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Obamacare Marketplace Profile: New York State's Health Insurance Exchange

Obamacare Marketplace Profile: New York State's Health Insurance Exchange

Posted Aug 28, 2013 by Jenifer Dorsey

Exchange name: New York State of Health: The Official Health Plan Marketplace

On Aug. 20, the state of New York announced the official name for its online health insurance exchange. New York State of Health is a nod to native New Yorker Billy Joel’s famous song “New York State of Mind.” The exchange had been known as the New York Health Benefit Exchange.

Website: http://www.nystateofhealth.ny.gov

State-based or federally run: New York’s health insurance marketplace is among the 17 declared state-based health insurance exchanges, which include Washington, D.C., that came out of the Affordable Care Act. The exchange structure is state-operated, which means it has been established as part of an existing state agency, as opposed to a nonprofit structure or quasigovernmental structure in which the exchange is run as an independent public agency. 

Plans: Seventeen health insurance plans and 12 dental plans have been approved for sale on New York’s online marketplace. Individual and/or small group coverage will be available from the following carriers, according to a July 17 press release from the New York Governor’s Press Office:

  • Aetna
  • Affinity Health Plan, Inc.
  • American Progressive Life & Health Insurance Company of New York
  • Capital District Physicians Health Plan, Inc.
  • Health Insurance Plan of Greater New York
  • Empire BlueCross BlueShield
  • Excellus
  • Fidelis Care
  • Freelancers Co-Op
  • Healthfirst New York
  • HealthNow New York, Inc.
  • Independent Health
  • MetroPlus Health Plan
  • MVP Health Plan, Inc.
  • North Shore LIJ
  • Oscar Health Insurance Co.
  • United Healthcare

The New York State of Health website offers a plans map that allows users to click on their county or borough name to view certified plans in that area. 

As with all marketplaces, New York State of Health will offer plans at all metal level requirements —bronze, silver, gold and platinum—and include benefits in the 10 categories of essential health benefits and preventive care at no additional cost; both are Obamacare requirements for all health plans. A catastrophic plan will also be available to those who qualify, which include those younger than 30 or those who get a hardship exemption because they cannot afford health coverage through the marketplace.

New York State of Health contracts with plans as an active purchaser, according to the Kaiser Family Foundation’s state exchange profiles. This means it will “choose to have an exchange contract with selected health plans and/or negotiate premium prices with health plans,” as opposed to allowing all plans that meet minimum federal requirements for qualified health plans to be sold on the exchange, which is the clearinghouse model.

Supplemental coverage, such as critical illness insurance and bundled gap plans, is not available through state-based or federally operated health insurance exchanges; however, it easy to obtain directly from the plan’s carrier or a licensed agent or broker. Bundled gap plans offer additional protection, including accident medical expense insurance and accident disability income insurance, that helps create more comprehensive benefits like those offered through an employer. A critical illness insurance plan pays out lump-sum cash benefits upon diagnosis of certain illnesses that can be used for everything from medical bills to childcare.


New York is among the handful of states that have made their approved exchange health insurance rates publically available. States are not required to release approved 2014 premiums or plan details until open enrollment begins nationwide on Oct. 1.  Approved 2014 monthly premium rates were released by the New York Governor’s Office and can be viewed by clicking here. Rates shown are the average cost for a single adult and are listed by insurer, region and metal level; there are instructions below the chart for estimated rates with spouse and children. 

Plan rates for New York are lower than expected. According to a July press release from the New York Governor’s office, even at the highest tiers—gold and platinum—the approved rates for 2014 “represent a 53 percent reduction compared to last year’s direct-pay individual rates.” This does not include savings through federal tax credits and subsidies and is attributed to the expectation that more individuals will coverage through the individual insurance market.

Monthly premium rates will vary based on age, geography, family size and tobacco use. Under the Affordable Care Act, Americans cannot be denied coverage or charged more due to preexisting conditions. These provisions apply whether plans are purchased via the marketplace or not. Plans purchased off the marketplace will not qualify for subsidies or tax credits. 

Use the healthedeals.com Health Care Reform Calculator, which was listed among The Financial Times “Best Online Tools for the Toughest Health Questions,” to estimate your Obamacare health insurance cost and tax credit. 

Marketing campaign: New York’s health insurance marketplace name and logo were announced Aug. 20. At the same time, the state released a new video advertisement to introduce New York State of Health.” Available on YouTube—click here—the promotional clip, which is slightly more than 1 minute, features scenic footage from around the state and a multi-voice narration that highlights New Yorkers’ diversity as well as their mutual aims—to build, protect, thrive, etc.—and need for affordable health insurance. 

Need coverage now?

If you need health insurance to get you by until January 1, 2014, a temporary insurance plan can provide coverage for as few as 30 days. Start shopping on healthedeals.com or contact a healthedeals.com sales consultant for more information on short-term health insurance and supplemental plans.

Jenifer Dorsey is a freelance writer whose specialties include health and fitness, wellness, sports and recreation. She is a competitive amateur track cyclist who also enjoys mountain biking, hiking, camping and other outdoor adventure. Jenifer received a B.A. in journalism from Columbia College Chicago and is an MFA candidate at Naropa University. She lives in Colorado.