans (EP) in New York for the year 2024. Depending on the county of residence, New Yorkers will find they have between two to seven insurer options for Essential Plans. To provide perspective, the majority of counties will present at least four insurer choices, giving consumers a range of selections to match their health care needs.
| Essential Plan 1 | Essential Plan 2 | Essential Plan 3 & 4 | |
|---|---|---|---|
| Income Eligibility | 150%-200% FPL | 138%-150% FPL | Up to 138% FPL |
| Premium | $0 | $0 | $0 |
| Deductible | $0 | $0 | $0 |
| Maximum Out-of-pocket | $360 | $200 | $0 |
| Vision and Dental Cost Sharing | Included with no additional cost and no co-pay for services | Included with no additional cost and no co-pay for services | Included with no additional cost and no co-pay for services |
| Additional Benefits | N/A | N/A | Additional benefits include non-emergency transportation, non-prescription drugs, orthotic services and orthotic footwear. |
- Up to 138% FPL: For a single individual, this would be 138% of the Federal Poverty Level. If the FPL were $13,590, this would be approximately $18,754.
- 138%-150% FPL: This range would be between 138% and 150% of the FPL. Using the same base FPL of $13,590, this income range would be approximately $18,754 to $20,385 for a single individual.
- 150%-200% FPL: This range would be between 150% and 200% of the FPL. Again, using $13,590 as the base, this would translate to an income range of approximately $20,385 to $27,180 for a single individual.
Network and Coverage Area Expansion
Recent Expansion Mention: Notably, MVP Health Care broadened its reach by expanding into eight additional counties in May 2023, including Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Montgomery, and St. Lawrence. This expansion means increased options for residents in these areas, potentially enhancing the competition and offering more comprehensive coverage networks.
Who Are Essential Plans For?
Essential Plans are designed to provide a low-cost insurance option for lower-income individuals who do not qualify for Medicaid. These plans often include all the essential health benefits with very low or no premiums and minimal out-of-pocket costs. Such benefits typically cover preventive care, emergency services, prescription drugs, and more.
Selecting the Right Plan
While 12 insurers provide Essential Plans, each may offer different benefits, networks of providers, or additional perks, so it’s crucial to compare what each one provides. NY State of Health offers comparison tools and resources to assist in evaluating the range of Essential Plans. These tools help to assess factors such as included benefits, provider networks, and consumer reviews of the insurance companies.
V. Small Business Marketplace (SBM)
Seven (7) insurers are set to offer coverage through the New York Small Business Marketplace in 2024. Over 1,700 policy options are made available to small businesses, ensuring a wide range of choices.The variety of insurer choices ranges between one (1) and six (6), depending on the county.
Healthy NY Program
Healthy NY coverage will be offered in every county across the state in 2024, with insurers EmblemHealth, MVP Health Care, and Excellus/Univera continuing their participation. Healthy NY, in conjunction with federal small business tax credits, offers substantial cost benefits to qualifying small employers.
Federal Tax Credit Access Through SBM Direct Enrollment
The Direct Enrollment option in NY’s SBM facilitates easier access for small businesses to the Federal Small Business Health Care Tax Credit. The tax credit can significantly lower the cost of providing health insurance for employees, making it a crucial consideration for small business owners.
VI. Dental Plan Information
A variety of SADPs will be available for individuals in New York for the year 2024. For pediatric dental, the maximum out-of-pocket costs allowed have increased to $400 for an individual child and $800 for multiple children.
Coverage Details
Upon enrollment in a SADP, adults will receive basic dental coverage immediately. Certain SADPs may include waiting periods before specific benefits become available. Plans with such waiting periods will be identified with "WP" in their plan names.
Choosing a Dental Plan
- Dental Plan Comparison Tool: This online resource is available at https://info.nystateofhealth.ny.gov/dental/dental-tool and allows consumers to compare pediatric, family dental plans, and QHPs that include dental benefits, by county.
- Use of the Tool: By factoring in the type of coverage desired and the user's county of residence, the tool helps narrow down the choices to the most applicable dental plans available.
VII. Tools for Choosing a Plan
Selecting the right health insurance plan can be complex, but several resources are provided by NY State of Health to assist you in making an informed decision for 2024. The "Plans by County Search Tool" allows you to easily identify which health and dental plans are available in your county, ensuring you explore all potential options. Access the tool at https://info.nystateofhealth.ny.gov/plans-by-county
If you are keen to understand which hospitals participate in a health insurer's network, utilize the "Hospital Participation Search Tool" provided at https://info.nystateofhealth.ny.gov/hospital-participation. This is particularly useful for assessing whether your preferred hospitals and healthcare facilities are covered.
Diligence is key when reviewing provider networks and health plans. The "NYS Provider & Health Plan Look-Up Tool" is an online utility that helps research which healthcare providers and facilities are associated with different plans. It’s available at https://pndslookup.health.ny.gov
For those interested in estimating potential premiums and available tax credits without providing personal information, the "NYSOH Anonymous Plan Search Tool" serves as an excellent starting point. Find the tool at https://nystateofhealth.ny.gov/individual
Lastly, the "QHP Out-of-Pocket Cost Estimator" is a valuable resource for comparing expected annual costs across different standard and non-standard plans, taking into account your estimated medical needs. It can be a significant aid in financial planning for potential healthcare expenses. Visit the estimator tool here: https://info.nystateofhealth.ny.gov/cost-estimator
FAQ Section: Shopping for Health Insurance in New York
Q: When is the Open Enrollment period for health insurance in 2024 in New York?
A: The Open Enrollment period for 2024 runs from November 16, 2023, to May 31, 2024.
Q: If I enroll in a plan, when does my coverage start?
A: Coverage start dates depend on when you enroll. For instance, if you enroll between November 16 and December 15, 2023, your coverage begins January 1, 2024. There are specific date ranges that determine your coverage start date throughout the Open Enrollment period.
Q: How many health insurance options do I have in New York?
A: The number of insurance options varies by county, ranging from two to seven insurers. In general, you will find at least four insurer options available.
Q: What is a Qualified Health Plan (QHP)?
A: A QHP is an insurance plan that meets the affordability and coverage standards set by the Affordable Care Act and is sold through the NY State of Health Marketplace.
Q: What is the Essential Plan?
A: The Essential Plan is an affordable health insurance plan for eligible New Yorkers with low to moderate incomes. It covers all essential health benefits and has low monthly premiums and out-of-pocket costs.
Q: What are the differences between standard and non-standard QHPs?
A: Standard QHPs must offer essential health benefits and have the same cost-sharing structure across all insurers. Non-standard QHPs may offer additional benefits, such as adult dental or vision care, and can have varying cost-sharing structures.
Q: What is the maximum out-of-pocket cost for pediatric dental in 2024?
A: For 2024, the maximum out-of-pocket cost for pediatric dental cannot exceed $400 for an individual or $800 for a family.
Q: How can I compare the costs of different health plans?
A: You can use the QHP Out-of-Pocket Cost Estimator tool available on the NY State of Health website to compare estimated premiums and out-of-pocket costs for different plans based on your household information and medical cost estimates.
Q: Can I receive assistance in selecting the right health plan?
A: Yes, you can seek assistance from various sources. You can use the NY State of Health's online anonymous plan search tool, consult directly with insurance assistors, or use the NYS Provider & Health Plan Look-Up tool for more personalized support. If you have specific questions, you can email Eligibility.Training.Support@health.ny.gov or call the NY State of Health Customer Service Center.
Q: Are tax credits available to help lower the cost of my health insurance premium?
A: Yes, there are federal tax credits available for those who qualify based on income and other factors. The anonymous plan search tool can help estimate your eligibility and the amount of financial assistance you could receive.
Q: What if I'm a small business owner? Can I still get health insurance through the NY State of Health?
A: Small business owners can explore health insurance options through the Small Business Marketplace (SBM). They may also qualify for Healthy NY offerings and federal small business health care tax credits. There are seven insurers offering diverse policies.