Insurance

1. Presentation to
Health Insurance Options Available in NYC
New York City
Human Resources
Administration’s
Office of Citywide
Health Insurance
Access (OCHIA)

2. Why do New Yorkers need health insurance coverage?
What is the NY State of Health Marketplace?
Health insurance helps pay for medical bills you may have when
going for a regular checkup or when you must go to the hospital.
If something happens to you, you can get a large medical bill. You
do not plan to get sick or hurt, but it can happen.
The NY State of Health Marketplace is New York’s one stop shop
for public and private health insurance.
You can compare each plan’s features and prices side-by-side, and
then choose the one that fits your needs and your budget.
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3. How do most New Yorkers get health insurance?
Most New Yorkers can get health insurance through the NY State of Health Marketplace.
You can enroll in Medicaid, Child Health Plus, Essential Plan or private health insurance,
depending on your household size and income.
You can apply and enroll in the privacy of your own home using the internet:
www.nystateofhealthny.ny.gov, at a library or with the help of an in-person assistor, free
of charge.
Individuals 65 and over, living with a disability or visual impairment apply through HRA.
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4. How much will my health insurance cost? Can I get
financial help to pay for coverage?
Other people will get financial help to pay for the cost of private health insurance.
The amount of financial help depends on an individual’s or family’s income and
household size.
Individuals earning up to $23,760 are eligible for the Essential Plan.
Some people will qualify for free or low-cost health insurance through Medicaid, Child
Health Plus or the Essential Plan. Coverage through the Essential Plan is $20 a month or
free if you qualify.
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Individuals earning up to $29,700 are eligible for subsidies to pay for private
health insurance and additional help pay for out-of-pocket expenses
(deductibles, co-payments and co-insurance).

5. Public Health Insurance Eligibility Criteria
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Eligibility requires information about:
• Income
– Child Health Plus: Child in a family of four – up to $98,400
– Medicaid: Single Adult - $16,643; Adult in a family of four – up to
$33,948
– Medicaid for Pregnant Women:
• Pregnant woman carrying one child (household of two): $36,216
• Pregnant woman carrying triplets (household of four): $54,858
• Residency
– Must be a New York State resident
– Short-term visa holders (tourist, work, school) are not eligible
• Appropriate immigration status (Medicaid)
• Age
– Medicaid, Medicaid for Pregnant Women and FPBP: no age limits
– Child Health Plus: children under 19 years old

6. What will my health insurance cover?
Doctor’s visits
Emergency services and hospitalization
Free preventive care
Prescription coverage
Mental health services
Maternity care
Infant and children’s care
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7. Examples of preventive care
Vaccinations
Cholesterol screening
Blood pressure screening
Colorectal cancer screening
Mammograms
Pap smears
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8. When can I get health insurance?
You can get Medicaid, Child Health Plus and the Essential plan all year round.
You can enroll in private health insurance during open enrollment for the Marketplace, November
1, 2017 – December 15, 2017
Certain life changes called “qualifying life events,” might allow you to sign up for health insurance
through the Marketplace outside of open enrollment. This is the special enrollment period:
December 16, 2017 – October 31, 2018
Some qualifying events are:
o Getting married
o Getting pregnant
o Having a baby or adopting a child
o Losing you health insurance coverage
o Moving to another county or state
o Changing your immigration status
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9. What type of plan is right for you?
$$$$
Platinum
If you are willing to spend more, a Platinum plan might make the most sense for you.
Your monthly premium will be higher, but you’ll pay less for doctor visits and
prescriptions. If you visit the doctor often and/or need a lot of prescription drugs, a
Platinum plan will offer the most savings for you. On average, Platinum plans cover
90% of medical costs, and you will pay about 10%.
With a Gold plan, you will have a higher monthly premium, but you will likely
pay less for doctor visits and prescriptions. If you visit the doctor often and/or
need a lot of prescription drugs, a Gold plan will likely offer the most savings for
you. If you visit the doctor often and/or need a lot of prescription drugs, a Gold
plan will offer the more savings for you. On average, Gold plans cover 80% of
medical costs, and you will pay about 20%.
$$$
Gold
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If you have a doctor you see regularly or a hospital you like, check to see
if they are in the health plan before you enroll. Also check to see if your
prescriptions are covered.

10. What type of plan is right for you?
$$
Silver
With a Silver plan, you can expect lower monthly costs than a Gold plan, but more
coverage and benefits than a Bronze plan. If you don’t visit the doctor often or need a
lot of prescription drugs, a Silver plan will likely fit your needs. On average, Silver
plans cover 70% of medical costs, and you will pay about 30%.
If your income is below $29,700 for an individual or $60,750 for a family of four) and
you choose a health plan from the Silver plan category, you may qualify for help with
out-of-pocket costs. (Out-of-pocket costs are the costs that your insurance doesn’t
cover that you have to pay when you visit the doctor or fill a prescription. They
include co-insurance, co-pays and deductibles)
The Bronze plan has the lowest monthly premium, but you will likely pay more
when you visit the doctor or fill a prescription. If you do not go to the doctor
often and you do not need a lot of prescription drugs, a Bronze plan will likely
offer the most savings for you. On average, Bronze plans cover 60% of medical
costs, and you will pay about 40%.
$
Bronze
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11. Health Care and
Coverage Options
for Undocumented
Immigrants
Child Health
Plus for
children
under 19
Medicaid for
Pregnant
Women
Medicaid for
the treatment
of an
emergency
medical
condition
Hospitals and
Community
Health
Centers
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nyc.gov/ochialowcostcare
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Where can you get free or low-cost health care?
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12. Community Service Society’s Community Health Advocates
(CHA) provides free, confidential counseling to individuals,
families, small businesses and advocates to help them
understand their health insurance access the health care
services they need.
Website: http://www.communityhealthadvocates.org/,
Telephone: 888-614-5400
Where can you go to get help with problems you have when using
your coverage?
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13. Questions about health plans or financial assistance?
Contact the
NY State of
Health
If you have questions about health plans, financial
assistance, or anything else about the NY State of
Health please call the Customer Service
Representative Help Line toll free at
1-855-355-5777; TTY: 800-662-1220
Customer Service hours of operation are:
Monday – Friday, 8 am – 8 pm
Saturday, 9 am – 1 pm
Shop, compare, purchase and enroll in public or
private health insurance coverage at
www.nystateofhealth.ny.gov/
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