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What to expect at the New York State Health Insurance Marketplace on October 1st

Sep 27th, 2013

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New York State Health Insurance

Credit: Glyn Lowe Photoworks, via Flickr under Creative Commons

On October 1st we finally get to see a bit of what the Affordable Care Act is made out of. That’s less than a week away as of this writing (4 days actually).

In case you haven’t heard yet, the Affordable Care Act’s state health insurance marketplaces will open for business starting on October 1st. These online marketplaces are where residents in  each of their respective states can purchase subsidized health insurance that meets the standards of the Affordable Care Act.

For this article we’re going to be focusing on what to expect from the New York State marketplace, also know as “A New York State of Health”, but a lot of the general information discussed here will likely be applicable in your home state.

So let’s dive in!


The basics

First some basics about the Affordable Care Act so we can give those just tuning in some context. Back in March 2010, President Obama signed into law the Affordable Care Act (ACA), now more commonly known as Obamacare.

The ACA is a sweeping piece of legislation whose primary goal is to overhaul the American health care system and extend comprehensive, affordable health insurance to as many Americans as possible.

It does this through a (fairly) complicated system of subsidies, tax penalties, and health insurance marketplaces as ways to incentivize people to buy health insurance, and at the same time help lower the cost of insurance for those who couldn’t normally afford it.


So what’s happening on October 1?

The primary avenue for most uninsured people buying health insurance under the ACA will be their state’s health insurance marketplace (as discussed in the intro). The ACA required every state to either establish their own health insurance marketplace or allow the federal government to establish and run it for them.

So the significance of October 1st will be that it’s the day when the marketplaces open and residents can begin shopping for health insurance.


New York State Health Insurance Marketplace

In New York State the marketplace will be selling health insurance policies from 20 different companies, available in different prices and configurations depending on your location throughout the state.

The thing to know about the policies at a New York State of Health is that they’re available in four different metal coded tiers: Bronze, Silver, Gold, and Platinum.

Just like their values in real life, Bronze is the plan tier with the cheapest monthly premiums, and Platinum is the one with the most expensive premiums. Why one tier is cheaper than the other has to do with the amount of out-of-pocket costs at each tier. For example, Bronze plans are the cheapest per month but come with higher copays and deductibles. While Platinum plans cost the most every month, they have the lowest copays and deductibles on the market.

For a detailed description of the differences between the plan tiers check out our comprehensive guide to the New York State health insurance marketplace:



How much will it cost me?

Rates will differ depending on which part of the state you’re living in. New York State has been split up into eight different health insurance regions: Albany, Buffalo, Mid-Hudson, New York City, Rochester, Syracuse, Utica, and Long Island.

Plans in certain regions will be more expensive than others. For example in the Mid-Hudson Region a Silver tier Empire HMO plan will cost an individual $514.41 per month, while the same plan in New York City costs 468.43, and in Utica it costs $694.24.

(*Note Aetna will not longer be selling plans at the New York State marketplace*)

If those monthly numbers appear to be alarmingly expensive at first keep in mind that those figures are before any of the ACA health insurance subsidies are factored in. Remember when I said that the ACA marketplaces were where you could buy subsidized health insurance?



To qualify for a health insurance subsidy at the New York State marketplace, your annual income needs to be between 133 percent and 400 percent of the Federal Poverty Line. That’s roughly between $11,490 for an individual or $19,530 for a family of three, and $46,000 for an individual or $78,000 for a family of three.

If you meet those qualifications and don’t already get health insurance through your or your spouse’s job then, you get a subsidy if you buy health insurance at the marketplace. How much that subsidy will be depends on a range of factors. I recommend that you use our healthcare reform calculator to see how much you’ll save.

Another calculator I’d recommend is from the Kaiser Family Foundation.


So what should I do on October 1st?

Be prepared to shop for health insurance

The first and best advice we can give is that you should not rush into the marketplace and buy the first plan you see. You must take some time and assess your specific health insurance needs before logging on. Ask yourself some questions like “How many people will be covered by this plan?”, “Do I or anyone else joining my plan have a condition that will require special care?”, “How often will I or my dependents see the doctor?”, and perhaps most importantly, “How much am I willing to spend?”.

It’s important to know that every plan sold at the New York State marketplace covers medical services in all 10 essential benefits categories of the Affordable Care Act.


You can drop subsidized coverage, but it’s hard to get it back.

Another reason to be careful picking a plan at the marketplace is that once you buy a plan you’re locked into it for a year. Before the ACA if you bought a plan and didn’t like it you could cancel the plan and then immediately buy another one so long as it was a plan through another company and not the same one you just left.

While that first part is still true, you can cancel your plan at any time under the ACA, you cannot re-enroll right away in another plan at the marketplace even if you buy from a different company.  You would have to wait until the next open enrollment period in the fall to buy another subsidized plan. At that point, you could always decide to buy a plan at the private market, but you would receive no subsidies for it.


Do your homework

One more thing to keep in mind during your health insurance search is that certified marketplace navigators and call center staff are not allowed to make health insurance recommendations to you. This means that these groups of people, while helpful for explaining the technical aspects and procedures of the marketplace, cannot legally recommend a health insurance plan to you.

The only options for you are to either study up on the plans being offered yourself or consult with a health insurance broker who is certified to sell the New York State of Health insurance plan.

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email [email protected]