New York Health Insurance
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Facts and Figures
- Place in State
Health Report Card
18th
- Insured
16,553,022
- Uninsured
2,778,900
- Insurance
Carriers
17
- Number of
General Doctors
59280
- Number of
Hospitals
189
- Average Cost of
Health Insurance*
$947
Breakdown of Insureds
- Employer-sponsored health insurance 57%
- Private plans 5%
- Medicaid 24%
- Medicare 14%
State Health Report Card
In the last ten years, obesity went up from 17.7 percent to 24.5 percent among adults in New York. Today, there are 3.7 million obese adults living in New York.
There are more than 1.3 million adults with diabetes in New York, representing 8.9 percent of the adult population.
There are more 2.3 million adult smokers in New York. This number is down from 20.5 percent to 15.5 percent in the last five years.
Violent crime rate decreased from 444 to 392 offenses per 100,000 population in the last five years.
Preventable hospitalization rate went down from 73.0 to 69.0 discharges per 1,000 Medicare enrollees in the past year.
New York Health Insurance Laws and Regulations
New York health insurance plans are required to be sold with a guaranteed renewability clause. With this clause, a policyholders can renew their coverage as many times they want provided they do not violate their contracts and keep up with their premium payments. State laws prevent insurers from canceling an existing health coverage because of deteriorating health.
Parent’s of newborns and newly adopted children are automatically covered under their parent’s policy as long as it covers dependents. This coverage can be up to 30 days, to facilitate transition to a more permanent solution. In addition, disabled dependents can stay covered under a parent’s policy even after the policy’s maximum dependent age is reached.
New York health insurance plans can exclude coverage for a pre-existing condition for up to 12 months. After this exclusion period, coverage should start. Switching to a new plan will not require to undergo another waiting period provided you’ve maintained continuous coverage.
New York residents are qualified to purchase health insurance regardless of age, health, gender, or other related factors. Health insurers cannot deny an application based on these factors alone.
Small businesses with two to fifty employees can purchase group health insurance similar to what is being offered in other parts of the state. However, certain conditions like having a minimum percentage of employee participation or minimum employer contribution must be met in order to maintain coverage. HMOs are not allowed to impose such demands.
Like individual health insurance, group health insurance plans cannot be terminated due to a member’s poor health. New York health insurance quotes for group coverage can vary according to the risk factors of its members.
Self-employed individuals in New York have access to group coverage similar to what is being offered to small groups in the state, despite being just the lone employee. They can also opt for individual health plans, and a portion of the premiums for these plans can be tax-deductible.
State Government Insurance Programs Offered
Healthy NY
www.healthyny.com
866-432-5849
Healthy NY offers streamlined benefits to qualified employees, dependents, and other qualified individuals living in New York. State funding makes these packages more affordable compared to others, helping small businesses and uninsured individuals purchase health coverage.
Benefits for Healthy NY include preventative health services, physician services, diagnostic and x-ray services, inpatient and outpatient hospital services, and maternity care.
Eligibility:
1. Must be New York individuals and sole proprietors living in New York.
2. Businesses must operate within New York.
3. Must meet income requirements.
NY Bridge Plan
Federal program run by
Group Health Incorporated
www.ghi.com
(Search: NY Bridge Plan)
866-693-9277
www.PCIP.gov
866-693-9277
New York Bridge plan is a federal program run Group Health Incorporated which aims to provide health insurance to those who have difficulties getting coverage because of a pre-existing condition.
Coverage includes a wide range of benefits which includes hospital care, primary care, specialty care, and prescription drugs.
Eligibility:
1. Must be a U.S. resident living in New York.
2. Must be uninsured for at least six months.
3. Must have a qualified pre-existing health condition.
Medicaid
www.nyhealth.gov/health_care/medicaid
800-541-2831
877-472-8411
718-557-1399
Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program
should meet financial and other eligibility requirements.
Benefits for this program include physician services, inpatient hospital, outpatient services, home health services, dental & vision, laboratory
& x-ray, ambulatory surgery centers, non-emergency transportation, nursing, family planning, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program services, Medicare Premium Assistance,
Eligibility:
1. Must be U.S. citizens or legal residents living in New York.
2. Must not exceed income limits.
Child Health Plus
(CHP)
www.nyhealth.gov
(Search: Child Health Plus)
800-698-4543
Child Health Plus in New York offers health insurance to children who belong to low income families.
There are two programs available under Child Health Plus: Child Health Plus A and Child Health Plus B. Both are available through trusted providers across the state.
Services include inpatient hospital medical or surgical care, x-ray and lab tests, diagnosis and treatment of illness and injury, outpatient surgery, short-term therapeutic outpatient services, dental, vision, speech and hearing, limited inpatient and outpatient treatment for alcoholism and substance abuse, and many more.
Eligibility:
1. Must be U.S. citizens or qualified residents living in New York.
2. Must be children under 19 years old.
3. Must be uninsured.
4. Income must not exceed 400% of the federal poverty level. Those over the income limit may join the program as long as they pay the full premium.
Medicaid Cancer
Treatment Program
(MCTP)
Run by the New York State
Department of Health
Cancer Services Program (CSP)
www.nyhealth.gov
(Search: MCTP)
800-422-2262
Medicaid Cancer Treatment Program (MCTP) offers preventive care and total care for individuals with a specific pre-cancerous or cancerous condition.
Services include complete health coverage through Medicaid if policyholder is screened and diagnosed with breast, cervical, colorectal, or prostate cancer.
Eligibility:
1. Must be a U.S. citizen or qualified resident living in New York.
2. Must be uninsured and ineligible for Medicaid coverage under other eligibility groups.
Medicare
www.medicare.gov
800-633-4227
Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease.
Coverage has four parts:
Part A: provides inpatient care in hospitals and rehabilitative centers.
Part B: provides doctor and some preventive services and outpatient care.
Part C: provides Medicare benefits through Medicare Advantage.
Part D: provides prescription drug coverage.
Eligibility:
1. Must be a U.S. citizen or permanent U.S. resident.
2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.
VA Medical
Benefits Package
www.va.gov
877-222-8387
The Veteran Affairs (VA) Medical Benefits provides standard health benefits plan to veterans enrolled in the program. Benefits are portable and can be accessed anywhere in the VA system.
Benefits include preventive and primary care, and a full range of outpatient and inpatient services.
Eligibility
1. Must have veteran status.
Family Health Plus
(FHP)
www.nyhealth.gov
(Search: Family Health Plus)
877-934-7587
Family Health Plus offers health coverage to uninsured adults between 19 and 64 whose income and resources disqualifies them for Medicaid coverage.
Services covered include prevention, primary care, hospitalization, prescriptions, and many more.
Eligibility:
1. Must be U.S. citizens or qualified residents living in New York.
2. Must be between ages 19 and 64.
3. Must be uninsured.
4. Must not exceed income limits:
Singles and couples without children: 100% of the federal poverty level (FPL).
Parents and guardians living with at least one participating child: 150% of the FPL.
Heath Care Reform
With the new health care law, children under the age of 26 can choose to stay under their parent’s New York health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In New York, 150,428 young adults have insurance coverage through this provision as of June 2011.
The new health care law allowed 254,083 Medicare policyholders in New York to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 230,115 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $695 per person or a total of $159,916,221 was saved in New York.
Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 2,632 individuals in New York have benefited from this new law.
When looking at New York health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. Around 4,651,000 private policyholders in New York will get greater value for their premium payments because of this 80/20 rule.
Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all New York health insurance with no deductibles or co-pays. In 2011, 2,012,136 Medicare subscribers and 3,342,000 individuals with private policies received such services in New York.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 6,432,000 New York residents have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of New York received a total of $5.5 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In New York, 552 community health centers received a total of $104.6 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. New York has already received a total of $62 million to support its policies, programs, and communities to help its residents lead healthier lives.
