Health Insurance in New York

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Are you trying to find affordable health coverage within the state of New York? You’re in luck. New York is one of the most aggressive and forward-thinking states when it comes to health care reforms that help get and keep more people insured. If you aren’t familiar with your options yet, then we strongly suggest you keep reading. You have a lot of choice when it comes to your health insurance in New York, and the information below can help you find a plan that fits you and your family’s health care needs at an affordable price.

Major Medical Insurance in New York

When the Patient Protection and Affordable Care Act was passed back in 2010, it created a series of laws, rules, and regulations that dovetailed nicely with New York State’s progressive attitude towards making sure all of its residents received proper healthcare. Although Most states choose to let their residents get covered through the federally facilitated national Health Insurance Marketplace, New York has been running its own state exchange (NY State of Health) for quite a while. This is the website New York residents go to every year during Open Enrollment in order to get the health insurance coverage they need.

It’s actually a lot easier to get a health insurance policy through NY state of health then it is in most other states. Open Enrollment was extended this past year all the way to January 1st of 2020 for health insurance coverage that would be active that same Year. There are 12 insurance companies who offer policies for New York residents, which is a substantially higher number than what is available on other state exchanges. Thanks to all of these efforts, New York state has seen a 47% drop in the number of uninsured residents since 2013.

If you purchase a health insurance policy through the NY State of Health Exchange, you will be purchasing a guaranteed issue policy. Guaranteed issue policies are special because once you qualify and apply for coverage, you cannot be denied or rejected. Furthermore, you can’t be charged a higher monthly premium compared to the next person if you happen to be unhealthy or come in with pre-existing conditions. Only four factors can allow your insurance provider to charge you a higher monthly rate, and those factors are:

  • Your age 
  • Your location
  • Your use of tobacco products
  • Whether you are applying for an individual policy or a family policy

Furthermore, major medical insurance sold through the NY State of Health comes with the guaranteed Essential Health Benefits promised by the ACA legislation. Most insurance policies outside either New York or the federal Health Insurance Marketplace are loathe to sell all of these coverages because of how expensive it can get to provide this level of care for their customers:

  • Ambulatory/outpatient services
  • Emergency services
  • Hospitalization
  • maternity/newborn care
  • Mental health and substance abuse
  • Prescription drugs
  • hab/rehab services and devices
  • Lab tests
  • Preventive and wellness services and chronic disease management
  • Pediatrics (including oral and vision)

Christian Health Plans/Health-Sharing Plans in New York

Since short-term health insurance isn’t available in New York state, people who are looking for health care coverage outside of the Marketplace my first turn to a Christian health plan, also known as a health share plan. These plans were very popular during the early days of the ACA legislation because of the individual mandate. Whether they are referred to as a Christian health plan or a health share plan, they are usually offered by a non-profit religious entity. This religious status not only gave consumers an exemption to the individual mandate, but it allows these providers to operate with very little federal oversight or regulation.

This lack of Regulation means that, unlike with short-term health insurance in other states, you can’t take your Christian health plan provider to court if you feel like they have denied you benefits unjustly. But the truth is that Christian health plans actually have a lot in common with short-term health insurance companies, such as:

  • These plans are NOT guaranteed issue
  • They have unlimited out-of-pocket costs
  • They have lifetime and annual benefit caps
  • They likely won’t have all of the guaranteed essential health benefits

Still, it’s important to go into the differences between short-term health insurance and health share plans so that you have a better idea of what one of these policies can give you. You will have to follow membership guidelines if you sign up for a Christian health plan. Usually this involves declaring some sort of Christian faith and living a healthier lifestyle by refusing to use tobacco products. Some Christian health plans have longer and more involved membership guidelines than most. They also charge you a monthly share amount instead of a monthly premium, and an “unshared amount” or a “personal responsibility amount” instead of a copay, a deductible, or a coinsurance fee. But if ACA Marketplace insurance isn’t an option for you, you’ll be pleased to know that these plans can cost cup to 1/3 less than an unsubsidized major medical plan, which can make some competitively affordable with other types of coverage. 

Fixed Indemnity Plans in New York

Fixed indemnity plans can provide hospital benefits, doctor visit benefits, dental benefits, or even some combination of the above depending on who provides your plan. They usually pay out their claims on a per day, per visit, per week, per month, or per incident basis. The amount of money they pay out is fixed for each claim, as opposed to a major medical insurance policy that pays out a certain percentage of your total medical costs regardless of the care you receive. Because fixed indemnity plans are fixed and therefore limited, they do not qualify as a legitimate replacement for major medical coverage. In fact, many people purchase fixed indemnity plans in order to supplement the coverage they have – not to replace it if they can’t or won’t purchase health insurance through the Marketplace.

Fixed indemnity plans have a few things in common with things like short-term health insurance or a health share plan. They come with both annual and lifetime benefit caps, as well as unlimited out-of-pocket costs. They also involve medical underwriting, which means you could be rejected for coverage or charged a substantially higher premium based on your health circumstances. But that doesn’t mean they aren’t without value. They can help keep your out-of-pocket costs under control with a less comprehensive major medical plan, or if you have no coverage at all. Just keep in mind that fixed indemnity plans work better as a supplement then a replacement for major medical coverage.

Discount Cards in New York

Another good way to lower your out-of-pocket costs is with a medical discount card. Keep in mind that these cards are in no way, shape, or form a replacement for health insurance. All these cards can do is provide you a modest discount on prescription costs, medical services, and other healthcare related expenses. You won’t be filing any claims or waiting for reimbursement. And anyone who tells you differently might be running an illegal scam. 

Medical discount cards work like any other membership program: you pay a fee, usually on an annual or monthly basis, and they send you a card in the mail. When you go to a participating doctor, pharmacy, or medical supply retailer, simply show them your card and get a discount at the register. It’s as simple as that. If your membership fees end up costing less than what you would pay without your discounts, then a medical discount card could be a huge boon for you. But if the membership fee turns out to be more expensive compared to the money that you save with your discounts, it might not be worth it. And you will also want to do a little homework and make sure the company who’s selling you a medical discount card actually works with the providers they say they work with and offers the discounts they say they offer – because it’s not uncommon for medical discount card companies to make lofty promises just to get your business.  

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