New York Health Insurance Glossary
Understand the terms that matter when choosing health insurance in New York — from state programs to income rules and coverage types.
Affordable Care Act (ACA)
Federal health reform law that expanded coverage and created the New York State of Health marketplace.
Bronze Plan
A health insurance metal tier available in New York that covers about 60% of total healthcare costs.
Child Health Plus
A New York State health insurance program for children under 19 who do not qualify for Medicaid. Learn more.
Deductible
The amount you must pay for covered health care services before your plan starts to pay. NY plans vary by tier.
Essential Plan
A low-cost New York health plan for residents who don’t qualify for Medicaid or employer coverage. Learn more.
Federal Poverty Level (FPL)
Income threshold used to determine eligibility for Medicaid, the Essential Plan, and subsidies in New York.
Group Health Insurance
Coverage offered to employees and their dependents by employers. In NY, groups as small as one may qualify. Learn more.
Healthy NY
A NY State program offering affordable health insurance to small businesses and employees who meet certain criteria. See eligibility.
Income Limits
Guidelines that determine if you qualify for programs like Medicaid, Essential Plan, or subsidies through NYSOH.
MAGI (Modified Adjusted Gross Income)
The income calculation method used in NY to determine eligibility for Medicaid, Essential Plan, and subsidies. Learn how it’s used.
NY State of Health (NYSOH)
New York’s official health insurance marketplace where individuals, families, and small businesses can shop for plans. Explore now.
Open Enrollment
The yearly period when New Yorkers can enroll in or make changes to a health insurance plan through NYSOH.
PPO (Preferred Provider Organization)
A health insurance plan that allows NY enrollees to visit any doctor without referrals and includes nationwide access. Compare PPOs.
Qualified Health Plan (QHP)
Insurance plans certified by NYSOH that offer essential health benefits and meet established affordability standards. Explore QHPs.
Residency Requirement
To be eligible for most NY health insurance programs, you must prove state residency with documentation.
Self-Employed Health Insurance
Options available for NY freelancers, consultants, and business owners without W-2 employees. Includes PPOs and QHPs. Learn more.
Tax Credits
Subsidies available to NY residents based on income that reduce monthly premiums on Qualified Health Plans.
Uninsured Rate
The percentage of New York residents without health insurance. Programs like Essential Plan aim to lower this rate.
Vista Health Solutions
A New York–based health insurance brokerage that helps individuals, families, and businesses compare and enroll in plans. More about us.
Waiting Period
The time between applying for NY coverage and when your plan benefits begin, typically at the start of the next month.
Year-Round Enrollment
Available in NY for programs like Medicaid, Child Health Plus, and the Essential Plan regardless of the open enrollment period.
Affordable Care Act (ACA)
Federal health reform law that expanded coverage and created the New York State of Health marketplace.
Bronze Plan
A health insurance metal tier available in New York that covers about 60% of total healthcare costs.
Child Health Plus
A New York State health insurance program for children under 19 who do not qualify for Medicaid. Learn more.
Deductible
The amount you must pay for covered health care services before your plan starts to pay. NY plans vary by tier.
Essential Plan
A low-cost New York health plan for residents who don’t qualify for Medicaid or employer coverage. Learn more.
Federal Poverty Level (FPL)
Income threshold used to determine eligibility for Medicaid, the Essential Plan, and subsidies in New York.
Group Health Insurance
Coverage offered to employees and their dependents by employers. In NY, groups as small as one may qualify. Learn more.
Healthy NY
A NY State program offering affordable health insurance to small businesses and employees who meet certain criteria. See eligibility.
Income Limits
Guidelines that determine if you qualify for programs like Medicaid, Essential Plan, or subsidies through NYSOH.
MAGI (Modified Adjusted Gross Income)
The income calculation method used in NY to determine eligibility for Medicaid, Essential Plan, and subsidies. Learn how it’s used.
NY State of Health (NYSOH)
New York’s official health insurance marketplace where individuals, families, and small businesses can shop for plans. Explore now.
Open Enrollment
The yearly period when New Yorkers can enroll in or make changes to a health insurance plan through NYSOH.
PPO (Preferred Provider Organization)
A health insurance plan that allows NY enrollees to visit any doctor without referrals and includes nationwide access. Compare PPOs.
Qualified Health Plan (QHP)
Insurance plans certified by NYSOH that offer essential health benefits and meet established affordability standards. Explore QHPs.
Residency Requirement
To be eligible for most NY health insurance programs, you must prove state residency with documentation.
Self-Employed Health Insurance
Options available for NY freelancers, consultants, and business owners without W-2 employees. Includes PPOs and QHPs. Learn more.
Tax Credits
Subsidies available to NY residents based on income that reduce monthly premiums on Qualified Health Plans.
Uninsured Rate
The percentage of New York residents without health insurance. Programs like Essential Plan aim to lower this rate.
Vista Health Solutions
A New York–based health insurance brokerage that helps individuals, families, and businesses compare and enroll in plans. More about us.
Waiting Period
The time between applying for NY coverage and when your plan benefits begin, typically at the start of the next month.
Year-Round Enrollment
Available in NY for programs like Medicaid, Child Health Plus, and the Essential Plan regardless of the open enrollment period.