NYS Insurance Marketplace: Providing Affordable Health Insurance for New Yorkers

In 2010, the Affordable Care Act was signed into law to provide access to affordable health care for all Americans. One of the key provisions of the law was the creation of state-based insurance marketplaces, also known as exchanges. The New York State (NYS) insurance marketplace, also known as New York State of Health, was established to provide affordable health insurance options for individuals and small businesses in the state of New York.

Overview of the NYS Insurance Marketplace

The NYS insurance marketplace is a platform where individuals, families, and small businesses can shop for and enroll in affordable health insurance plans. The marketplace offers a variety of plans from different insurance companies, including Medicaid, Child Health Plus, and Qualified Health Plans (QHPs).

The marketplace is administered by the New York State Department of Health, in partnership with the federal government. It is open for enrollment during the annual open enrollment period, which usually occurs from November to January. However, individuals and families who experience a qualifying life event, such as losing their job or getting married, can enroll in a plan outside of the open enrollment period.

Who Can Enroll in the NYS Insurance Marketplace?

The NYS insurance marketplace is open to individuals and families who are legal residents of New York and are not eligible for employer-sponsored health insurance coverage. Small businesses with up to 100 employees can also purchase health insurance plans through the marketplace.

In addition, individuals and families with incomes up to 400% of the federal poverty level (FPL) may be eligible for financial assistance to help pay their monthly premiums and out-of-pocket costs. This financial assistance is provided in the form of tax credits and cost-sharing reductions, which are based on income and household size.

Benefits of Enrolling in the NYS Insurance Marketplace

Enrolling in a health insurance plan through the NYS insurance marketplace offers several benefits, including:

FAQs

What is a Qualified Health Plan (QHP)?

A Qualified Health Plan (QHP) is a health insurance plan that meets certain requirements under the Affordable Care Act, such as covering essential health benefits and providing consumer protections. These plans are offered by private insurance companies through the NYS insurance marketplace.

What are Essential Health Benefits?

Essential Health Benefits are a set of 10 categories of health services that all QHPs must cover, including:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, 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

What is Medicaid?

Medicaid is a federal and state program that provides health coverage to low-income individuals and families. In New York State, Medicaid is offered through the NYS insurance marketplace and covers a broad range of health services, including doctor visits, hospitalization, and preventive care.

What is Child Health Plus?

Child Health Plus is a program that provides free or low-cost health insurance for children and teenagers up to age 19 who live in New York State. It covers a wide range of health services, including doctor visits, immunizations, and dental care.

What is the Open Enrollment Period?

The open enrollment period is the time of year when individuals and families can enroll in a health insurance plan through the NYS insurance marketplace. The open enrollment period usually occurs from November to January, but may vary from year to year. Outside of the open enrollment period, individuals and families can only enroll in a plan if they experience a qualifying life event, such as losing their job or getting married.