New York Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
August 27, 2020

New York Affordable Healthcare Insurance

There are quite a few health insurance carriers and plan options for the residents of New York. It’s important to understand benefits and coverage before comparing rates carefully. If you’re buying a plan as an individual or you’re buying coverage for a family, you can buy the coverage you need at the best prices by comparing your options with SmartFinancial. Keep in mind that you may only enroll in a health plan during open enrollment, unless you are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in New York?

October 15, 2020 - January 31, 2021. Coverage begins January 2021.

How to Get Health Insurance in New York

To get a good idea of which plan fits your needs and budget, it’s a good idea to review your past year’s healthcare needs and costs. If you visited doctors several times in a year and paid a copay each time, it may make sense to buy a higher tier plan. If you went to the doctor once only and expect your health to remain vital, a bronze plan may be more economical. It’s important to look at the big picture and not get too stuck on which premium costs less because there are deductibles, copays and coinsurance to consider as well.

Get the most competitive rates for the health plan that fits your needs by comparing health insurance companies and health insurance quotes. After you submit the form from SmartFinancial you’ll get health insurance rates, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions about the plans you may be considering.

What Types of Health Insurance Are Available in New York?

In addition to short-term health coverage and catastrophic plans, HMOs, EPOs, PPOs and POS plans are available in New York. You can also select a plan based on which tier fits your needs. In New York you have the option of all the tiers, bronze, silver, gold and platinum. A bronze plan will pay 60% of costs, a silver plan 70%, gold 80% and platinum 90%. Someone with a chronic condition who receives multiple treatments in a given month or year may benefit from the platinum plan whereas a healthy 27 year old who only gets an annual checkup may consider a bronze plan.

Does Health Insurance Cover Pre-existing Conditions?

Yes, the Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • Lost or quit a job. If you lost your job, quit your job or started a new business, you qualify to buy health coverage during the special enrollment period. If you got a new job that does not offer health insurance, you qualify to buy health insurance outside the open enrollment period too.
  • Turned 26. If you had health coverage through a parent’s plan and turned 26, you can enroll in a new health plan.
  • Moved to another state or out of a coverage area. Some health plans are only valid in certain areas. If you lost coverage after moving, you can sign up for a new health plan.
  • Cobra coverage ended. If you had Cobra coverage which reached the deadline, you can enroll in a new health plan.
  • Divorce. Married people often share a health plan. If you did just that but divorced, you may sign up for a new health plan.
  • Marriage. Married people can buy individual plans or one together. If you just got married, you can enroll in a new plan, either together or separately.
  • Birth or adoption. If you became a parent outside the open enrollment date, you can buy health insurance for that child.
  • Death of spouse or partner. If you were covered under your spouse or partner’s health plan but that person passed away, you can enroll in a new health insurance plan.
  • Spouse of partner loses coverage. If your partner or spouse lost his/her coverage for any qualifying reason and you shared a plan with him/her, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in New York?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in New York?

The average cost of health insurance in New York for a 40 year old is about $478 a month. Health insurance becomes more expensive as you age. Tobacco use increases health insurance rates.

How to Save on Health Insurance in New York

The best way to save on health insurance in New York is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs

Medicare in New York

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in New York?

19% of the people in New York are on Medicare.

How Much Is Medicare in New York?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan for qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B, along with dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in New York

It’s important to find out if you need to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in New York?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

New York State Health System Ranking

  • New York: Overall State Ranking: 14 of 51
  • New York: Overall Performance: Better than Average
  • New York: Access & Affordability: 17
  • New York: Prevention & Treatment: 26
  • New York: Avoidable Hospital Use & Cost: 36
  • New York: Healthy Lives: 7
  • New York: Health Care Disparities: 2

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New York Health Insurance Coverage

The people of New York have different kinds of health insurance while some New York residents are not insured at all. See the breakdown below:

  • Private coverage: 48%
  • Medicaid: 26%
  • Medicare: 19%
  • Uninsured: 7%

New York Health Insurance Companies

  • MVP
  • Oscar Health Insurance Plan
  • Empire Blue Cross Blue Shield
  • Excellus Blue Cross Blue Shield
  • Affinity Health Plan
  • Capital District Physicians Health Plan
  • Crystal Run Health Plan
  • EmblemHealth
  • Fidelis Care
  • GHI (Group Health Incorporated)
  • Healthfirst New York
  • HealthNow
  • Independent Health
  • Molina Healthcare
  • Oxford Health Plans
  • UnitedHealthcare
  • Univera Healthcare

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