One of the common misconceptions with health care reform is that all individuals must enroll in medical coverage through the NY State of Health online insurance marketplace. Well, depending on one’s particular situation, this may or may not be the case.
As part of the Affordable Care Act (commonly known as “ObamaCare”), individuals with household incomes below 400% of the federal poverty level ($45,960 for individuals, or $94,200 for a family of four) may be eligible to receive an advance premium tax credit subsidy to help pay their health insurance premiums. The truth is, it is only if you wish to apply for subsidized premium assistance that you must enroll through online exchanges or “marketplaces”. Otherwise, you can work directly with a licensed insurance broker, just as you would in a pre-ObamaCare world, or like the way you go about securing homeowners insurance. Thus with a little research, you can determine on your own (and with a little help from the insurance broker who wrote this article) where you need to go for coverage.
Subsidy Eligibility Calculator
The first step is determining if you are eligible to receive a subsidy to help pay your premiums for individual health insurance. The best way to determine this is to use the Tax Credit and Premium Estimator calculator, located on the NY State of Health Marketplace website. Once on the page, click on the link to the tool. Then follow the instructions in the Microsoft Excel-based calculator tool. For complex household situations, it’s best to contact the NYS Marketplace Service Center at 1-855-355-5777 to fine tune your subsidy eligibility.
If You Qualify For a Subsidy
Consumers who qualify for a premium subsidy will need to purchase an individual health plan online using the government-run, NY exchange website, which involves an extensive application & verification process. Since this will be a very confusing task for most (if not all) consumers, it is recommended to seek the assistance from a licensed insurance broker to help you with the enrollment process.
If You Do NOT Qualify For a Subsidy
Consumers who do not qualify for a premium subsidy can purchase individual health plans outside of government-run exchanges using traditional, simplified paper applications with licensed broker assistance. These consumers will have access to health plans with the same actuarial values as compared to those sold on the NYSOH. Bear in mind that the Marketplace Service Center, “navigators”, and the online exchange marketplace will not provide assistance for off-exchange health plan enrollments.
There are many insurance companies offering health insurance options for downstate NY residents. Depending on your geographic location, the following carriers are recommended with respect to high quality customer service and pricing:
-Long Island, Queens, Staten Island, and New York City: North Shore-LIJ CareConnect
-All of downstate New York: Oscar Insurance Corp
-All of downstate New York: Empire Blue Cross (available only through the exchange)
Below are the 2014 individual policy rates for the carriers listed above:
For more information regarding individual health insurance plans in New York, contact a licensed insurance broker.