New York Marketplace Health Insurance Plans
Qualified Plans on NY State of Health
Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.
You should also look at a NY State of Health plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a NY State of Health plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"
Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.
Affinity Health Plan. Established in 1986, Affinity is an independent, nonprofit organization offering health care services to low-income residents in New York. Affinity serves residents in New York City and Nassau, Suffolk, Westchester, Rockland and Orange counties. Its network includes 33,000 doctors and 68 hospitals, giving it one of the exchange’s largest, according to Yahoo!.
American Progressive Life & Health Insurance of New York (Today’s Options of NY). Established in 1945, the company is one of five companies affiliated with Universal American and provides health and life insurance products to seniors and low-income residents on Medicare.
Capital District Physicians Health Plan. This independent, nonprofit was established by physicians in Albany in 1984. The physician-led company offers coverage in 24 counties and includes a network of 5,000 physicians and 3,000 mid-level practitioners, according to the company.
Health Insurance Plan of Greater New York (EmblemHealth). Established in 2006, the health maintenance organization (HMO) claims to be the largest health insurer in New York.
Empire Blue Cross and Empire Blue Cross Blue Shield. Empire is an independent licensee of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one-third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of professional providers. New Yorkers who buy a Blue Cross Blue Shield exchange plan, whether from Empire or Excellus (below), may not have access to the entire network of doctors and hospitals.
Excellus (Excellus BlueCross BlueShield in Central NY and Univera in Western NY). Excellus is also a Blue Cross and Blue Shield Association licensee. In New York, Excellus BlueCross BlueShield previously sold Medicaid plans. Its recent decision to stop selling those plans affects approximately 22,000 residents in the central part of the state, the Wall Street Journal reported.
Fidelis Care. Established in 1993 as the Catholic Health Services Plan of Brooklyn and Queens, Fidelis Care offers free or low-cost health coverage in 59 counties in New York. Its statewide network includes over 55,000 providers.
Freelancers Co-Op (Health Republic Insurance). With funding from the federal government, this nonprofit, member-governed, co-op is affiliated with Freelancers Union, a Brooklyn-based union established in 2003. Freelancers Union has experience providing health coverage to its members, who generally don’t have access to employer coverage. Now the co-op will sell health plans under the name Health Republic to anyone eligible to purchase insurance through the New York exchange. The Union received $174.4 million to establish the New York co-op, according to The Post-Standard.
Healthfirst New York. Established in 1993, this nonprofit managed care organization offers health coverage to low-income children, adults and families living in metropolitan New York. Healthfirst Leaf Plans, the brand of the company’s qualified health insurance plans on the New York exchange, are available in every tier.
HealthNow New York. (Blue Shield of NENY; BlueCross & BlueShield of Western NY). Established in 1936, HealthNow covers Western New York and is also an independent licensee of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. New Yorkers who buy a Blue Cross and Blue Shield exchange plan may not have access to the entire network of doctors and hospitals.
Independent Health. Established in 1980, this nonprofit serves almost 365,000 residents nationwide, including residents of Western New York. Independent Health offers a searchable directory of its in-network doctors, hospitals, pharmacies and urgent care centers.
MetroPlus Health Plan (Market Plus). The company provides low or no-cost health insurance to eligible people living in Manhattan, Brooklyn, the Bronx and Queens. In 2010, the New York State Department of Health rated MetroPlus as the number one Medicaid Managed Care health plan in the state, according to the New York City Health and Hospitals Corporation.
MVP Health Plan. MVP describes itself as a nonprofit health plan headquartered in Schenectady, N.Y. In addition to covering New York residents, it offers health plans in Vermont and New Hampshire.
North Shore-LIJ (North Shore-LIJ CareConnect). The North Shore-Long Island Jewish Health System claims to be the 14th largest healthcare system, according to The Island Now. Its network includes more than 7,000 providers and 16 hospitals in metropolitan New York. Though enrollees will be restricted to in-network coverage, emergency care is covered anywhere. North Shore-LIJ serves the Nassau, Suffolk, Queens and Richmond counties.
Oscar. Recently established by tech venture capitalist Josh Kushner and supported with $40 million in start-up capital by Silicon Valley investors like Vinod Khosla and Peter Thiel, this Manhattan-based start-up insurance company is focused on user experience, according to Businessweek. One of the insurer’s featured services is “tele-doc,” a round-the-clock service that promises to have a doctor call a customer back within an hour, according to NY1.
United Healthcare of New York (United, Oxford). United Healthcare, a division of UnitedHealth Group, is the single largest U.S. health insurance carrier, according to the company, which claims its national network includes more than 720,000 providers, 80,000 dentists, and 5,500 hospitals.
Wherever you live in New York, you will want to check the details of any marketplace plan to see if your doctor or hospital is in the network. Check out the NY State of Health, the state’s marketplace, which has published links to each insurer’s provider network.
Last updated by Heilbrunn, Evi | December 5, 2013