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Health Shopping Made Easy

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Niagara Health Insurance

Are you shopping for a Niagara health insurance plan? Are you looking to better understand the health insurance market? Here you will find key resources to help you make an informed decision and an instant quoting tool showing all Niagara health insurance options. Start by entering your zip code above to find plans offered in your area.

Facts and Figures

  • Place in County
    Health Report Card
    59
  • Insured 200,762
  • Uninsured 10,566
  • Insurance
    Carriers
    18
  • Number of
    Primary Care Physicians
    94
  • Number of
    Hospitals
    33
  • Avg. Cost of
    Health Insurance Age 27*
    $468
  • Avg. Cost of
    Health Insurance Age 40*
    $468
  • Avg. Cost of
    Health Insurance Age 60*
    $468

Breakdown of Insureds

  •  Private Health Insurance 14%
  • Public Health Insurance 14%
  • Employer-Based Health Insurance 10%
  • Direct Purchase Health Insurance 11%
  • Medicare 9%
  • Medicaid 12%
  • Tricare/Military Health Insurance 13%
  • VA Health Care 12%
  • Uninsured 5%

What to Know When Shopping for Health Insurance

Below are some of the most commons concerns when shopping for a Niagara health insurance plan.


Are Your Doctors In-NetworkBefore purchasing a health insurance plan you should always make sure that your doctor(s) are part of the network. Going to an out-of-network doctor may cost substantially more than if that doctor is in-network. Don’t just ask the doctor’s office if they accept a certain insurance plan before you enroll. You should always confirm with the insurance company or an agent that your doctors are in-network. Why the concern? Well, keep in mind that if an out-of-network provider suggests services, then all of those services provided by that recommended doctor will be considered out of network, even if the facilities and providers are in-network

Lower Monthly Premium May Result in Higher CostsHealth insurance follows a simple formula: the lower your monthly premium is, the more likely you are to pay higher costs when you use the insurance. If you’re someone who happens to be in good health and does not foresee any health-related issues and doesn’t use medicine on a very regular basis, then perhaps you’re better off opting for a lower costing health insurance plan. However, if you find that your medical expenses and prescription usages are high, then you may save money by purchasing a plan that costs more per month. Be sure to consider your current health condition when shopping for a health insurance plan. 

Health Insurance is a ContractWhen purchasing a plan, both parties agree to live up to the contract (usually for a period of one year). If you find that you are not happy with your plan, you can’t go back to your insurance company mid-year and ask them to change coverage. You’ll have to wait for your contract to expire. Additionally, if you buy an individual health plan on your state exchange or through healthcare.gov and you allow that plan to lapse or you stop coverage, then you don’t qualify to buy a health plan on that exchange for the rest of that calendar year. As such, be sure to choose the right plan that suits your needs before signing the contract. 

Types of Insurance Coverage — EPO, PPO, POS, HMO, HDHP and HSA. The first 4 are acronyms that describe different types of health insurance coverage, which provide you with or without the flexibility to see specialists and receive out-of-network and out-of-state care. Also, different plans have different requirements related to the need for referrals. If you’re often seeing specialists out-of-network then you want a plan that offers that flexibility. If you find that you travel often for work or live in multiple states per year, then perhaps a plan that offers that flexibility is needed. The last two types, HDHP and HSA’s allow you to set up a tax-free savings account specifically for qualified medical costs For a better understanding of these types of coverage please refer to the following article.

Metal LevelsIn order to make shopping and comparing health plans easier, a metal system to represent different insurance coverage levels was created. These insurance levels are grouped into 4 metals based on actual metal value. Bronze, silver, gold, and platinum all represent the metal worth and the level of coverage offered under each metal plan. In theory, a bronze plan will cover 60% of your medical costs and provide you with a maximum out of pocket dollar amount that does not equal the remaining 40% but instead is a threshold set for most bronze plans. Silver is set at 70%, Gold 80%, and the most valuable metal platinum is set at 90%. Based on your medical needs you should be able to relatively compare an appropriate metal level. For example, if you find that you have minimal health insurance needs then perhaps a bronze plan would best suit you. However, if your health status requires a good deal of care, then perhaps a gold or platinum plan, which costs more, will actually cost you less in the long run.

Are Essential Health Benefits Covered? One way of ensuring the plan you purchase or intend to purchase covers the 10 essential health benefits, is to buy an on-exchange plan. All exchange plans must cover 10 essential health benefits. This provides you with a guaranteed minimum level of coverage, which is the standard set by the Affordable Care Act. Why would we need a minimum standard level? Well, the cost of medical care is prohibitive without insurance in place and can often lead to financial ruin. Ensuring that a plan includes the minimum essential health benefits provides a safeguard.

Premium, Deductible and Out-Of-Pocket Costs. Each term relates to the cost of using and maintaining your plan.

Premium is the cost of the insurance that you usually pay on a monthly basis to the insurance company. Premiums are often locked in for a period of one year, meaning the insurance carrier cannot arbitrarily charge you a higher premium within that year

Deductible is a yearly dollar threshold that you must meet prior to the insurance company paying for medical services. This almost always excludes preventative care.

Out-of-pocket costs are the maximum annual dollar amount that you can spend on health care services and medicine.

Health Insurance Subsidies A Subsidy is a dollar amount provided by the federal government paid directly to your insurance company based on your current yearly income. This money does not have to be paid back, however, if your income does increase, there is a strong possibility that your subsidy may change, which would then increase your monthly premium (retroactively). Conversely, if your income decreases within the year, that may reduce your monthly premium at which point you have the right to contact your insurance company and inform them of your income change.

Essential Health Benefits

What Are Essential Health Benefits? Essential Health Benefits are a set of 10 health care benefits established by the federal government under the Affordable Care Act of 2014. The purpose is to ensure that all persons are covered by a set of minimum standards. Specific insurance services may vary by state and all plans must provide dental coverage for children.

1.Ambulatory Patient ServicesMedical care provided without admission to a hospital, including doctor’s office visits, clinics, and outpatient surgery centers.

2.Emergency ServicesOrganizations that are responsible to deal with emergencies when they occur. This includes medical care that if not treated could lead to serious conditions or disabilities.

3.HospitalizationMedical care that patients receive when they are hospitalized. This includes the care of nurses, doctors, and other staff. This also includes medication received, room and board, tests and laboratory work.

4.Maternity Medical care that a woman receives during pregnancy and post pregnancy. This includes labor, delivery, post delivery and the care for newborn babies.  

5.Mental Health Services and Addiction Treatment — Patient care provided to evaluate, diagnose, and treat any mental health conditions or substance abuse disorders.

6.Rehabilitative Services and DevicesServices provided after an injury, accident, disability, or a chronic condition. The purpose is to attempt to help regain the patient’s mental and/or physical skills that were lost (to make the person whole again).

7.Pediatric Services — Medical care that is provided to children and infants, including regular check-ups, recommended vaccines, dental and vision care.

8.Prescription Drugs — Medicine that is prescribed by a doctor, and nurse practitioner, to treat any illness or existing condition.

9.Preventative and Wellness Services and Chronic Disease Treatment — Physicals, Immunizations, and cancer screenings to prevent or detect certain medical conditions, and to provide care for chronic conditions.

10.Laboratory Services Medical tests that are usually ordered by your doctor which include coverage for X-Rays and diagnostic imaging, blood and fluid tests, biopsies, pathology, and pregnancy tests.



Which Types of Insurance Plans are Not Required to Cover the Essential Health Benefits? The following insurance plan types are not required to include essential health benefits and most often don’t.

Short Term Medical Insurance

Accident

Critical Illness/Cancer

Hospital Confinement

Association Health Plans

Faith-Based Healthcare

Large Group Insurance plans (50 employees or more)

Travel Insurance

Dual Citizenship insurance (As long as you have proof of Identification)


State Government Insurance Programs Offered

Adult Cystic Fibrosis Assistance Program (ACFAP)

NY State Department of Health
Riverview Center 3rd FL West
150 Broadway
Menands, NY 12204
TEL: 518-408-5089

Reimbursements for health, dental, and/or vision insurance premiums, co-payments, and deductibles. Allowable health insurance premiums must include CF related care or services. Also, reimburse for CF related expenses not fully covered by insurance.
 
At least age 21 (can apply 90 days before 21st birthday); diagnosed with CF; ineligible for Medicaid; resident of NY State for minimum of 12 continuous months (exception made for college students); maintain health insurance (or obtain new coverage within 90 days of enrollment).

Cancer Services Program

CSP of Steuben/
Allegany/Cattaraugus/
Chautauqua (CSPSACC) 
c/o Allegany County Health Department
7 Court ST
Belmont, NY 14813
TEL: 877-778-6857

Free clinical breast exam, Pap tests, mammograms, colorectal cancer screening, and, for certain patients, a colonoscopy. Clients receiving positive screening tests also receive diagnostic testing, are referred to treatment if needed, and may be enrolled in the Medicaid Cancer Treatment Program.Resident of this state; uninsured or underinsured (i.e. insurance does not cover screening exams); meet income guidelines.

 Also, there are age requirements, which vary by test: e.g. ages 21 to 64 for cervical cancer screening; ages 40 to 64 for breast cancer screening; men and women ages 50 and over for colorectal cancer. If high risk for colorectal cancer due to family history (polyps, etc.), a colonoscopy may be ordered.

Child Health Plus

New York State Department Health 
Erastus Corning Tower II — Empire State Plaza
Albany, NY 12237
TEL: 800-698-4543

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

Child must be a resident of New York, under the age of 19, and meet family income guidelines, and not currently on Medicaid. The income guidelines are different than Medicaid.

Children & Youth with Special Health Care Needs / CYSHCN

New York State Department of Health
Corning Tower — Empire State Plaza
Albany, NY 12237
TEL: 518-473-7922

Services MAY include: physical exams, screening services, hearing & vision services, nutrition services, doctor visits, early intervention services, lab tests, immunizations, prescription drugs, routine care coordination, social services, home health care, etc.

Children under age 21 that reside in this state; have a qualifying chronic condition; and meet financial eligibility guidelines.

Early Intervention Program (EIP)

Department Health -Bureau Early Intervention
Corning Tower Rm 287
Albany, NY 12237
TEL: 800-522-5006


Diagnosis and evaluation; physical and occupational therapies, speech-language pathology and other health services such as assistive technology, audiology, medical (limited), nursing, nutrition, psychological, etc.

Children birth to age 3 who are experiencing developmental delays or who have a diagnosed condition that has a high probability of resulting in a developmental delay.

Elderly Pharmaceutical Insurance Coverage (EPIC)

NY State Department of Health
PO Box 15018
Albany, NY 12212
TEL: 800-332-3742

Fee Plan for those with moderate incomes: a low annual fee paid in quarterly installments; save about 80% on prescriptions at participating pharmacies. Deductible Plan (seniors with higher incomes): pay full cost till you meet annual deductible; then a copay (save about 80%). For both plans, fee and deductible amounts are based on income and marital status. Coverage is coordinated with Medicare Part D, if you have it.

Resident of NY state; meet income requirements (does not include scholarships); be 65 years or older, use a pharmacy located in NY state.


Health Insurance Information Counseling & Assistance Program (HIICAP)

NYS Office for the Aging (NYSOFA)
2 Empire State Plaza 
Albany, NY 12223
TEL: 800-701-0501

Assistance with Medicare: eligibility, enrollment, benefits; premiums, costs and claims; comparison of Part D prescription drug plans; Medigap supplemental insurance; health plan options; and programs which help pay Medicare premiums, deductibles, etc. Also: assistance with long term care options; and information on low income programs such as the Elderly Pharmaceutical Insurance Coverage (EPIC) Program, Medicare Savings Programs, «Extra Help» prescription assistance and pharmacy discount programs.

Residents of this state that are eligible for, or enrolled in, Medicare.

HIV Uninsured Care Programs

Department of Health
Empire Station
PO Box 2052
Albany, NY 12220
TEL: 800-542-2437

Financial assistance for: specific HIV/AIDS related FDA approved prescription drugs; specific outpatient medical and support services; case management; insurance premiums/deductibles/co-payments; mental health services; substance abuse, etc.

Applicant must be a resident of New York, be HIV positive, and meet income guidelines.

iCanConnect — New York State

c/o Helen Keller National Center (HKNC) 
— Region 2 Mid Atlantic
141 Middle Neck Road
Sands Point, NY 11050


Telephones (including wireless phones); interoperable video conferencing services; computers and access to the Internet; etc. Equipment may be hardware, software, applications, etc. Installation and training may be provided.
 

Resident of this state; have a combined vision and hearing loss that causes extreme difficulty in attaining independence in daily life activities or working; household income equal to or less than 400% of the Federal Poverty Level. See web site for details.

MEDICAID (New York State)

NY State Department of Health
Corning Tower
Empire State Plaza
Albany, NY 12237
TEL: 800a-541-2831

Comprehensive medical care, including, but not limited to, physician visits, hospitalization, dental, emergency ambulance, lab & x-ray services etc. There is no cost for those who meet income guidelines. Within Medicaid there are several programs that address the needs of specific groups; e.g. pregnant women, children etc.

High medical bills; receive Supplemental Security Income (SSI); pregnant woman; or meet certain income, resources, age or disability requirements.


Medicaid Buy-in Program for Working People with Disabilities

NYS Department of Health
Corning Tower 
Empire State Plaza
Albany, NY 12237
TEL: 800-541-2831

Comprehensive medical Medicaid coverage with a modest or no premium based on income

Resident of NY state; age 16 thru 64; have a disability as defined by Social Security; engaged in paid full-time or part-time work; meet gross income limits; have nonexempt resources below $20,000 ($30,000 for a couple). See web site for details.

Medicaid Cancer Treatment Program (MCTP)

NYS Department of Health 
Corning Tower
Empire State Plaza
Albany, NY 12237
TEL: 866-442-2262

Full Medicaid benefits.

Under age 65; have an income at or below 250% of the Federal Poverty Level, not be covered under any creditable insurance, be ineligible for Medicaid under other eligibility groups, be a resident of New York state and a U.S. citizen or eligible alien, and were screened by a NY State licensed health care provider or were screened by another state’s National Breast & Cervical Cancer Early Detection Program.

Medicare Savings Programs (MSP) (NY)

NYS Medicaid
NYS Department of Health
Corning Tower — Empire State Plaza
Albany, NY 12237
TEL: 800-541-2831

QMB helps pay for Part A & B premiums, deductibles, copays, and coinsurance. SLMB and QI both help pay for Part B premiums only; however, their income guidelines differ. QDWI helps pay for Part A premiums. If you qualify for QMB, SLMB or QI, you automatically qualify for another program, Extra Help, which helps pay for Medicare prescription drug costs.

For all 4 programs: Must be enrolled in or eligible for Medicare Part A and meet assets (resources) and income guidelines. Income limits vary by program. Resource limits are the same for QMB, SLMB, and QI but differ for QDWI. For QDWI, you must be disabled. See program web site for details; also, see federal site http://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html

Naloxone Co-Payment Assistance Program (N-CAP)

New York State Department of Health
 Distribution Center
Corning Tower — Empire State Plaza
Albany, NY 12237
TEL: 800-233-7432

Program covers co-payments in the amount of up to $40 per prescription; No individual enrollment necessary; Over 2000 participating pharmacies in the New York State. For a list of participating pharmacies: see link on program website to Naloxone Pharmacy Directory.

Prescription coverage as part of their health insurance plan; who are themselves at risk of an overdose, or their family members or friends; Resident of the State of New York; Have a prescription.

New York Connects -Aging & Disability Resource Center (ADRC-NY)

NYS Office for the Aging
2 Empire State Plaza
Albany, NY 12223
TEL: 800-342-9871

Staff members are trained and knowledgeable about programs/agencies that specialize in older adults and the disabled. Examples of potential issues include: health issues such as nutrition and management of chronic medical conditions; adaptive equipment; assistive technology; long term care options; low-income housing; assisted living; financial issues such as paying your bills; elderly and disability benefits; community resources; adult protective services, etc. Staff can help with completing applications for public and private benefit programs including but not limited to: Social Security, SSI, Medicare, Medicaid, etc. This is a federal/state program.

Elderly or disabled adult resident of this state (or their caregiver).

One Commerce Plaza RM 1609
Albany, NY 12237
TEL: 800-505-5678

Primary & specialty medical care, emergency care, prescription drugs, physical therapy, adult day care etc.; i.e. all the care and services covered by Medicaid and Medicare. There are neither co-pays nor deductibles. If you are not on Medicaid, there is a premium for the long-term care portion of your care. For most enrollees, you must use PACE physicians. The program is voluntary and you can leave the program at any time.

Age 55 years or older who: require a “nursing facility level of care”; must be able to live safely in the community at the time of initial enrollment; and live in the service area of a PACE organization. You can be on Medicaid or Medicare or both; if you are in neither program, you may private pay. Note: “nursing facility level of care» is defined by the State’s Medicaid office.

Prenatal Care Assistance Program (PCAP)

NYS Department of Health
Corning Tower 
Empire State Plaza
Albany, NY 12237
TEL: 800-522-5006

Routine prenatal care, hospital care during pregnancy and delivery, HIV counseling and testing, full health care up two months after delivery, health care for your baby up to one year after delivery, family planning services etc.

Pregnant women and teens who reside in New York and meet income guidelines may be eligible

Technology-Related Assistance for Individuals Disabilities (TRAID) Program

NYS Justice Center for Protection of People
 with Special Needs
161 Delaware AVE
Bethlehem, NY 12054
TEL: 800-624-4143

Through the 12 Regional TRAID Centers (RTCs): information, training, device demonstration and loan, technical assistance and advocacy on how to obtain & use assistive technology services & devices. Also, the TRAID-IN Equipment Exchange program is for individuals who are looking to sell, donate or obtain used assistive devices for people with disabilities. This agency receives funds from various NYS agencies.

Resident of this state of all ages with disabilities, their family members, service providers, employers, educators, etc.

Vaccines for Children Program (VFC) — New York City

Department Health/
Mental Hygiene -Immunization
42-09 28th ST 5th FL -CN-21
Queens, NY 11101
TEL: 212-447-2574

Diseases preventable by vaccines include: Diphtheria, hepatitis, influenza, measles, pneumococcal, mumps pertussis, polio, tetanus etc. A small administrative fee (amount regulated by State) may be charged; also an office visit charge may be applicable.

Children thru age 18 who meet one of the following criteria: child is Medicaid eligible; or uninsured; or American Indian or Alaska Native; or qualifying underinsured. See CDC web site for details including maximum admin. fee by state: http://www.cdc.gov/vaccines/programs/vfc/parents/qa-detailed.html

Vaccines for Children Program (VFC) — NY State

NYS Department of Health -Immunization
Corning Tower -Empire State Plaza
Albany, NY 12237
TEL: 800-543-7468

Diseases preventable by vaccines include: Diphtheria, hepatitis, influenza, measles, pneumococcal, mumps pertussis, polio, tetanus etc. A small administrative fee (amount regulated by State) may be charged; also an office visit charge may be applicable.

Children thru age 18 who meet one of the following criteria: child is Medicaid eligible; or uninsured; or American Indian or Alaska Native; or qualifying underinsured. See CDC web site for details including maximum admin. fee by state: http://www.cdc.gov/vaccines/programs/vfc/parents/qa-detailed.html

Women Infants & Children’s Program (WIC) (NY)

NYS Department of Health
150 Broadway — FL6W
Albany, NY 12204
TEL: 800-522-5006

Provides the following at no cost: health screening at initial appointment for all applying family members; nutritional foods; nutrition education; help finding health care; breast-feeding support etc.

Low income and nutritionally at risk; resident of this state; and are one of the following: pregnant, breast-feeding a baby under age 1, just had a baby, or have an infant or child under the age or 5. See web site for details.

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email info@nyhealthinsurer.com