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New York State of Health  (NY State of Health) is the official name of the New York State Health Plan Marketplace, also known as the New York State Health Benefit Exchange (NYSOH). The marketplace was created by the Affordable Care Act and is the place where New York’s individuals, families, and small businesses can shop for affordable health insurance.

Under the Affordable Care Act’s regulations, each state is required to have a health insurance exchange, either operated by the state or by the federal government as well as quasi-state/federal government-run exchanges. New York State opted to establish and operate its exchange.

Since October 2013, NY State of Health customers has been able to shop for and compare different health insurance plans from a variety of insurers through the online marketplace.

These health insurance plans from NY State Health are available right here through Vista Health Solutions for you to explore and purchase (as well as non-health insurance marketplace plans).

Please take the time to explore our FAQs about the Affordable Care Act, and a brief history of New York health insurance.

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NY State of HealthIndividuals: What you need to know about the Affordable Care Act


1. You are required to have health insurance

Every citizen and permanent United States resident needs to have health insurance. This insurance can be through your place of employment, insurance from your spouse’s workplace, a plan purchased through a broker, a plan at the NY State of health, or coverage through a government assistance program like Medicare or Medicaid.

Since 2014, the penalty for not having health insurance was $95 for individuals, or 1 percent of income, whichever is greater. In 2015 that penalty increased to $325 or 2 percent of income, and in 2016 it went up again to $695 or 2.5 percent of taxable income. After 2016, the penalty increase was tied to the annual cost of living adjustment. HOWEVER, The ACA’s federal individual mandate penalty has been$0 since the start of 2019 and that will continue to be the case in 2022 and perhaps beyond. As such, there has been no federal government penalty for being uninsured in the years 2019 and 2020, but you still needed coverage, and still do.

People who are uninsured will not face a penalty unless they’re in a state that has its own individual mandate and penalty for non-compliance

2. The four levels of insurance plans to choose from at the NY State of Health Marketplace

At the NY health marketplace, you have the option to choose from four tiers of health insurance plans:

  • Bronze level – 60 percent coverage
  • Silver level – 70 percent coverage
  • Gold level – 80 percent coverage
  • Platinum level – 90 percent coverage

Each level offers different premiums covering different levels of medical expenses. For example, the Bronze level plans have a lower premium than the Silver level plans, but the Bronze plans have higher out-of-pocket costs. The consumer makes up for those other costs through deductibles, co-pays, and/or coinsurance.

For each tier, there is a limit on out-of-pocket spending that’s equal to the Health Savings Account (HSA) current law limit. In 2022 that limit is $3,650 for an individual and$7,300 for a family.

If your annual income falls somewhere between 100 and 400 percent of the federal poverty line, then there will be an even lower cap on out-of-pocket expenses.

For example, if your income is:

  • 100-200% FPL: one-third of the HSA limits ($1,217/individual and $2,433/family);
  • 200-300% FPL: one-half of the HSA limits ($1,825/individual and $3,650/family);
  • 300-400% FPL: two-thirds of the HSA limits ($2,107/individual and $4,215/family).

3. You might qualify for a tax credit

Depending on your income level, you might qualify for a tax credit when purchasing health insurance at the NY State of Health exchange. Those with annual incomes between 133 and 400 percent of the Federal Poverty Line (FPL) will have their premium contributions capped at a maximum of 9.5 percent of their income when purchasing a Silver level plan.

For example, if your 2021 income is:

  • Up to 133 percent of the FPL = your maximum premium contribution will be 2.07 % of your annual income
  • 133-150 percent of the FPL = your maximum premium contribution will be 3.10 – 4.14 % of your annual income
  • 150-200 percent of the FPL = your maximum premium contribution will be 4.14 – 6.52 % of your annual income
  • 200-250 percent of the FPL = your maximum premium contribution will be 6.52 – 8.33 % of your annual income
  • 250-300 percent of the FPL = your maximum premium contribution will be 8.33 – 9.83 % of your annual income
  • 300-400 percent of the FPL = your maximum premium contribution will be 9.83 % of your annual income

Individuals in the 133 to 400 percent of the FPL range are also eligible for a premium tax credit. The premium tax credit is determined by subtracting the difference between the individual’s maximum premium contribution and the unsubsidized cost of the second-lowest Silver level plan offered in an individual’s geographic area. That amount is their premium tax credit.

Let’s take a look at an example:

John is a 29-year-old individual earning $30,000 a year and he wants to purchase a health insurance plan through the NY State of health. The yearly premium cost of the unsubsidized, second to lowest level Silver plan in the area is $3,337. John’s income puts him at 257 percent of the federal poverty line, making him eligible for a premium tax credit.

Because John’s income is 257 percent of the FPL his maximum premium contribution is 8.33 percent of his yearly income, which is $2,488. Now to determine his tax credit we subtract $3,337 (the amount of the unsubsidized second-lowest Silver plan) from $2,499 (his maximum premium contribution or 8.33 percent of his annual income).

This gives John an annual tax credit of $838, which is paid directly to the insurance company that John signs up with at the exchange.

Bear in mind though that the cap is only for the premium at the Silver level. There are three other levels of plans to choose from at the NYS exchange. You can still receive your premium tax credit for the higher planes, but the amount of the credit does not increase.

Take for a further example that John wanted to purchase the Gold level plan. The premium for that plan would be more expensive than the Silver level premium from which his tax credit was calculated. But he would still receive the $838 premium tax credit. The same goes for John if he decides on a lower-cost Bronze level plan instead of the Silver.

Please note though that if your annual income exceeds 400 percent of the FPL then you will not be eligible for a tax credit when purchasing health insurance at the NY State of Health.

4. Insurance plans sold through the NY State of  Health insurance marketplace need to cover certain essential benefits.

Any NY health insurance plan sold through the NY State of Health will need to include coverage for medical services in the following 10 categories under the Affordable Care Act legislation:

  • Ambulatory patient services, such as doctor’s visits and outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

States will also play a role in determining which minimum essential benefits will be covered under the Affordable Care Act.

5. If you like your current health insurance, you can keep it

If you were already insured on March 23, 2010, when the Affordable Care Plan was signed into law or you are currently enrolled in a plan that existed before the ACA’s signing, then your plan is eligible to be “grandfathered in.” That means you will be able to keep your current plan as is.

Please note though that some insurance companies or employers may choose not to grandfather in some of their health insurance plans.

If your current plan is not eligible to be grandfathered in or if it is discontinued, you should receive notice from your insurance company.

For the correct information, make sure to check with your employer or health insurance company.



NY State of HealthBusinesses: What you need to know about the Affordable Care Act


1. The Employer Mandate

If your business employs at least 50 full-time workers then you are subject to the employer mandate, that is, to provide your workers with health insurance. This plan is called The Employer Shared Responsibility Payment.

Originally the plan was to implement the employer mandate at the same time as the individual mandate. However, in early July 2013, the Obama administration opted to delay the employer mandate for a year.

According to numbers from the White House, many small businesses already provided their workers with some form of health insurance. It may also be worth noting that the vast majority of small businesses in the United States employ fewer than 50 full-time workers, and will thus not be subject to the Affordable Care Act’s employer mandate.

If your business does fall into the mandate range, and you do not offer your worker’s health insurance, you will be subject to a penalty. According to the Congress Research Services, the penalty is, “Number of full-time employees minus thirty multiplied by 2,000.”

2. SHOP Exchange

New York small businesses with 100 or fewer employees will have access to the state’s Small Business Health Insurance Options Program (SHOP), which is a health insurance exchange created just for small businesses.

There, businesses can shop for health insurance plans, tailored specifically to their needs. Business owners can then offer a choice of plans and carriers to their employees and pay only one bill directly to the SHOP exchange for the plans chosen.

 in 2014, the federal government announced that it would be delaying the opening of the SHOP Exchanges through the marketplace. By 2015, those with 50 or fewer employees had access to SHOP plans, and by 2016, employers with a team of 100 or less had the ability to use SHOP.

New York is one of the states that operated its own health benefit exchange in New York and launched the SHOP Exchange in 2013 alongside the individual exchange.

3. Tax Credit

Businesses with fewer than 25 employees paying average salaries of less than $56,000 who choose to offer their workers health insurance through the SHOP Exchange will qualify for a tax credit. This tax credit is already in place for small businesses, currently, it covers up to 35 percent of the cost of health insurance.

In 2014, that number increased to cover up to 50 percent of costs. However, it’s only available to businesses that provide their employee’s coverage through the SHOP Exchange.

Businesses are able to claim a business expense deduction for the amount the premiums paid that exceed the tax credit. That means those businesses will receive a tax credit and a tax deduction.

4. Affordability is not an option

In New York State, businesses with 50 or more full-time employees are required to provide affordable health insurance. That means the insurance plan must cover at least 60 percent of medical expenses, and not cost an employee more than 9.83 percent of their annual income. If a business fails to meet those requirements, it will pay a penalty.

Grandfathered plans are not subject to the affordability requirement.

5. Penalties

If a business of 50 or more full-time employees offers no health insurance then the employer faces an annual penalty of $2,700 times the number of full-time employees minus 30. That amount is scheduled to increase each year with the growth in insurance premiums.

If a business does provide health insurance, but workers still choose to seek coverage at the exchange then the business will face a penalty of $3,860 per worker that goes to the exchange. This number is also pegged to the growth in insurance premiums each year.

If an employer’s plan is unaffordable and/or does not provide minimum value, then the business will face a penalty of $4,060 per worker that goes to the exchange.  This number is also pegged to the growth in insurance premiums each year.


New York State of HealthFrequently Asked Questions about the NY State of Health Insurance Marketplace


Who’s eligible for a plan through the NY State of Health?

All U.S. citizens or legal permanent residents are eligible to purchase insurance through the public health benefits exchange.

How much does the NY State of Health insurance plan cost?

Health insurance plans sold through the New York State Health Benefit Exchange have risen steadily since the creation of the NYSOH. Original estimates expected health insurance rates to fall. Unfortunately due to several factors, rates have increased annually. The major factors attributed to rate increase are

  • Less carrier competition in the marketplace
  • a greater pool of unhealthy insureds
  • younger people not signing up for insurance as anticipated
  • Congress removing promised risk optimization funding to insureds

Can I buy any other kinds of insurance through the NY State of Health?

Health insurance and dental insurance are available for purchase through the New York State Health Benefit Exchange.

Doesn’t my employer have to offer me health insurance?

That depends on the size of your employer. For companies employing at least 50 full-time workers, working a minimum of 30 hours per week, they are required to at least offer a health insurance option to their employees.

Companies employing less than 50 full-time workers are exempt from the employer mandate and can choose not to offer their employees health insurance without penalties.

How much are my premiums going to go up this year?

That entirely depends on several factors such as what company you are currently insured with, what health plan you have and what your expected income is if you’re currently receiving a subsidy

What’s the difference between an exchange plan and going through a private insurer?

When going through a private insurance company, individuals will not receive the possible premium tax credit they might have received had they gone through the exchange. Also, plans previously sold through private insurance companies can be grandfathered in.

How much do I need to pay if I don’t want health insurance?

Under the Affordable Care Act, everyone is mandated to have health insurance coverage.

Since 2019, the ACA’s federal individual mandate penalty has been $0 and that will continue to be the case in 2021. People who are uninsured will not face a penalty unless they’re in a state that has its own mandate and penalty for non-compliance. However, in 2014  the fee for not having coverage was $95 for an individual or 1 percent of income, whichever was higher. In 2015 that penalty went up to $325 or 2 percent of income. Then, in 2016 the penalty increased to $695 or 2.5 percent of income. From 2017 to 2018, the increase in penalty was tied to an annual cost of living adjustment and based on inflation.

What does the percentage of the federal poverty line mean?

It means your annual total income is measured against that year’s definition of the federal poverty level. This number is used when calculating your premium tax credit.

See where you stand using our health care reform calculators.

How do I calculate my income vs. the percentage of the federal poverty line?

We recommend calculating your income vs the federal poverty line using this calculator

What is the NY State of Health?

NY State of Health (NYSOH)  is the official name of the New York State of Health Plan Marketplace, also known as the New York State Health Benefit Exchange. It’s an open marketplace where individuals and families can search for and then purchase affordable health insurance as part of the Affordable Care Act (also known as Obamacare).

What types of plans does the NY State of Health offer?

The exchange offers insurance plans at four different levels that at least meet the minimum requirements for insurance plans sold under the Affordable Care Act. Those tiered insurance plans are broken down into “Metals”; bronze, silver, gold, and platinum level insurance plans. The plans are further broken into Healthy NY, HCTC Healthy NY, or Non-Group/Individual HMO/PSO.

When did the marketplace open?

In the summer of 2013, insurance companies began unveiling their plans and offering plans to customers through the New York State Health Benefit Exchange. However, it was on October 1st, 2013 that the first enrollment period opened.

Where can I find the NY State of Health plans online?

The marketplace is accessible through the link here.

You can shop at the marketplace right now on our website by clicking here, and comparing all of the plans available at The New York State Health Benefit Exchange.

What is Medicaid?

Medicaid is a federally subsidized health insurance program for low-income and disabled individuals who are not insured through their spouse or employer and cannot afford to purchase health insurance.

Each state runs its own Medicaid program, and the eligibility requirements differ from state to state. There is usually a minimum threshold of age and/or income.

What if I already have insurance?

If you are enrolled in a health insurance plan that existed before the Affordable Care Act became law on March 23, 2010, then you can choose to keep that same plan after the rollout of the majority of the ACA provisions on Jan. 1, 2014.

This is called having your insurance plan, “grandfathered in”.

However not all insurance companies or businesses may choose to grandfather in their plans. For the best information contact your insurance company or your human resource department.

How does this affect my Healthy NY plan?

On January 1st, 2014, Healthy NY ceased to provide care for individuals and solos, but rather only pursing small businesses. Its benefits will match the benefits of a Gold plan which could bring up the price.

Those individuals who were enrolled in a Healthy NY plan on March 23, 2010, when the Affordable Care Act was signed into law are eligible for grandfathered status. Individuals and sole proprietors not eligible for grandfathered status will be moved over to the exchange.

At the New York State Health Benefit Exchange, the equivalent health insurance coverage to the Healthy NY plans will be plans sold at the gold level.

Am I going to get a tax break to help pay for my health insurance?

Maybe. If your income falls between 138 and 400 percent of the Federal Poverty Line (FPL) you will receive credit paid directly to your insurer to help offset the cost of health insurance. It should also be added that these tax credits will only be available to those purchasing health insurance through the health care exchange and those who qualified for the subsidy.

The credit will be set up on a sliding scale so the lower your income the bigger your tax credit.

What is the SHOP Exchange?

The Small Business Health Options Program, or SHOP, is a separate health insurance exchange created as part of the Affordable Care Act exclusively for small businesses. The SHOP exchanges help employers search for affordable insurance plans for their workers and then easily enroll them.

If I get Medicare, how does the exchange affect me?

If you receive Medicare, the exchanges should not affect you at all. You will continue to get your health benefits uninterrupted.

Can I keep my doctor when I’m picking out my new exchange plan?

Doctors are associated with NY Health Insurance plans. If a doctor belongs to Oxford and a person joins an Oxford plan on the exchange, then they should be able to see that same doctor.

Don’t forget, you also have the option of grandfathering in your plan if the plan existed before March 23, 2010, when the Affordable Care Act was signed into law.

Many of the health insurance companies in NY are now selling health insurance plans both on and off the NY state of health  exchange, marketing to both individuals and small businesses


New York State ExchangeThe History of Health Insurance in New York State

New York State has one of the country’s most progressive health insurance systems. Since 1990, New York State residents have enjoyed the benefits of community rating and guaranteed issue. These two laws are key components of the Affordable Care Act that went into effect on March 23rd, 2010.

Respectively community rating and guaranteed issue mean insurance companies cannot charge people more based on their background or medical history, and deny health insurance coverage to anyone for any reason.

These two laws have expanded health insurance coverage to many New Yorkers since their introduction more than 20 years ago. However, these two policies have also contributed to higher health insurance costs in the state.

Before the Affordable Care Act was enacted and allowing these two laws to now become a right for Americans, some experts thought health insurance rates nationwide would increase. By some estimates, premiums were said to rise by as much as 30 percent, according to a study released by the Society of Actuaries.

In New York. however, it was thought that health insurance rates could fall by as much as 14 percent when the rest of the Care Act was to take effect, according to the same study.

Again, before the Affordable Care Act, states that already have community rating and/or guaranteed issue laws on the books like Maine, Vermont, Massachusetts, and New Jersey thought they’d also see the same cost declining effect.

NY State of Health

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