Open Enrollment Period in New York

• Open Enrollment for 2025 runs from November 1, 2024, to January 31, 2025.

• Enroll by December 15 for coverage starting January 1, 2025; enroll after December 15 and before January 31 for coverage starting February 1, 2025.

• You can browse plan options starting October 1, 2024.

Special Enrollment Period (SEP) Rules

You may qualify for a SEP if you experience a qualifying life event, such as:

• Loss of other health coverage (including Medicaid)

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

Generally, you have 60 days before or after the event to enroll. Coverage usually starts the first of the month after you enroll, but some events (like birth/adoption) may have retroactive coverage.

Types of Health Insurance Plans Available

Plans are offered in four metal tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs; best for those who rarely use care.

• Silver: Moderate premiums/costs; required for cost-sharing reductions.

• Gold: Higher premiums, lower out-of-pocket costs; good for frequent care.

• Platinum: Highest premiums, lowest costs; best for those needing frequent care.

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These plans have low premiums, high deductibles, and cover essential benefits after the deductible is met, but do not qualify for subsidies.

Plan Types:

• HMO: Lower premiums, limited network, referrals required.

• PPO: Higher premiums, larger network, out-of-network coverage, no referrals.

• EPO: Larger network than HMO, no out-of-network coverage except emergencies, generally lower premiums than PPO.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available based on income, generally up to 400% of the federal poverty level.

• Cost-Sharing Reductions (CSR): For incomes up to 250% of the federal poverty level on Silver plans.

• Essential Plan: For incomes up to 250% of the federal poverty level, premium-free or low-cost, with comprehensive benefits and no deductible.

• Medicaid/Child Health Plus: Medicaid covers low-income residents; Child Health Plus covers children in families with higher incomes. Both offer year-round enrollment.

How to Compare and Choose a Plan in New York

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Use the NYS Provider & Health Plan Look-Up Tool to ensure your doctors/hospitals are in-network

• Drug Formularies: Check if your medications are covered

• Additional Benefits: Some plans offer dental, vision, or telehealth

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65.

Top Insurance Providers on the New York Exchange

A variety of private insurers participate, including:

• Independent Health

• Fidelis Care

• Healthfirst

• MetroPlusHealth

• Excellus BlueCross BlueShield

• MVP Health Care

• UnitedHealthcare

• CDPHP

• EmblemHealth

• Oscar

• Highmark

• Other regional plans unique to specific counties and major cities

Navigating New York’s Online Enrollment Portal

How to Apply:

Create an account on the NY State of Health website.

Enter household and income information to check eligibility for subsidies or programs.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Free, in-person help is available from NYS Certified Navigators and Enrollment Assistors. Assistance is available in multiple languages and locations statewide.

Alternatives to the Marketplace

• Short-term health plans: Not ACA-compliant, limited coverage, may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies, may offer broader provider networks.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may be an option for some.

Common Mistakes to Avoid During Enrollment

• Forgetting to update income, which can affect subsidy eligibility and lead to tax repayment.

• Missing deadlines, resulting in loss of coverage or waiting until the next Open Enrollment.

• Choosing the wrong metal tier for your needs.

• Not checking if your providers are in-network.

State-Specific Health Programs or Initiatives

• Essential Plan: Expanded eligibility in 2024 to 250% of the federal poverty level, premium-free for many.

• Medicaid Expansion: New York fully expanded Medicaid under the ACA.

• Child Health Plus: Comprehensive coverage for children up to age 19.

• Social Care Initiatives: Programs like Medically Tailored Meals, Street Medicine, and Community Health Worker Expansion support Medicaid members with complex needs.

• Telehealth Expansion: Many plans now include expanded telehealth, especially for mental health.

New York’s Marketplace is one of the most robust in the nation, offering a wide range of plans, strong consumer protections, and innovative programs for residents.