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New York Health Insurance Consumer Guide
We’ve created this guide to help you understand the health coverage options and financial assistance available to you and your family in New York. The options found in New York’s Marketplace may be a good choice for many consumers, and we will guide you through the options below.
New York residents use a fully state-run health insurance Marketplace known as NY State of Health to enroll in Marketplace plans. The Marketplace also provides residents access to apply for the state’s Basic Health Program known as the Essential Plan (BHP), which offers premium-free coverage to residents who don’t qualify for Medicaid or Child Health Plus.1
Dental coverage in New York
In 2023, seven insurers offer stand-alone individual/family dental coverage through NY State of Health.2
New York’s Medicaid program
Medicaid expansion in New York took effect in 2014. Total Medicaid enrollment in the state has increased to more than 7 million people in 2023.3
Medicare coverage and enrollment in New York
Medicare enrollment in New York stood at nearly 3.8 million people as of 2023.4 Our guide will help you better understand Medicare coverage options and Medicare-specific regulations in New York.
Short-term coverage in New York
The sale of short-term health plans is not permitted in New York.5
Frequently asked questions about health insurance in New York
Who can buy Marketplace health insurance?
To qualify for health coverage through the Marketplace, you must:6
- Live in New York
- Be lawfully present in the United States
- Not be incarcerated
- Not be enrolled in Medicare
Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
- Not be eligible for Medicaid or CHIP.
When can I enroll in an ACA-compliant plan in New York?
In New York, the open enrollment period has both a start and end date that differ from the schedule used in most other states.
Open enrollment in New York starts November 16, and continues through January 31.7
Enrollment in Medicaid, Child Health Plus, and the Essential Plan continues year-round for eligible people.
How do I enroll in a New York Marketplace plan?
To enroll in an ACA Marketplace plan in New York, you can:
- Visit NY State of Health to access New York’s Marketplace, an online platform where you can compare plans, determine whether you’re eligible for financial assistance, and enroll in the plan that best meets your needs.
- Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.8
How can I find affordable health insurance in New York?
New York residents use NY State of Health to enroll in health coverage as well as to determine eligibility for subsidies.
In the New York exchange, about 60% of enrollees were receiving premium subsidies as of early 2023 with an average subsidy of $364/month. After applying subsidies, enrollee premiums averaged $279/month.9
In addition to the private individual market plans available through the state exchange, more than 1.1 million people were enrolled in coverage through New York’s Essential Plan by mid-January 2023.10
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250%of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
How many insurers offer Marketplace coverage in New York?
Twelve insurers offer 2023 plans on the New York exchange:11
- Capital District Physicians’ Health Plan (CDPHP)
- Emblem (Health Insurance Plan of Greater New York)
- Excellus Health Plan
- Fidelis (New York Quality Health Care Corp.)
- Healthfirst PHSP
- Health Plus HP (formerly Empire)
- Highmark Western and Northeastern New York (formerly HealthNow)
- Independent Health Benefits Corporation
- Metro Plus Health Plan
- MVP Health Plan
- UnitedHealthcare of New York
Are Marketplace health insurance premiums increasing in New York?
The overall weighted average rate change for 2023 qualified health plans in New York amounted to an increase of 9.7%.12
This was larger than the national average for 2023, but it was only a little more than half of the rate increase that New York’s insurers had proposed for 2023.
Health insurance companies in New York have requested the following rate changes for 2024. (Note that these rates haven’t been approved by DFS yet.)13
New York’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company
|Capital District Physicians’ Health Plan (CDPHP)||23.5%|
|Emblem (Health Insurance Plan of Greater New York)||52.7%|
|Health Plus HP (formerly Empire)||20.7%|
|Excellus Health Plan||15.2%|
|Fidelis (New York Quality Health Care Corp)||18.2%|
|Highmark Western and Northeastern New York (formerly HealthNow)||22.6%|
|Independent Health Benefits Corporation||39.2%|
|Metro Plus Health Plan||26.4%|
|MVP Health Plan||13.3%|
|UnitedHealthcare of New York||20.9%|
Source: New York State Department of Financial Services13
It’s important to understand that net rate changes for people who receive premium subsidies can be quite different from the overall rate changes for that person’s plan, since it also depends on how the benchmark plan premium changes.
How many people are insured through New York’s Marketplace?
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Footnotes
- “Essential Plan Fact Sheet” nystateofhealth.ny.gov, March 2022
- “New York dental insurance guide 2023” healthinsurance.org, Accessed September 2023
- “April 2023 Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, April 28, 2023
- “Medicare Monthly Enrollment” CMS.gov, April 2023
- “Availability of short-term health insurance in New York” healthinsurance.org, March 3, 2023
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov
- “Enrollment Periods” newyorkstateofhealth.ny.gov, Accessed September 2023
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2023, 2023
- “Marketplace 2023 Open Enrollment Period Report: Final National Snapshot” CMS.gov, Jan. 25, 2023
- ”New York Rate Review Submissions” HealthCare.gov, 2023
- “DFS Announces 2023 Health Insurance Premium Rates” NY Dept. of Financial Services, April 17, 2022
- “2024 Individual and Small Group Requested Rate Actions” New York State Department of Financial Services, May 30, 2023
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, 2023
- “ASPE Issue Brief (2014)” ASPE, 2015
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022