Frequently Asked Questions

You can look through our Frequently Asked Questions (FAQs) to learn more about applying for health coverage. Click here for additional FAQs about the New York Health Plan Marketplace, Individuals & Families, Small Businesses, Brokers, and Navigators.

General FAQ

What is New York State of Health?

New York State of Health is a new Health Plan Marketplace. Individuals, families, and small businesses can use it to buy health insurance. It lets you shop and compare many health plans. It is the only place to get help lowering the cost of health coverage.

Why does New York need a Health Plan Marketplace?

Nearly 2.7 million New Yorkers under age 65 do not have a health plan. That is about 16 percent of people in New York State.

Who can use the Marketplace?

New York State of Health can be used by individuals, families and small businesses with 50 or fewer employees. Everyone should come to the Marketplace to see what it can offer.

How is New York State of Health different from other online marketplaces?

New York State of Health is a state-of-the-art website. It lets you shop for, compare, and buy a health plan online, in person or over the phone. Small employers can set a fixed amount to pay toward employee health plans. They can also provide a choice of health plans. We offer expert "helpers" for every step of the process. The Marketplace is the only place you can get tax credits to help lowering the cost of a health plan.

When does coverage begin?

For individuals, coverage can start as early as January 1, 2014. Small businesses can choose the date when their plan starts. It can be the first day of any month starting with January 1, 2014.

Where can I get help understanding health insurance terms?

Visit the glossary (include link) page on this web site. It contains many common terms that are helpful to know.

When was the Marketplace established?

New York State of Health was launched In April of 2012. Governor Cuomo issued an order to set up a statewide Health Plan Marketplace.

How is New York's Marketplace funded?

New York State of Health is funded by the federal government. It has to be able to support itself by 2015.

What grants has New York State received to support the Marketplace?

New York has received federal grants to build and roll out New York State of Health. To learn more, see the Resources page of this website under "Grants." .

Individuals & Families FAQ

Why should I buy a health plan through the Marketplace?

Because you will benefit from the great features listed below. All of them are found only at New York State of Health:

  • Choice and Value: Compare health plans side-by-side to find the right one for you.
  • Financial Support: See if you can get help reducing the cost of your premiums.
  • In-Person Assistance: Enroll with the help of experts who are trained and certified by New York State of Health.
  • Online Enrollment: Use our fast and easy online sign-up process.
  • Phone Support: Talk with Call Center helpers who will answer your questions.
  • Public Programs: Enroll in Medicaid or Child Health Plus if you qualify.

How should I get ready to buy a health plan through the Marketplace?

Think about your coverage needs. Ask yourself these kinds of questions:

  • What kinds of medical services do I need?
  • Are there prescription drugs that I have to take?
  • Are there doctors and other health care providers I prefer?

Where can I get help to understand my insurance options in the Marketplace?

Starting in October 2013, experts will be able to guide you through the enrollment process. They will help you find the right health plan based on your needs. They will also help you figure out if you can get help reducing the cost of coverage. You can get help online, in person where you live or work, and by phone. You pick what works best for you.

Can I buy insurance through the Marketplace if I already have a serious health problem?

Yes. The amount you pay for a health plan will not be affected by your health status. This means that you cannot be charged more because of your health problem. It also means you will not have to wait to get the coverage you need.

What if I choose to go without health insurance coverage?

People who do not get a health plan may have to pay a tax penalty to the federal government. But in some cases, the penalty will not have to be paid. To learn more, talk to one of our helpers.

Who can get coverage through the Marketplace?

To shop in the Marketplace, you:

  • Must live in New York
  • Must be a US citizen, national, or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid based on your income)
  • Cannot be currently incarcerated

Can I give someone else permission to get information about my application?

Anyone can call us to ask general questions, but we cannot discuss specific information about your application with anyone else, unless you give us permission to do so. You can give a trusted friend, relative, partner, or lawyer permission to talk with us about your application, and to act for you on matters related to your application. This person is called an authorized representative.

What do I need to apply for coverage through the Marketplace?

We ask about income and other information about you to tell you what coverage you qualify for and if you can get help paying for it. We keep all of the information you provide private, as required by law. For everyone applying for help paying for your health insurance through the Marketplace, you may need:

  • Social Security numbers (or document numbers for legal immigrants who need health insurance)
  • Birth dates
  • Employer and income information for everyone in your family
  • Policy numbers for any current health insurance
  • Information about any ob related health insurance available to your family

What if I speak or read in a language other than English?

New York is a diverse state with many people that may speak or read in a language other than English. Call the Marketplace at 1-855-355-5777 for more information or help applying for coverage in your language. All help is free.

Why do I need to provide a Social Security number (SSN)?

The Marketplace needs Social Security numbers for everyone who has one and is applying for health insurance. We use SSNs to check federal and state data sources to help speed up the application process. Providing your SSN can be helpful even if you do not want health coverage. If you don't have a SSN, call the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov to see if you can get a SSN and to apply for one.

Who can get coverage through the Marketplace?

To shop in the Marketplace, you:

  • Must live in New York
  • Must be a US citizen, national, or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid based on your income)
  • Cannot be incarcerated

Can I give someone else permission to get information about my application?

Anyone can call us to ask general questions, but we cannot discuss specific information about your application with anyone else, unless you give us permission to do so. You can give a trusted friend, relative, partner, or lawyer permission to talk with us about your application, and to act for you on matters related to your application. This person is called an authorized representative. You can call 1-855-355-5777 to find out how to name someone as your authorized representative.

What do I need to apply for coverage through the Marketplace?

We ask about income and other information about you to tell you what coverage you qualify for and if you can get help paying for it. We keep all of the information you provide private, as required by law. For everyone applying for help paying for your health insurance through the Marketplace, things you should know:

  • Social Security numbers (or document numbers for legal immigrants who need health insurance)
  • Birth dates
  • Employer and income information for everyone in your family
  • Policy numbers for any current health insurance
  • Information about any ob related health insurance available to your family

What if I speak or read in a language other than English?

New York is a diverse state with many people that may speak or read in a language other than English. Call the Marketplace at 1-855-355-5777 for more information or help applying for coverage in your language. All help is free.

Why do I need to provide a Social Security number (SSN)?

The Marketplace needs Social Security numbers for everyone who has one and is applying for health insurance. We use SSNs to check federal and state data sources to help speed up the application process. Providing your SSN can be helpful even if you do not want health coverage. If you don't have a SSN, call the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov to see if you can get a SSN and to apply for one.

Who should I include on my application?

Your income and family size help us decide what programs you qualify for. Include these people on your application for health coverage:

  • Yourself
  • Your spouse, if you're married
  • Any children you are caring for who live with you
  • Your partner, who lives with you
  • Anyone you include on your federal income tax return

You do not have to file taxes to apply for health insurance coverage for the Marketplace. Anyone else who lives with you will need to file their own application if they want insurance. Not everyone has to be living at the same address to apply on the same application.

Why does the Marketplace ask about race and ethnicity?

As part of the health insurance application process, there are optional questions about each applicant's race and ethnicity. You do not have to answer these questions, but answering them can help us serve your community better. Giving us this information will not affect your eligibility, plan choices, or access to programs.

What benefits do American Indians or Alaska Natives get through the Marketplace?

American Indians and Alaska Natives recognized by the U.S. government may qualify for special health care cost-sharing and other benefits as a result of the Affordable Care Act. These include:

  • No cost sharing such as deductibles or copayments if the household income is below 300% of the federal poverty level and the individual is enrolled in a qualified health plan in the Marketplace
  • The ability to change a health plan once per month, if they are enrolled in a qualified health plan
  • Exemption from the individual responsibility payment if they do not maintain health insurance coverage.

For more information, click here.

Can I still get health insurance if I am disabled or chronically ill?

You may still qualify for health insurance if you are disabled or chronically ill. Chronically ill persons include persons who cannot work for at least 12 months because of an illness or injury. They also include persons who have an illness or disability that has lasted or is expected to last for at least 12 months. The Marketplace will make sure that you get the right services. This may involve referring your application to our Local Departments of Social Services for additional assistance.

What is the Family Planning Benefit Program?

The Family Planning Benefit Program (FPBP) provides family planning services from any family planning service provider who accepts Medicaid. Some individuals with private health insurance may need to keep their family planning services confidential. Those people may enroll in FPBP if they meet eligibility requirements.

What is the Address Confidentiality Program?

The Address Confidentiality Program is administered by the Department of State for victims of domestic violence. To learn more about this program, visit http://www.dos.ny.gov/acp/.

I am moving to New York in the next few months. Can I apply for health insurance in New York now?

You can apply for health insurance through the Marketplace if you are moving to NYS for a job or to find a job within the next 90 days. However, you cannot enroll into a health plan until you have moved to New York State and have told us your NYS address. You can update your address by logging into your Marketplace account or calling us at 1-855-355-5777.

Can I still apply for health coverage through the Marketplace if I have other insurance?

You and your family may still be eligible for health coverage even if you have other health insurance. Based on the information you tell us about your other insurance, the Marketplace will see if you can get help paying for your health insurance coverage.

Do I have to file taxes to get help paying for health insurance?

Each program has its own rules regarding filing taxes. One of the eligibility criteria for an advanced premium tax credit is that you must file taxes, and if married, you must file jointly. To determine which program you and your family may be eligible for, we need to know about the filing status of everyone on your application for the upcoming tax year. If someone is married and will file jointly, we need to know who they will file with. We will also need to know about dependents whom you plan to claim. You also need to let us know if you or other household members will not be filing taxes. To be eligible for an advanced premium tax credit, you must file taxes, and if married, you must file jointly.

How do my marital and tax filing statuses affect my eligibility for financial assistance with health coverage?

We need to ask about marital status and tax filing status as part of the application process. To qualify for the premium tax credit, most married individuals applying through the Marketplace must file their federal taxes jointly. However, there may be situations when married individuals may qualify without filing taxes jointly. You may qualify for a premium tax credit if you were legally separated by the end of the year, and you have a court decree of separate maintenance or divorce. Signing and filing a separation agreement with the court is not a decree. You may also qualify for the premium tax credit if you are married but live apart from your spouse and meet the requirements to file as Head of Household. You should consult a tax advisor or the Internal Revenue Service to determine whether your situation exempts you from the requirement to file jointly to receive a premium tax credit. If you are in one of these situations, call the Marketplace at 1-855-355-5777 for more information.

Can I still get a tax credit if I will be claimed as a dependent on another person's tax return?

Eligibility for advanced premium tax credits is based on a variety of factors, including tax filing status. If you will be claimed as a dependent on another person's tax return, the income of everyone on that tax return will be considered in determining eligibility. You cannot get an advanced premium tax credit on your own if you will be claimed as a dependent on another person's tax return.

Why does the Marketplace need to know how much money I make?

Eligibility for help paying for health insurance is based on a variety of factors, including how much money you plan to make in the upcoming year. This includes income from a job as well as other types of income, such as unemployment benefits and Social Security.

I recently dropped my employer coverage because it was too expensive. Is my child still eligible for Child Health Plus?

Children who were previously covered by employer based coverage that was voluntarily dropped may be subject to a 90 day waiting period before they can enroll in Child Health Plus unless the child meets one of the waiting period exceptions.

Can my child still enroll in Child Health Plus if I have health insurance through the New York State Health Insurance Program (NYSHIP)?

State Health Benefits Plans provide health insurance through the New York State Health Insurance Program (NYSHIP). Coverage is offered to employees/retirees of NYS government, the State Legislature and the Unified Court System. Some local government agencies and school districts also elect to participate in NYSHIP. If you are not sure, check with your employer. If your child has access to State Health Insurance Benefits through NYSHIP, he/she will not be able to enroll in Child Health Plus.

Do I qualify for premium tax credits if my employer offers a health plan that meets minimum value standard?

An employer-sponsored health plan meets "minimum value standard" if the health plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of those costs. If your employer offers a health plan that does meet minimum value, then you do not qualify for premium tax credits.

Can I still apply for health coverage through the Marketplace if my employer offers health insurance?

You can still apply for health insurance through the Marketplace if your employer offers health insurance. If the insurance offered by your employer does not meet minimum value or is unaffordable, then you may be eligible to get premium tax credits to help pay for the health insurance you purchase through the Marketplace. Minimum value means that the health plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of those costs. Unaffordable, in this context, means that the employee's share of the premium for the employer's self-only plan is more than 9.5% of the employee's household income.

Am I still eligible for health insurance if I am incarcerated?

If information from state data sources show that you are incarcerated (except for pending disposition), then you are not eligible to purchase health insurance through the Marketplace. You are also not eligible for public health insurance programs such as Medicaid during this time. However, your household members can still apply for health coverage through the Marketplace.

What if I cannot afford to buy health insurance, or I don't want to buy health insurance for another reason?

Certain people may qualify for an exemption from the federal mandate to have health insurance. If you are approved for an exemption, you will not have to pay a penalty to the Internal Revenue Service for not having health insurance. You can find out information about Exemptions in the Marketplace.

I hardly ever get sick. Is there a health insurance plan that just provides coverage for major illnesses?

People who are under age 30 and some people who cannot afford to buy a more comprehensive health insurance plan may buy a type of health insurance plan called “catastrophic coverage.” Catastrophic health plans have lower monthly premiums than traditional health insurance plans, but have much higher out-of-pocket costs. If you are over age 30, you will first need to be approved for affordability hardship exemption. You can find out more information in the Marketplace.

What is the premium tax credit?

The premium tax credit is the financial assistance provided by the federal government to help you and your household pay the monthly premium for the qualified health plan you enroll in the Marketplace. This assistance is only available to health plans in the market place.

How can I use the premium tax credit?

The premium tax credit can be used "in advance." This means that the federal government will send the amount of the premium tax credit you choose to use to help pay for your qualified health plan’s monthly premium. If the advance premium tax credit does not cover all of the monthly premium, then you will pay for the remaining amount. You can choose to use all, some, or none of the tax credit. If there are household members that want to enroll in different plan, you can allocate the amount of the tax credit across the household members.

How will changes in my income or family size affect my premium tax credit?

Changes in your income and family size during the coverage year may increase or decrease the premium tax credit you qualify for. When you file your federal income taxes for this year, the IRS will look at the annual income provided on your taxes and compare it to what you told us in this application that you expect your income to be for the year. Since the premium tax credit you get depends on your annual income, the IRS looks at the premium tax credit you took in advance and compares it to what you are eligible to take when you file your taxes.

If the advance premium tax credit you get for the year is less than the tax credit you are entitled to when you file taxes, you will get the difference as a refundable credit when you file your federal income tax return.

If your advance payments for the year are more than the amount of your credit you are eligible for, you must repay the excess advance payments with your tax return. If you experience any changes in your income or family size, you should update your Marketplace account or call customer service at 1-855-355-5777.

How can I find a health plan in the Marketplace for myself or for my household member(s)?

Based on the health insurance program that you and/or your household members qualify for, the Marketplace will show you the health plans that you can choose from. We will provide you information about the health plan including , the monthly premium, metal level, type (i.e., medical or dental), cost sharing such as deductibles or out of pocket costs, covered benefits and services, and their quality rating.

Can I search for doctors, hospital, or facility in the health plan's network?

Yes - You can search to see if your current doctors or facilities where you receive health care services are part of a plan's network of providers.

Can my household members be in the same or different health plan?

You and your household members may be in the same or different health plan, depending on how you want to cover them through the health plan. For example, a couple can choose to enroll in the same health plan for simplicity or be in different plans because each person may have different health care needs. The cost of premiums and cost-share sharing will vary based on the option that you select.

How do I pay the health plan premium?

You must pay the first month's premium in order for your coverage to be effective and to start using health care services. The Marketplace does not accept premium payments for the health plans for individuals and families. Your health plan will send you information about how to pay this premium or you can contact them directly.

What are the plan "metal levels" ?

The Marketplace offers four major types of qualified health plans - Bronze, Silver, Gold, and Platinum. Each plan type differs in the percentage of health care costs that a plan would pay for an average person. For example, the Bronze level plan will pay for 60% of all health care costs for an average person and individuals that enroll into this plan level will pay for 40% of the costs. Health plans in the Platinum level will cover 90% of the health care costs and the individual will have to pay for the remaining 10%.

What if I disagree with a determination made by the Marketplace?

You can call us at 1-855-355-5777 (TTY: 1-800-662-1220) to discuss your concerns and we will do our best to help you. If you are not satisfied with the result of the informal resolution process you may request a formal appeal, if the time limit for requesting an appeal has not ended. Or you can ask us for an appeal without using the informal resolution process.

What is an appeal?

An appeal is a formal request to have a review of your eligibility determination because you do not agree with the one the Marketplace made. You can request an appeal for yourself and anyone in your household who also applied for health insurance.

Once you request an appeal, the Marketplace will schedule a hearing. A hearing is a formal conversation where you will have the opportunity to explain why you disagree with the eligibility determination we have made. An impartial hearing officer will conduct your hearing. If you have documents that you think would help your appeal, you can submit them for the hearing. During the hearing, you can also explain why you think we made a mistake.

What can I appeal?

You can appeal determinations made by the Marketplace including:

  • Your eligibility for Medicaid or Child Health Plus
  • The amount of financial assistance you will receive toward your monthly health insurance premium
  • The amount of financial assistance you will receive toward your out-of-pocket expenses when you use health care services
  • A denial for a special enrollment period; and
  • Whether we made a timely eligibility determination

Where do I go to appeal a decision about my health care services?

The Marketplace cannot accept appeals about health care services such as the types of health care benefits your plan offers, access to doctors or specialists, or a denial of prior authorization for services.

  • If you have Medicaid, please contact the Office of Administrative Hearings at www.otda.ny.gov/oah/ or at 1-800-342-3334 to appeal coverage decisions.
  • If you have Child Health Plus or are enrolled in a qualified health plan, please contact your health plan to appeal coverage decisions. Information on health insurance complaints and appeals can be found on the Department of Financial Services website at http://www.dfs.ny.gov/consumer/chealth.htm

Are there time limits to file an appeal request?

Yes, there are time limits. Generally, you have 60 days to request an appeal. Once the Marketplace has received your appeal request, we will review it and let you know what happens next.

Where do I go for my hearing?

We conduct all hearings by telephone and will call you at the telephone number(s) you provided in your Marketplace account. If you want us to call you at a different number, you may give us that number in your Marketplace account or when you call us to request the hearing.

When you request a hearing, you can let us know which day of the week and time (morning or afternoon) is convenient for you. We will do our best to schedule your hearing on the day and time that works for you. After we receive your appeal request, we will send you a scheduling notice to let you know when we will call you for your hearing.

What if I need special assistance or accommodations for my hearing?

You can request for special assistance or accommodations for your hearing. This includes language assistance (such as translation from English to another language) and accommodation for any hearing impairment.

Can I have someone help me at my hearing?

Yes. You can have a lawyer, relative, or friend help you during the appeal process. If you think you need a lawyer, you might find one at no cost by calling your local Legal Aid, Legal Services Office, or local Bar Association. You can also represent yourself.

If you want help during your appeal, you can designate a person or an organization to act as your authorized representative. Your authorized representative receives the same appeal notices and other communications that you do.

What can I do after I submit my appeal request?

While you are waiting for your hearing to be scheduled, we can help you try to resolve your problem informally. You can also provide new information or documents that will help us understand your concerns during the informal process. To do so, you can call us at 1-855-355-5777. If we have resolved your concerns during this informal process, we will then work with you to withdraw the request.

Can I continue my coverage during the appeal process?

Yes, but it is optional. If you are enrolled in a Medicaid, Child Health Plus or a qualified health plan, you may be able to continue the same coverage or amount of financial assistance during the appeal process. Financial assistance includes aid you received to pay for your health insurance premiums or to reduce out-of-pocket costs when you use health care services.

If you have Medicaid, you need to act quickly. You have ten (10) days from the date of your eligibility determination notice to ask us to have your Medicaid continued during your appeal process.

How will the appeal decision affect me or other people in my household?

Depending on the appeal decision, you may have to repay some or all of the financial assistance you received during the appeal process. If we determined other people in your household eligible for health insurance through the Marketplace, their eligibility may also change. The Marketplace will let you know of the changes and redetermine the eligibility for you and your household, if applicable.

What do I do if I no longer want to appeal?

If you have requested an appeal and feel it is no longer necessary, you may withdraw your appeal request. Call the Marketplace at 1-855-355-5777 to learn how to withdraw.

Small Business Marketplace FAQ

Who can buy health insurance coverage through the Small Business Marketplace?

New York State of Health is for small businesses with 50 or fewer employees.

Why should I buy health insurance for my employees through the Marketplace?

Small business owners can benefit from all the features listed below. Each is found only at New York State of Health:

  • Choice and Value: You have many health plans and prices to pick from. You can also choose how much to pay toward employee's coverage, and when you want it to start.
  • Tax Benefits: You may be able to get a tax credit for the amount you pay toward your employee's premiums. It can cover as much as 50 percent of that cost.
  • Defined Contribution: Small employers can set a fixed amount to pay toward employee coverage.
  • In-Person Assistance: Small businesses and their employees can receive in-person help with enrollment. This help will come from brokers, agents, and other in-person "helpers" trained and certified by New York State of Health.
  • Simplicity: One account, online enrollment and one monthly bill, even if employees choose different health plans. All these things take away the most difficult and time-consuming parts of providing health insurance.

How can I contact a "helper" to assist me in choosing the right health plan for my business?

After October 1, 2013, you can get help in 3 different ways. Our experts will walk you through your choices:

  • Online at this website
  • By phone at 1-855-355-5777
  • In person

What can I do now to prepare to shop on the Marketplace?

  1. Think about your coverage needs and those of your employees. Does your current health plan meet those needs?
  2. Ask yourself what benefits you'd like to give your employees and the amount you are willing to pay toward a health plan.
  3. Talk with your insurance broker and discuss how he or she can help you make the best choices for your business and your employees.
  4. Consult your tax advisor to see if you can get the Small Business Health Care Tax Credits.

Do I have to contribute to employees' health insurance through the Marketplace?

No. There is no minimum amount you must contribute toward your employees' health insurance at New York State of Health.

Does the Marketplace collect payments from small business owners or employees to pay for health insurance coverage?

New York State of Health collects premiums from small business owners and pays the carriers directly. Employers continue to collect premiums from their employees.

Can I choose when my employees' insurance coverage takes effect?

Yes. That date can be as early as January 1, 2014 or on the first of any month after January.

How will I know if my small business is eligible for the Small Business Health Care Tax Credit?

Businesses with up to 25 employees that provide health insurance and pay an average annual wage of less than $50,000 (not including the owner's salary) may qualify for the Small Business Health Care Tax Credit. It can be up to 50% of their share of employee premiums. Or up to 35% for nonprofits. New York State of Health will be the only place you get the Small Business Health Care Tax Credit. Employers may also consult their tax advisor.

How lengthy is the Small Business Marketplace application?

The online application will take about 30 minutes to complete. This includes the time required to upload a list of employees, select health plans and decide how much you will pay toward your employees' insurance. Your insurance broker can help you with the application provided that he or she is certified by the Marketplace.

When enrolling through the website, can I save my application and come back later?

Yes. The website lets you fill out part of the form and then save it. You can come back later if you are not able to complete the form in one sitting.

Will the Marketplace be open to other employers in the future?

For the first 2 years, only businesses with 50 or fewer employees can use New York State of Health. In 2016, it will open to larger businesses with 100 or fewer employees.

Brokers FAQ

Can brokers receive commission?

Yes, commissions will come directly from carrier and will vary based on company commission rules.

Do small businesses need to buy through the Exchange to be eligible for tax credits?

Yes.

Are there any minimum participation requirements?

No.

Which Exchange covers sole proprietors?

Federal guidelines require sole proprietors to go the Individual Exchange.

Can a small business with employees outside New York State purchase on the Exchange?

Yes, provided the business is headquartered in New York State.

Is there one application for all carriers?

Yes.

Is there a minimum contribution required for employers?

No.

Navigators

What is an In Person Assistor/Navigator?

An In Person Assistor (IPA)/Navigator is a person trained to educate and provide enrollment assistance to individuals and small businesses about the health insurance options available through New York’s Health Plan Marketplace, NY State of Health (NYSOH)

Who does the IPA/Navigator work for?

IPAs/Navigators work for various agencies that received grants from the NYSOH to provide education and application assistance. These include community based organizations, hospitals, clinics and other human service agencies.

Who can an IPA/Navigator help?

IPAs/Navigators can assist individuals and families, as well as small businesses and their employees.

What kind of training does an IPA/Navigator have?

A person must complete an intensive training course and pass a qualifying exam before being certified as an IPA/Navigator.

Will my information be kept confidential?

There are very strict privacy and confidentiality laws that prohibit the disclosure of personal, financial and health information to anyone, except to the NYSOH as authorized by the applicant for the purpose of determining eligibility for and enrollment into programs available through the Exchange.

Does it cost anything to apply through an IPA/Navigator?

No, IPA/Navigator services are free.

Are there IPA/Navigators who can assist non-English speaking people?

IPA/Navigator services are available in many languages. Many Navigators speak languages other than English, or the community-based organization itself may employ bilingual staff or offer Language Line services. Contact the IPA/Navigator agency on your county for specific information on the availability of assistance in a specific language.

Are IPA/Navigators available after regular working hours?

IPA/Navigators are available in every county, in convenient community-based locations, and during non-traditional hours, such as evenings and weekends. Contact the Navigator Agency in your county for specific information on their days and hours of operation.

Do I need to make an appointment or can I simply walk in?

IPA/Navigator may have different scheduling methods, so it is best to contact the agency in your area to determine if you need an appointment. Many of the sites accommodate walk-ins if an IPA/Navigator is available at that time.

What if I have a problem after I enroll. Can the IPA/Navigator help me?

The Navigator will be able to give you referral information on how to file a grievance or complaint, or obtain assistance with questions on your health plan, coverage or program eligibility.

Privacy/Security

What should I do when I am done browsing the Marketplace web site through a public computer?

Public computers in libraries, Internet cafes, airports, and copy shops can be safe if you follow a few simple rules when you use them so please consider the following when accessing the Marketplace web site ; Don't leave the computer unattended with sensitive information on the screen and please log out and close the Internet browser prior to leaving this computer .

Technical

What are the browsers supported by the Marketplace web site?

The Marketplace web site was tested with the following browsers:

  • Internet Explorer - 8, 9
  • Safari - 5, 6
  • Google Chrome - 18, 19
  • Mozilla Firefox - 12, 13

What to do if I get a time out or error page?

You should close your browser and login using a new browser window.

If a page times out or gives an error, do I lose my data that I have already saved?

All the data you entered before a time out or error occurred would have been saved in the database and is not lost. Once you can log back into the application, you should be able to see your saved data.

How do I refresh/reload a page in the NYSOH Marketplace?

You can refresh your page by pressing Ctrl and F5 keys simultaneously on the key board. The refresh will guarantee that if the content is changed, you will get the new content. Please note just pressing F5 may give you the old page, without showing your new information.

Enrollment FAQ

How many people does the Marketplace expect to enroll in coverage?

We expect that nearly 1.1 million people will buy a health plan at New York State of Health.

When can I begin shopping for a health plan in the Marketplace?

New York State of Health opens on October 1, 2013.

What is open enrollment?

Open enrollment is the time period when you can apply for a health plan through New York State of Health. The first open enrollment is October 1, 2013 through March 31, 2014 for individuals and families. Except in very limited circumstances, if you do not purchase coverage before March 31, 2014, you will have to wait until January 2015 for coverage and you may be subject to a federal penalty.

How can I apply?

Starting on October 1, 2013, you can apply online, by phone or by mail. There are experts to provide in-person help for filling out your forms.

When enrolling through the website, can I save my application and come back later?

Yes. The website lets you fill out part of the form and then save it. You can come back later if you are not able to complete the form in one sitting.

How long will it take me to apply?

Filling out the forms online will take about 45 minutes. Applying over the phone will take 45 minutes to 1 hour. If you are not requesting financial assistance, it will not take as long to complete the application.

What kind of information do I need to give when I apply?

You will need to provide facts about the people in your household and their income. We will also ask for your name, address, phone number, and social security number. If you have access to other health insurance, you must state that.

Cost FAQ

Will the Marketplace make coverage more affordable for individuals and families?

Yes. Even the highest level plan for individuals in the Marketplace (platinum or gold) costs less than half of what consumers used to pay when they bought insurance on their own. Costs are so much lower now because of the large number of people expected to buy insurance in the Marketplace. And for people with a low enough income, costs will be reduced even more. That is because of the help they get paying for their insurance.

Will the Marketplace offer affordable coverage to small businesses?

Yes. Small employers and their employees will experience affordable rates. The Marketplace's approved 2014 small business plan rates can't be accurately compared to the 2013 rates because of changes to the insurance market. In 2013, insurers offered more than 15,000 different small group plans that significantly varied in terms of the quality and level of coverage provided. For 2014, insurers are offering standardized contracts and product offerings within metal tiers (bronze, silver, gold, and platinum). Also, a number of small businesses will be eligible for tax credits that will lower those premium costs even further.

How will I know if I can get help paying for my health insurance coverage?

Just come to the Marketplace, online or by phone. We will tell you if your income qualifies you to get this kind of help. If you are the only person in your household and your income is under $45,960, you may be able to get help paying for a health plan. If you are a family of four with a combined income of less than $94,200, you too, may be eligible for this help.

One way the Marketplace helps with cost is in the form of tax credits. What are tax credits?

With most tax credits, you have to wait until you file your taxes to get the credit. But the new tax credit available through the Exchange will allow you to reduce your costs right away. People who qualify can take the tax credit in the form of advance payments directly to their health plan to lower their monthly health plan premiums starting in 2014. This will help make insurance more affordable because you will pay less each month.

What is cost-sharing help? How do know if I qualify?

"Co-pays" and "coinsurance" are the part of a medical bill that are charged to you, not your insurance company. A "deductible" is the total you must pay in health costs before your insurance kicks in. At New York State of Health, you may get help paying these extra costs if your income falls below a certain point. When you apply for a health plan, we will tell you if you can get this kind of help.

How much do I have to pay for my insurance coverage?

Marketplace health plans will be available in four easy-to-compare metal tiers (platinum, gold, silver and bronze). The amount a person pays out of pocket when they receive services will vary by metal tier. Plans in all metal tiers cover the required Essential Health Benefits, such as hospital stays, doctor's visits, behavioral health, emergency care and prescription drugs. Some health plans will offer additional benefits, such as adult vision and dental coverage.

Premium rates will be further reduced for individuals and families with incomes below 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for a family of four) because of financial assistance in the form of federal tax credits only available through the Marketplace. Federal tax credits limit the amount a person pays for insurance each month. Monthly payments will be far below the cost of buying insurance today. For example, if a silver level plan is selected:

  • An individual with annual income of $17,000 will pay $55 per month.
  • An individual with annual income of $28,000 will pay $183 per month.
  • An individual with annual income of $40,000 will pay $252 per month.
  • A family of 4 with annual income of $35,000 will pay $114 per month.
  • A family of 4 with annual income of $59,000 will pay $457 per month.
  • A family of 4 with annual income of $82,000 will pay $739 per month.

Sole Proprietors FAQ

Who is considered a sole proprietor?

Sole proprietors are businesses that do not have at least one eligible employee. An eligible employee is any employee who works an average of 20 hours a week each month. A sole proprietor's husband or wife is not considered an eligible employee.

I am a sole proprietor. How do I buy health insurance coverage in the Marketplace?

Sole Proprietors will shop for, compare and buy health insurance coverage through the Individual Marketplace. Sole proprietors may be eligible for financial assistance to reduce the cost of coverage. Sole proprietors will not be eligible to purchase coverage through the Small Business Marketplace.

How will the Marketplace serve people who speak languages other than English?

Marketplace Customer Service Center Representatives and In-Person Assistors/Navigators, who will guide consumers through the process of shopping for and enrolling in health insurance, will be available to help consumers in their language. Customer Service Center Representatives, who will be available by phone, speak 13 languages and can contact translators in additional languages. In-Person Assistors/Navigators will speak the languages spoken in the communities they serve.

Will the Marketplace provide written materials in languages other than English?

Yes, in addition to English, you will be able to get New York State of Health written materials in the languages spoken most by New Yorkers: Chinese, Spanish, French, Haitian Creole, Italian, Korean and Russian. Health plans must have written materials in other languages when 5% of people applying for coverage in a county do not speak English as a first language. You will also be able to get someone to help translate or interpret information for you.

Benefits FAQ

What are essential health benefits?

These are the 10 key health services that must be covered by every health plan. All health plans sold at New York State of Health must include them. Most plans sold elsewhere for individuals and small businesses must also include them. The 10 "essential" services are:

  1. Care at a doctor's office
  2. Emergency services
  3. Hospital care
  4. Pregnant mother and baby care
  5. Mental health and addiction treatment
  6. Prescription drugs
  7. Rehab and skill development services and devices
  8. Lab services
  9. Prevention & wellness services and long-lasting disease management
  10. Dental and vision care for children

What kinds of health plans are offered on the Marketplace?

All health plans offered by New York State of Health are licensed and approved by New York State. These plans are called Qualified Health Plans. New Yorkers can also apply for public programs such as Medicaid and Child Health Plus. If you qualify for one of these programs, you can sign up right away.

Do I have a choice of health plans and medical providers?

You can choose from many Qualified Health Plans at New York State of Health. We provide you with all the facts about each one. This helps you choose a plan that is best for you and your family. We also let you know which providers (like doctors and hospitals) are part of each health plan.

What is a metal tier?

Health plans offered in the Marketplace will fall into categories called metal tiers. The metal tiers are bronze, silver, gold and platinum, and are associated with an actuarial value. Actuarial value is the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, the consumer would be responsible for, on average, 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy. Platinum provides the highest level of coverage, followed by gold, silver and bronze.

Public Input FAQ

How does the Marketplace involve the public in its decision-making process?

The Marketplace has groups of community members and health industry experts in five regions of the state. These groups give advice to the Marketplace staff at meetings held throughout the state. You can attend these meetings in-person if you wish or by watching "webcasts" online. You can find information about the time and place of the meetings and webcasts on this website.