Individuals and small businesses can get health insurance through NY State’s official health plan marketplace, NY State of Health (NYSOH). Medicaid, Child Health Plus and private health insurance is available. It is the only place to get tax credits and other assistance to lower insurance costs.
Who can use the NY State of Health?
NY State of Health runs two marketplaces: one for Individuals and one for Small Businesses.
The Individual Marketplace is for residents and sole proprietors (including freelancers and self-employed workers). It was created mainly to serve people who don’t get health insurance through a job, don’t have Medicare, live in NY, and are a citizen, national, or lawfully present immigrant.
The Small Business Marketplace currently serves businesses with 50 or fewer employees.
- All children, regardless of immigration status, can enroll in Child Health Plus through the Marketplace.
- Adults who are undocumented immigrants and have lower incomes can use the Marketplace to pre-certify themselves for Medicaid for the treatment of an emergency condition and get coverage for prenatal care.
When can you use the NY State of Health?
Outside of open enrollment, you can only enroll or change your health plan if you experience a qualifying event.
- Small businesses can get insurance at any time.
- Individuals who are eligible for public health insurance can enroll at any time.
- Individuals can apply for private insurance at any time but can only enroll – or change their plan – once a year, during “open enrollment ”. The next open enrollment period is from November 1, 2015 thru Janruary 31, 2016.
Once the Marketplace determines that you are eligible to purchase coverage, you cannot be denied by a specific plan. In addition, your premiums will not change during the plan year.
The Individual Marketplace
Applying for coverage. NY State of Health offers comprehensive health insurance. You can complete one application to purchase private health insurance at full cost or at a reduced cost.
Paying less for health insurance. Insurance Affordability Programs (IAPs) include Medicaid, Child Health Plus, Advance Premium Tax Credits, and Cost-Sharing Reductions. The Marketplace will determine if you qualify for any of these programs, which can lower the cost of your coverage.
Job-based coverage & the Marketplace. You can buy a private plan in NY State of Health even if you are offered coverage through a job. However, you probably cannot get financial assistance in the form of a tax credit.
Most people who can get insurance through their job or a spouse’s job cannot get a tax credit to lower their private insurance costs in the Marketplace. There are two exceptions:
Children under 19 who have health insurance through a parent’s job and drop that coverage to enroll in the Marketplace may be subject to a waiting period before they can enroll in Child Health Plus. Learn more.
- If the cost for you to get employee-only coverage from your employer is more than 9.5% of your household income, you and your family may be able to get coverage in the Marketplace and receive financial assistance.
- If your employer’s coverage is inadequate, meaning it pays less than 60% of the cost of covered benefits. Your employer can tell you if the coverage they offer is inadequate.
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The Small Business Marketplace
If you are a small business with fewer than 50 employees, you do not have to provide health insurance to your employees.
Rules for using the Marketplace: Small businesses with 50 or fewer employees in New York can use the NY State of Health’s Small Business Marketplace. You must offer coverage to all of your eligible employees, but there are no rules regarding how many employees must sign up or how much you contribute to the cost of coverage.
What the Marketplace offers: Buying in the Small Business Marketplace lets:
You can buy insurance in the Small Business Marketplace at any point during the year. The coverage you purchase will last one year.
- You offer your employees one plan - or a choice of plans and insurers. This means, you can set the amount you want to contribute then let your employees choose to enroll in different plans to meet their individual needs – both higher or lower cost plans - all while keeping your costs the same and still having only 1 bill to pay each month.
- You can still use a broker or other assistor who is certified by the Marketplace to help you and your employees sign up. This help is free to you.
- Very small for-profit and not-for-profit businesses who qualify claim a tax credit for up to half of their premium costs.