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Obamacare New York

Updated September 27th, 2017

Use the Form Below To Get Actual Updated Price Estimates For 2017 For Obamacare Plans In New York. You can also get pricing information on Obamacare alternatives if you find that the available plans are out of your budget. 

New York is one of a few states that maintains and administers its own state-based marketplace for health insurance coverage. Customers here can use the NY State of Health to shop for and enroll in ACA-compliant health plans. They can also use an independent agent, broker site or company to enroll directly while still taking advantage of cost-saving measures under the Affordable Care Act (Obamacare).

Requirement by Law

Despite the political upheaval this year over healthcare reform, it’s important to note that Obamacare’s individual mandate is still in effect. The IRS has stated that it will be enforcing the mandate as well. Under the Affordable Care Act, all eligible Americans – which represents much of the country – must hold qualifying health insurance or face a penalty fee. For this year, the fee is the greater of 2.5 percent of your household’s taxable income or a flat fee of $695 per adult ($347.50 per child under 18). The fee increases with inflation each year.


Obamacare Enrollment Options For New York State


During the 2017 open enrollment period, 242,880 people signed up for health insurance using the state exchange, compared to nearly 272,000 last year. The slight shift downward in enrollment can be contributed to several factors, including uncertainty over the current administration’s stance on healthcare reform and rising premium costs.

While customers in New York can use the federal marketplace site for enrollment, it may be beneficial to shop around using a comparison site like this one. Getting current quotes from multiple carriers can help you find a plan that adequately addresses your needs and fits your budget. Brokers can also help explain your options more clearly.

In 2018, New York enrollees will be able to choose from 12 carriers on the exchange, losing Affinity and CareConnect from the previous year.

Carriers Expected To Be Offering Coverage Include:

  • Capital District Physicians’ Health Plan
  • Emblem (Health Insurance Plan of Greater New York)
  • Empire Health Choice HMO
  • Excellus Health Plan
  • Fidelis Care New York
  • Healthfirst PHSP
  • HealthNow New York (BCBS of Western NY and Blue Shield of Northeastern NY)
  • Independent Health Benefits Corporation
  • Metro Plus Health Plan
  • MVP Health Plan
  • Oscar
  • UnitedHealthcare of New York

Plan options from these insurers will vary across the state. Premium rate increases for 2018 will also vary, but the average is about 13.9 percent assuming that cost-sharing reduction payments will not be made and that the individual mandate will not be enforced. If CSR payments are guaranteed, then the weighted average increase will go down among the various insurers.


Cost Assistance For Obamacare In New York 


For lower- and middle-income families and individuals – those earning between 100 and 400 percent of the federal poverty level – there are provisions in place for financial assistance, including tax credits and subsidies. Approximately 55 percent of exchange customers in New York qualified for premium subsidies in 2017. For more information about federal financial assistance, start the enrollment process today.

Open enrollment is different for people in state-based exchanges because these states have some flexibility in setting enrollment periods. For 2018, the open enrollment period in New York will run from November 1, 2017 to January 31, 2018. Those who want coverage starting on January 1 will need to enroll by December 15.

If you live in New York, you have access to a state-run health exchange, known as the New York State of Health. The agency released an annual report illustrating the state’s enrollment breakdown for Affordable Care Act (ACA)-approved plans. As of Feb. 28, 2015, more than 2.1 million New Yorkers had enrolled in a Marketplace plan, compared to 2014’s 960,762 enrollees.

In total, there are currently 16 different carriers that provide individual exchange plans. But for millions of lower-income New Yorkers, a new program, known as the Essential Plan, may dramatically transform the healthcare experience.

The Essential Plan is a Basic Health Plan (BHP), a state-run and generally federally funded plan for lower-income families and individuals. Typically, these are people with incomes from 139 percent to 200 percent of federal poverty level (FPL). But this plan has no deductible and no premium, as long as enrollees’ incomes are no more than 150 percent of the FPL.

While all states can implement the BHP option, as of yet, only New York and Minnesota have received the necessary federal funding. Essential Plan enrollment will begin on Nov. 1, 2015, the first day of the regular Open Enrollment Period (OEP).  Enrollment in the Essential Plan, as well as all other policies, will run through Jan. 31, 2016.

And for those beneficiaries who don’t want to enroll in the Essential Plan, New York offers other healthcare subsidies, as well. Currently, enrollees with incomes between 138 percent and 200 percent of poverty are eligible for premium subsidies and cost-sharing subsidies, but switching to a BHP during the upcoming open enrollment may result in lower premiums and lower cost-sharing.

When considering their 2016 healthcare plans, New York residents should take the time to explore the New York State of Health website. Here, you can receive direct quotes from providers and compare pricing and benefit information, as you make an informed decision.