1) Current Age

Based on Age alone, these are your current health plan options

• Individual  New York health insurance is available to persons age 19 -64.
• Individual Dependent coverage is available from ages 0 – 26  in New York
• Catastrophic health insurance is available to non-dependent persons age 19 – 29
• Medicare and Medicare Advantage is available to persons age 65 and above

2) Current Income

Based on Income, you may qualify for the following New York Health Insurance options

The individual coverage above and the following factor in your income to determine your eligibility for a subsidized, discounted, or free health insurance plan:

• subsidized individual health insurance
• Essential plan 
• Medicaid

3) Current Employment

Based on Employment Status, you may qualify for the following New York Health Insurance options

• Small group health insurance
• Large group health insurance including Third Party Administered coverage
• COBRA
• Association Plan Health Insurance 

Standard Health Insurance Programs in New York

Use the chart below to determine what plan you may qualify for and then follow the link to review the plan information

Type of Coverage	Age Based	Financial Based	Work Based
Individual with or without Subsidy
Catastrophic Health Insurance
Essential Plan Health Insurance
Association Health Plans
Small and Large Business Health Insurance
COBRA
TPA
Medicare
Medicare Advantage

Additionally, other reasons to purchase individual health insurance may include one or more of the following: 

• You just turned 26
• You are unemployed or self-employed
• You work part-time
• You are starting a business with employees
• You have recently retired
• Your spouse or dependents are not covered in your group plan

Broker – A good source for shopping individual New York health insurance is through the online quoting tool above. Just enter your zip code and results will appear on the next page. 

State Exchange – Individual health plans, also known as  Qualified Health Plans, are managed by private insurance companies rather than New York State. Insurance companies participate in state exchanges and offer plans for sale to the public.  If you are under 65, you can potentially buy one of these plans,  and based on your income, receive financial assistance in the form of a subsidy or tax credit. For additional information please review our New York state of health marketplace dedicated page

Insurance Company – Individual  New York health insurance plans can also be bought directly from New York health insurance companies however by going direct through an insurance company you cannot purchase a qualified health plan and won’t be eligible for a tax subsidy or tax credit. 

Undocumented New York persons are also able to purchase an individual health plan directly from a health insurance company.

Associations – Since the creation of the Affordable Care Act, the Self-employed and freelancers are no longer considered businesses. for the sake of health insurance coverage, they now fall under the individual health insurance market. They are entitled to the same benefits including subsidies, however, they have the same restrictions as well. For Insurance on Association Health Plan options please call us (888)215-4045

This is a type of high-deductible health plan for adults under 30 or those who qualify for a Hardship Exemption.

Catastrophic plans are designed to protect you the coverage needed in the event of a worst-case scenario; for example, if you meet a medical emergency with medical costs totaling thousands of dollars.  Under a catastrophic health insurance plan, monthly premiums tend to be lower, but you’ll generally need to pay for all health-care costs yourself until you reach the plan’s annual deductible, which is usually at least a couple of thousand dollars.

Small Business health insurance plans are for persons:

• who are employed and qualify for insurance through their employment
• OR dependents, if coverage is available, of an employee that qualifies for insurance through their employment

Small Business as Owners

If you are a small business owner in New York and would like to offer health insurance to your employees, there are many benefits to doing so.  

You may qualify for the Small Business Health Care Tax Credit that would cover up to 50% of the cost the employer pays for their employees’ insurance premiums. The eligibility requirements are:

• Your business has 25 or fewer full-time or full-time equivalent employees.
• Your business pays an average annual salary of less than $53,000 a year per worker (this amount is indexed annually for inflation).
• Your business contributes at least 50 percent toward paying for the cost of employee premiums.
• Your business offers a Small Business Health Options Program (SHOP) plan coverage for all full-time employees.

It should be noted that eligibility is based on the number of full-time employees, rather than the number of total employees; businesses with part-time workers may also qualify for the credit even if more than 25 workers are under their employ. Further information on this can be found in New York Small Business Health Insurance.

If you are a NY small business owner with fewer than 10 full-time employers with an average annual salary of $25,000 or less, you may still be entitled to the full tax credit. For those companies with a higher number of full-time workers and higher salaries, the amount of credit is reduced.

There are many reasons you may provide New York health insurance to your employees. New York businesses with 50 or more employees must offer health insurance under the Affordable Care Act. However, even if it is not required by law, offering health insurance can have many benefits such as:

• Tax benefits for you, including tax deductions and credits. Tax credits are only available through the NY State of Health Marketplace.
• Tax benefits for workers when they pay a portion of their insurance with pre-tax salary deductions
• Better employee retention and healthier workers

Small Business as Employees

If you work for a small business and your employer does not offer New York health insurance benefits, you can enroll in an Individual/Family plan on the NY State of Health Marketplace. Remember, most people are required to have health insurance under the federal Affordable Care Act. Just like an individual, you may qualify for a lower premium based on your income. 

• loss of job
• reduction in working hours
• being in between jobs
• death or divorce. 

Qualified individuals, however,  may be required to pay the full cost of the premiums.

Additionally, large employers in New York, with 20 or more full-time workers, are required to provide Continuation of Health Coverage to their qualifying employees by paying a part of their New York health insurance premiums during employment.

If an employee then becomes ineligible to receive an employer’s health insurance benefits—which can happen for a variety of reasons (such as getting laid off or falling below a minimum threshold number of hours worked per week)—the employer may stop paying its share of the employee’s New York health insurance premiums. In that case, COBRA allows an employee and their dependents to retain the same health insurance coverage for a limited period of time, provided they are willing to pay for it on their own.

Under COBRA, former employees, spouses, former spouses, and dependent children must be offered the option of continued health insurance coverage at group rates, which otherwise would be terminated. While these individuals are likely to pay more for New York health insurance coverage through COBRA than they previously did as employees (because the employer will no longer pay a portion of the premium costs), COBRA coverage might be less expensive than an individual health insurance plan would be.

Generally, when placed in one of the fore-mentioned situations, New Yorkers either opt to continue health coverage through COBRA or seek another health plan in the marketplace. Benefits to continuing COBRA include keeping the same doctors and benefits you have been used to and keeping the same standard of coverage.

If you decide to look for an alternative plan in the marketplace, you should compare the coverage you had with your previous employer with that of insurance policies now available to you to see which benefit package best suits your needs.

We mention TPA’s here because large companies with over 300 employees often self insure in which they retain a minimum level of risk per employee, then have an insurance company cover the risk over that level. The TPA will handle all of the paperwork related to that self-insured risk per employee. Most companies set a level of 50,000 dollars as a self-insured limit before the insurance company begins to provide coverage. This ensures lower premiums and gives the employer the opportunity to possibly control costs

The use of third-party administrators for many New York Health Insurance plans is now common in many businesses, and the range of tasks they undertake is growing. They have distinct roles in the health insurance industry, commercial liability insurance, and investment company operations. Some firms are moving into new areas such as forensic accounting services, workers’ compensation audits, and emergency response planning.

Medicare is broken down into two parts: 

• Part A (Hospital Insurance) which you are eligible for if you are 65 or older and you or your spouse have worked and paid Medicare taxes for at least 10 years. *Part A is premium-free if you are: a) Receiving retirement benefits from Social Security or the Railroad Retirement Board; b) you are eligible to receive Social Security or Railroad benefits but you have not yet filed for them; c) You or your spouse has had Medicare-covered government employment.
• Part B (Medicare Insurance) is a voluntary program for which a monthly premium must be paid for all months of coverage. If you are eligible for premium-free Part A, you can also enroll in Part B. If however, you must pay a premium for Part A, you need to meet the following requirements to enroll in Part B: a) Be aged 65 or over; b) Be a US citizen; c) Be a US resident for at least 5 years prior to applying for Medicare.

Medicare is also a New York health insurance program that is offered both by insurance companies and other private companies approved by Medicare. 

Choosing  to join one of these plans, you must: 

• live in the service area of the plan you want to join; 
• have Medicare Parts A and B; 
• not have End-Stage Renal Disease (ESRD).

See here for more information: Who can join a Medicare Advantage Plan? It is worth noting that, currently, the largest carriers of Medicare Advantage Plans in New York are Humana, Empire Blue Cross Blue Shield, Cigna, Aetna, and Excellus

Of those who are presently covered under New York Medicaid,

• 1 in 5 are adults under 65, 
• 1 in 2 are low-income individuals, 
• 2 in 5 are children, 
• 2 in 3 are nursing home residents 
• 1 in 2 have disabilities. 

Medicaid provides a health plan for millions of Americans, including certain low-income adults, children, pregnant women, the elderly, and those certified blind or otherwise certified disabled. 

New York State offers one of the best long-term care benefit packages through Medicaid. The NY Medicaid program provides both institutional care and other long-term care as well as custodial and skilled services. Short-term plans, however, are not available in New York; a factor which lowers the risk of New Yorkers being without coverage at any one time. Additionally, another great benefit is that New York does not limit the number of those who receive such services in a given time, unlike many other states.

New Yorkers are able to receive Medicaid coverage if they earn an income of up to 138% of the FPL (monthly income)which is from $16,643 per year for one person up to $68,559 for a family of 10. Of NY Medicaid beneficiaries, 59% of non-disabled and non-elderly have some form of employment.

For individuals who are blind, disabled or over 65 to be eligible for Medicaid in New York, they must not earn more than $9,900 for a family of 1, $14,500, a family of 2, $16,675, a family of 3 or $18,850 for a family of 4.

These New York health insurance enrollees are commonly broken into two groups:

• Full-benefit dual-eligibles – who have Medicare but also receive benefits under Medicaid
• Partial duals – who have Medicare but qualify for Medicaid help in paying for expenses such as Medicare premiums and/or cost-sharing

Additionally, if you are a New Yorker with special needs, you can enroll in a Dual Special Needs Plan  (D-SNP) that includes Medicare and Medicaid benefits. These plans may pay for expenses that the two types of coverage do not cover individually, including some over-the-counter items. They could also offer extra coverage for things like hearing aids, vision, and dental care.  

Beneficiaries who are dual-eligible can change between Original Medicare and Medicare Advantage or switch to Part D plans at any time.

There are three qualifying elements for you to be eligible for the NY Essential Plan. They are:

1.   Income requirements
2.   Residency and Immigration Status
3.   Aging In and Aging Out

There are 18 CHP plans which are New York state-approved and eligible children must enroll in one of these plans in the county where they reside.

To qualify for the Child Health Plus program, children must:

• Be residents of New York State
• Be aged under 19
• Meet family income guidelines (different from those of Medicaid) based on the FPL (Federal Poverty Level ) table below
• Not be eligible for Medicaid
• Not already have health insurance 
• Not have access to family coverage through a state health benefits plan
• Qualify to join either Child Health Plus or Children’s Medicaid depending on the family’s gross income (often children who do not qualify for Children’s Medicaid can enroll in the Child Health Plus program).
• Not have been under an employer-based health insurance policy within the past six months  (This may mean a waiting period before children can qualify for Child Health Plus. The waiting period will depend solely on the household income and the reason your children lost employer-based health insurance coverage).
• Have the following documents: proof of age; proof of citizenship; proof of NY residency; proof of household income; proof of immigration status if applicable

Some services covered by the New York health insurance CHP program are well-child care, immunizations, diagnosis and treatment of illness and injury, emergency care, inpatient or surgical care, outpatient surgery, substance abuse treatment, mental health services, dental, vision, speech and hearing, medical equipment, and ambulance services

To see whether you would need to pay a premium for coverage, view the table below