On this website, you'll find clear and accurate information about getting health insurance under the Affordable Care Act (ACA), including:
whether or not you must get health insurance
what the available plans cover
how much coverage will cost
how to sign up for a plan, and
how to get help if you need it.
To begin, keep in mind these key points about health insurance in New York:
1. Obamacare, officially known as the Affordable Care Act, has not been repealed.
Though there has been much talk from the current Republican administration about repealing the Affordable Care Act, it is still the law. Lawmakers have not changed any of the ACA's requirements or benefits, nor have they yet proposed a replacement plan. We will update the information on this website when and if the ACA changes.
2. You are legally required to have health insurance, unless you qualify for an exemption.
Despite what you may have heard, you can’t be arrested or thrown in jail if you don’t have health insurance in New York. You may, however, be forced to pay a tax penalty if you aren't enrolled in a health insurance plan that meets the requirements of the Affordable Care Act.
To avoid the penalty, you must either obtain qualified health coverage or prove your eligibility for an exemption.
What Qualifies as Coverage?
If you have any of the following types of health coverage, you won’t have to pay a penalty:
an individual insurance plan, whether purchased on your own or through NY State of Health, the exchange serving New York
a plan (including COBRA or a retiree plan) provided by your employer
Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP) more...
This article explains the costs of health care plans offered under Obamacare (the Affordable Care Act of 2014) for individuals or families who are currently uninsured or not covered by a job-based health plan.
What you'll pay for an Obamacare plan depends on five things:
The level of coverage you choose
Whether you qualify for a subsidy
Where you live in New York
Whether you smoke
Read on to learn more about each of these factors.
1. The Level of Coverage You Choose
Obamacare insurance plans offer four levels of coverage:
The easiest way to sign up for a health plan under the Affordable Care Act is to go to the online health insurance marketplace for New York. If you're not ready to enroll right now, you can get more information online, over the phone, or in person.
Where's the New York Health Care Exchange?
You can find the health insurance exchange for New York at NY State of Health. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online. If you prefer to apply with a paper application, call the NY State of Health customer service center or contact an in-perrson assister using the information just below.
As Obamacare enters its fourth open-enrollment period, one would hope the health insurance application process would be as simple and fast as it was originally intended to be. But, for many, streamlined health plan enrollment and renewal -- not to mention truly affordable coverage -- still seems like a faraway goal.
Below are a couple strategies to keep your application moving forward and get your health insurance needs met.
Common Complaints from Health Insurance Applicants
The list of complaints from those caught in the health exchange bureaucracy is long, commonly including:
exchange websites are still buggy or broken
phone and chat hold times are unreasonable, and representatives often don’t have helpful answers to questions
applicants can’t easily compare health plan benefits and costs
applicants can’t figure out whether their current health care providers are included in the plan they’re considering
applicants choose plans only to discover later that they can’t afford them
application information isn’t recorded properly (or protected from privacy violations) by the health care exchange
exchanges are slow to respond to problems with applications, premium payments, or tax forms, and
health insurance plans are sometimes canceled or changed without notice.
Do you have to worry about IRS Forms 1095, 8965, or 8962? The Affordable Care Act, aka Obamacare, requires you to do one of the following three things when you file their taxes this year:
confirm they had health insurance coverage for 2016
claim an exemption from health coverage, or
pay a penalty when they file their return.
This remains true even though the Trump administration has issued an executive order allowing the IRS to accept tax without health insurance disclosures. Under the Affordable Care Act, you are still required to pay any Obamacare tax penalty you owe, and the IRS may question you if you fail to report your health insurance status on your tax return. The new rule does, however, imply that the Trump administration may not aggressively pursue people who don't pay their penalties.
Here’s what you should know about filing your taxes in this confusing era of health insurance reform.
Get a colonoscopy, mammogram, vaccinations, and other essential services for free
The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through NY State of Health, the health care marketplace for New York. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.
Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges
Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.
Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.
Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)
One way to satisfy Obamacare’s health insurance requirement is to obtain coverage under Medicaid. If you qualify for Medicaid and enroll in New York's Medicaid program, you do not have to sign up for another insurance plan.
It’s Now Easier to Qualify for Medicaid in New York
The Affordable Care Act expanded Medicaid eligibility to cover more people who can’t afford health insurance. The U.S. Supreme Court later decided that it was up to individual states to decide whether or not to expand Medicaid.
Because New York did decide to expand its Medicaid program, you can qualify for Medicaid if you earn up to 138% of the federal poverty level. For 2015, 138% of poverty level is about $16,240 for an individual or $33,460 for a family of four.
Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest hassles they face. But this may change for the better under Obamacare, which provides new coverage options for the self-employed.
Are You Self-Employed or an Employer?
Before you start evaluating your options for health coverage, you need understand whether you are in fact considered self-employed under Obamacare.
The law says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) Self-employed people can use the new health care marketplace to purchase individual health insurance plans.
If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace.
The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because new coverage options are now available through NY State of Health, the health insurance marketplace serving New York.
All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.
When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. (For 2016, open enrollment ends on January 31.) But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan.
Here's an overview of your options for health insurance if you are unemployed, plus more information about what might happen if you don't get health coverage. (And if you're looking for information about applying or eligibility for unemployment, see our articles on New York unemployment benefits.)
When registered domestic partners or civil union partners apply for coverage in the new health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?
The answer depends on the state where you live.
States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)
California, Nevada, or Washington. In these states, which extend community property laws to registered domestic partners, domestic partners must usually apply using half of the partners’ combined incomes. (We confirmed this with the legal department at Covered California after repeatedly receiving conflicting information from representatives staffing the exchange’s customer service phone line.) This is because IRS rules require that domestic partners registered in these community property states report half of their combined community income on their federal taxes each year.
The U.S. Supreme Court has upheld health care subsidies for residents of all states, including those that rely on NY State of Health, the federal government’s health insurance exchange. As described below, King v. Burwell could have ended tax-credit subsidies for states that use the federal marketplace to facilitate the purchase of health insurance plans under Obamacare.
Even though New York operates its own health insurance exchange, the King v. Burwell decision is good news for consumers in the state. The 6-3 ruling means that almost 6.5 million Americans will continue to receive the financial assistance that lets them afford health insurance. This helps to keep insurance costs and coverage steady for everyone, avoiding the "death spiral" that might have undermined NY State of Health and destabilized the Affordable Care Act as a whole.
The following panel discussion from Kaiser Health News offers a comprehensive discussion of the Supreme Court decision:
All health plans purchased through the NY State of Health, the health insurance marketplace for New York, must include the following benefits. These are known under Obamacare as “essential health benefits”:
Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
Hospitalization (including surgery)
Maternity and newborn care
Mental health and substance use disorder services (including counseling and psychotherapy)
Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
Preventive and wellness services and chronic disease management
Pediatric services (including oral and vision care)
Companies that offer plans through a state exchange will compete on price and quality of service in delivering these benefits.
Am I exempt from Obamacare?
Under Obamacare, most people who don't have health insurance will be required to pay a tax penalty. But you may not have to pay if you qualify for one or more of the following exemptions:
You are uninsured for fewer than three months of the year.
You prove that you can’t afford coverage -- that is, premiums for the least-expensive policy cost more than 8% of your earnings.
You don’t have to file a federal income tax return because your income is too low.
You are a member of a federally recognized Indian tribe.
You are a member of a health care sharing ministry.
You are a member of a recognized religion that objects to health insurance.
You are in the United States illegally.
You are incarcerated.
You may be eligible for an exemption under other circumstances, as well -- for example, if you can show that obtaining coverage would subject you to serious financial hardship.
If you used the marketplace to purchase a plan last year. Most people who purchased their 2016 insurance plan from an online marketplace will be able to automatically renew their coverage for 2017. While automatic renewal sounds convenient, it has serious downsides:
If your insurer decides to cancel your current plan, you could be switched to another plan without warning. The new plan may cost you more or change your eligibility for financial assistance.
Automatic re-enrollment could mean you aren't getting the right subsidy package. That could leave you facing higher monthly premiums now or -- if you take more assistance than you're eligible for -- a big tax bill later.
You may miss out on a better deal or better coverage if you don't compare all available plans to your current plan.
While allowing yourself to be automatically re-enrolled is better than going without insurance, it's best to take advantage of open enrollment and research your options. Shop around and evaluate new plans and costs. Even if you decide to stay with the plan you have, you can use open enrollment to confirm your personal information and ensure you're getting the right amount of financial aid.
If you purchased an individual or family insurance plan outside the online marketplace. As long as the plan meets Obamacare's coverage requirements, you can keep it. Or, you may use NY State of Health to compare plans and replace it. If you keep your current plan, you won't be eligible for the cost-saving subsidies available for plans purchased through the exchange.
Be sure to check with your current insurance provider before canceling a health insurance policy; you may have to wait until the end of your current policy year to make a change.
If you have insurance through an employer. As long as you're happy with your plan, you can keep it. You're considered covered under Obamacare. On the other hand, if you're not satisfied with the coverage you have, you may be able to switch to an individual plan through NY State of Health.
Keep in mind that if you buy a plan through the exchange:
Your employer will not have to pay a portion of your monthly premiums.
You may not qualify for cost-saving subsidies, even if your income falls within the eligible range. If your employer offers coverage that is considered affordable and sufficient under the law, you won't qualify to save on premiums or out-of-pocket costs for plans purchased through NY State of Health.
What is the health insurance marketplace?
The health insurance marketplace (sometimes called an "exchange") is where to go to get health insurance under the Affordable Care Act. The marketplace for New York is NY State of Health. You can use the marketplace to compare plans, learn whether you qualify for cost-saving subsidies, and sign up for the plan that works best for you.
Where can I get in-person help with my application?
In New York, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from an IPA/Navigator (IPA stands for “In-Person Assistor") or from a certified agent or broker.
IPA/Navigators can explain your options, answer your questions, and help you apply for the plan you choose -- but they can't legally recommend a specific plan for you. Private insurance agents or brokers are allowed to offer suggestions about particular plans.
"Open enrollment" is the period of time, once a year, when you can choose or change your insurance provider or what kind of plan options you want -- for example, monthly premium and annual deductible amounts -- for the upcoming calendar year.
For 2017 health care plans, the open enrollment period will run from November 1, 2106 to January 31, 2017.
Choose carefully, because after you make your choices, you must usually live with them until the next open enrollment period.
"Special enrollment" is an exception to the usual enrollment rules. If you qualify for special enrollment, you can sign up during a time period outside of the open enrollment period. The circumstances under which you may qualify for special enrollment include:
You should purchase a plan from the marketplace in the state you consider your primary residence -- where you vote, pay taxes, and so on. But snowbirds need to be sure they choose an appropriate “multistate” plan.
Some multistate plans may be restricted to a certain region – for example, a metropolitan area that straddles state boundaries. Others will be more appropriate for someone who migrates longer distances, spending, say, summers in Alaska and winters in Arizona.
Ask the insurance provider for details, and don’t sign up for a plan until you’re sure it will cover you where and when you need it.
What if I travel frequently?
Traveling shouldn't present any problem under a marketplace insurance plan. Simply sign up for a plan in the state of your primary residence. The plan will cover you in case of emergencies that happen out of state.
For more information about Obamacare in any state, including a link to the state’s health insurance exchange, choose the state from this list.
Information & Documents to Have on Hand
Here's a checklist of information to gather before you apply for health coverage at NY State of Health.
Social Security numbers for you and other members of your household who will be covered by your insurance plan
Policy numbers for any current health insurance plans
Documents to help you calculate your annual income. Include all sources, such as employment, pensions, alimony, rental property, or other income. If you have a job, gather together pay stubs or W-2 forms. If you’re self-employed, have last year’s tax return handy, as well other records that can help you estimate your yearly income.
If you or anyone in your household is eligible for job-based health insurance, a completed Employer Coverage Tool for each available plan
A good idea of your budget for health insurance, so you know how much you can afford to spend each month. This will help you choose the best plan from among those offered to you.
HealthCare.gov offers an Application Checklist you can print to help you keep track of everything you'll need to sign up.
Finally, keep a list of any questions you want answered before you sign up for a health insurance plan. To get answers to your questions, or for information on signing up for a plan, see How Do I Sign Up for Obamacare in New York?
Glossary of Obamacare and Affordable Care Act Terms