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Health Insurance Under Affordable   Care Act

If you are uninsured or cannot get coverage through a job or family member, it’s important that you find out where you can get health insurance and understand your options.

The NY State of Health, the Official Health Insurance Marketplace, is where most uninsured New Yorkers can go to get public and private health insurance coverage. 

In most cases, if you are under the age of 65, the first step to getting coverage is filling out an application online, over the phone at 1-855-355-5777, or with help from a Certified Application Counselor or Navigator. 

Depending on your situation, you may qualify for public health insurance or private coverage.

Public Health Insurance

New York State offers free and low-cost public health insurance programs for low-income New Yorkers.  Individuals and families can qualify for public health insurance even if they have income, own a house, own a car, or have a bank account.

As of January 1, 2014, most residents under age 65 must apply for public health insurance coverage, Medicaid and Child Health Plus, through the NY State of Health.
You can get public health insurance at any time during the year. 

Who can apply for Medicaid through HRA?

Persons 65 years and older and people of any age who need Medicaid related to a disability or blindness can apply for public health insurance through HRA. Call the HRA Helpline at 1-888-692-6116 or visit a Medical Assistance Program Office.

Who can apply for public health insurance through NY State of Health?

Most adults under age 65 and children must apply for coverage through NY State of Health.  It is operated by New York State and is the Official Health Plan Marketplace.  Call NY State of Health at 1-855-355-5777 or go on-line and apply at: https://nystateofhealth.ny.gov/.  You can also have someone help you apply in-person, just call NY State of Health to find an In-person assistor, or search online.

Pregnant women can apply through NY State of Health or go to a provider to find out if they can receive presumptive eligibility for Medicaid.

How do I renew my Medicaid?

If you originally applied for Medicaid or Family Health Plus through HRA, you will continue to renew through HRA for the time being.  Please follow these Medicaid Renewal Instructions (in PDF).

Private Health Insurance and Help Paying for Coverage

The Affordable Care Act and New York State requires private health plans to offer comprehensive coverage to individuals.
 
The ACA also makes financial assistance available to eligible residents purchasing coverage through the NY State of Health. This financial assistance includes help paying the cost of monthly premiums and out-of-pocket expenses including co-payments, deductibles and co-insurance. To learn more, click here.

Enrollment in private health insurance plans is limited to specified enrollment periods – called “open enrollment” periods. The next open enrollment period for purchasing private health insurance starts November 15th, 2014. Open enrollment applies both to plans sold to individuals through the NY State of Health, as well as plans bought directly from insurance companies outside of the marketplace.

If you have a qualifying event, such as loss of coverage, a birth, or move to another state, you may qualify to buy private health insurance outside of open enrollment.  When you have a qualifying event you are entitled to a “Special Enrollment Period”.

Why get health insurance?

Now, more than ever, it’s important that everyone who can get insurance does so – that’s because the Affordable Care Act requires it. Since January 1, 2014, uninsured individuals have been required to have health insurance, or pay a fee when you file your taxes – unless you can claim an exemption.


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