Health insurance is a vital service that can protect you and your family from the high costs of medical care.
However, choosing a health insurance plan can be challenging, especially in a state like New York which has many options and regulations.
In this article, we will help you understand how health insurance works in New York, what are some of the top health insurance providers in the state, and how to apply for health insurance in New York.
Understanding Health Insurance in New York
The Affordable Care Act (ACA)
The Affordable Care Act (ACA), also known as Obamacare, is a federal law that aims to make health insurance more accessible and affordable for Americans.
The ACA has several provisions that affect health insurance in New York, such as:
- Expanding Medicaid eligibility to low-income adults and children.
- Creating a health insurance marketplace where individuals and small businesses can compare and buy health insurance plans.
- Providing subsidies and tax credits to help lower-income people pay for health insurance premiums and out-of-pocket costs.
- Requiring most people to have health insurance or pay a penalty (this requirement was repealed by Congress in 2017, but some states still have their own individual mandate).
- Prohibiting insurers from denying coverage or charging more based on pre-existing conditions, gender, or age.
- Establishing essential health benefits that all health insurance plans must cover, such as preventive care, maternity care, mental health services, and prescription drugs.
The New York Health Insurance Marketplace
The New York Health Insurance Marketplace is the state-run exchange where you can shop for health insurance plans that meet the standards of the ACA.
You can access the marketplace online at nystateofhealth.ny.gov, by phone at 1-855-355-5777, or in person at local enrollment centers or navigators.
The marketplace provides four plan types: bronze, silver, gold, and platinum. These plans differ in how much they cover and how much you pay in premiums, deductibles, copayments, and coinsurance.
Generally, bronze plans have the lowest premiums but the highest out-of-pocket costs, while platinum plans have the highest premiums but the lowest out-of-pocket costs.
The marketplace also offers a fifth type of plan called the Essential Plan, which is a low-cost option for people who earn too much to qualify for Medicaid but not enough to afford a regular plan.
The Essential Plan covers the same benefits as other plans, but with no deductibles and low copayments. The monthly premium for the Essential Plan ranges from $0 to $20, depending on your income.
Medicaid and Child Health Plus
Medicaid is a joint federal-state program that provides health insurance for low-income people who meet certain eligibility criteria, such as age, disability, pregnancy, or family status.
In New York, Medicaid covers a wide range of services, including doctor visits, hospital stays, prescription drugs, dental care, vision care, and long-term care.
Child Health Plus is a state program that provides health insurance for children under 19 who are not eligible for Medicaid or have no other health insurance.
Child Health Plus covers the same services as Medicaid, plus additional benefits such as hearing aids, speech therapy, and orthodontia.
The monthly premium for Child Health Plus depends on your income and family size, but it is never more than $60 per child.
You can apply for Medicaid or Child Health Plus through the New York Health Insurance Marketplace or directly through the New York State Department of Health.
Top Health Insurance Providers in New York
There are several health insurance providers in New York, each with its own strengths and weaknesses.
Some of the best health insurance providers in New York include:
1. CDPHP
Capital District Physicians’ Health Plan is a non-profit health plan that serves 24 counties in upstate New York. CDPHP offers a variety of plans for individuals, families, and businesses, with an emphasis on wellness and preventive care. CDPHP has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Affordable rates, comprehensive benefits, wellness programs, and high-quality care.
Cons: Limited service area, narrow provider network, high deductibles for some plans.
2. HealthNow New York
HealthNow New York is the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. HealthNow offers a range of plans for individuals and groups, with options for health savings accounts (HSAs) and flexible spending accounts (FSAs). HealthNow has a strong reputation for quality and innovation and a broad network of providers and facilities.
Pros: Competitive prices, wide provider network, innovative solutions, HSA and FSA options.
Cons: High deductibles and copayments for some plans, limited plan choices for individuals.
3. Independent Health
Independent Health is a non-profit health plan that serves western New York. Independent Health offers a variety of plans for individuals, families, and employers, with features such as telemedicine, wellness programs, and fitness discounts. Independent Health has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Affordable rates, comprehensive benefits, telemedicine services, wellness incentives.
Cons: Limited service area, narrow provider network, high deductibles for some plans.
4. MVP Health Care
MVP Health Care, a non-profit health plan, serves New York, Vermont, and New Hampshire. MVP offers a range of plans for individuals, families, and businesses, with options for HSAs and FSAs. MVP has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Reasonable prices, extensive provider network, HSA and FSA options, wellness programs.
Cons: Limited service area, high deductibles, and copayments for some plans, limited plan choices for individuals.
5. Excellus BlueCross BlueShield
Excellus BlueCross BlueShield is a non-profit health plan that serves central and northern New York. Excellus offers a variety of plans for individuals, families, and employers, with options for HSAs and FSAs. Excellus has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Affordable rates, comprehensive benefits, HSA and FSA options, wellness programs.
Cons: Limited service area, narrow provider network, high deductibles for some plans.
6. United Healthcare
United Healthcare is one of the largest health insurance companies in the nation, with plans available in all 50 states. United Healthcare offers a range of plans for individuals, families, and businesses, with options for HSAs and FSAs. United Healthcare has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Wide service area, expansive provider network, HSA and FSA options, wellness programs.
Cons: High premiums for some plans, high deductibles, and copayments for some plans, above average number of customer complaints.
7. Oxford Health Plans
Oxford Health Plans is a subsidiary of United Healthcare that serves New York, New Jersey, and Connecticut. Oxford offers a variety of plans for individuals, families, and employers, with options for HSAs and FSAs. Oxford has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Wide network of providers, Affordable premiums, Good customer service
Cons: High deductibles, Fewer plan options
8. Empire Blue Cross Blue Shield
Empire Blue Cross Blue Shield is a subsidiary of Anthem that serves New York City and surrounding counties. Empire offers a variety of plans for individuals, families, and businesses, with options for HSAs and FSAs. Empire has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Wide service area, expansive provider network, HSA and FSA options, wellness programs.
Cons: High premiums for some plans, high deductibles, and copayments for some plans, above average number of customer complaints.
9. Humana
Humana is one of the largest health insurance companies in the nation, with plans available in 22 states. Humana offers a range of plans for individuals, families, and businesses, with options for HSAs and FSAs. Humana has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Wide service area, expansive provider network, HSA and FSA options, wellness programs
Cons: High premiums for some plans, high deductibles, and copayments for some plans, above average number of customer complaints
10. Cigna Healthcare
Cigna Healthcare is one of the largest health insurance companies in the nation, with plans available in 30 states. Cigna offers a range of plans for individuals, families, and businesses, with options for HSAs and FSAs. Cigna has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Home delivery for prescriptions, Health management mobile apps, Easy ID card replacement
Cons: Potentially high deductibles, Not available in all 50 states
11. Kaiser Permanente
Kaiser Permanente is a non-profit health plan that serves eight states and the District of Columbia. Kaiser offers a range of plans for individuals, families, and employers, with an integrated model of care that combines insurance, doctors, hospitals, and pharmacies. Kaiser has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Integrated model of care, comprehensive benefits, wellness programs, low-cost plans available
Cons: Limited service area, narrow provider network, no HSA or FSA options
12. BlueCross BlueShield of Western New York
BlueCross BlueShield of Western New York is a subsidiary of HealthNow New York that serves eight counties in western New York. BlueCross BlueShield of Western New York offers a variety of plans for individuals, families, and businesses, with options for HSAs and FSAs. BlueCross BlueShield of Western New York has a high customer satisfaction rating and a large network of doctors and hospitals.
Pros: Competitive prices, wide provider network, innovative solutions, HSA and FSA options
Cons: High deductibles and copayments for some plans, limited plan choices for individuals
Factors to Consider When Choosing a Health Insurance Plan in New York
When choosing a health insurance plan in New York, you should consider several factors, such as:
- Premiums and Deductibles: Premiums are the monthly payments you make to your health insurance provider to keep your coverage active. Deductibles are the amount you have to pay out of pocket before your insurance starts to pay for covered services. Generally, plans with lower premiums have higher deductibles, and vice versa. You should choose a plan that fits your budget and your expected healthcare needs.
- Provider Networks: Provider networks consist of doctors, hospitals, pharmacies, and other healthcare providers who have contractual agreements with your health insurance plan. You usually pay less when you use providers in your network than when you use providers outside your network. You should choose a plan that has a network that includes your preferred providers and is accessible in your area.
- Prescription Drug Coverage: Prescription drug coverage is the part of your health insurance plan that pays for some or all of the cost of your medications. Different plans may have different lists of covered drugs, called formularies, and different levels of cost-sharing, such as copayments or coinsurance. You should choose a plan that covers the drugs you need and charges reasonable prices.
- Coverage and Benefits: Coverage and benefits are the services and items that your health insurance plan pays for, either partially or fully. All health insurance plans must cover the same essential health benefits that all health insurance plans must cover under the ACA, such as preventive care, maternity care, mental health services, and prescription drugs. However, different plans may have different limits, exclusions, and cost-sharing arrangements for these benefits. You should choose a plan that covers the services you need and charges reasonable prices.
- Customer Service and Support: Customer service and support are the ways that your health insurance provider helps you with questions, issues, or complaints related to your plan. Different providers may have different methods of communication, such as phone, email, online chat, or mobile apps. You should choose a provider that has a responsive, friendly, and knowledgeable customer service team that can assist you when you need it.
