Individuals & Families

Shop here to see what health insurance options are available to you and your family in the Individual Marketplace. You can quickly compare health plan options and apply for assistance that could lower the cost of health coverage. Individuals and families may also qualify for free or low-cost coverage from Medicaid, Child Health Plus, or the Essential Plan through the Marketplace. Anyone who needs health coverage can apply.

If you are already enrolled in health insurance and have questions about renewing, you can learn more here.

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Compare Plans and Estimate Cost

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Create an Account

You can create an account online though the NY.GOV site. Once you provide an email address and some information about yourself, you'll get an email invitation to the Marketplace site and can get started! You can also call the Marketplace or get help in your community to set up an account.

Tell us about you and your family.

When you apply, you will need to provide information about each member of your family, including demographics, any health insurance you or your family already has, and your income, if you want help paying for health coverage.

Choose a health insurance plan.

You will choose a health plan for yourself and your family members. The Marketplace will show you the health plans available to you, the benefits covered by the plans, the doctors and facilities that participate in the plan network, and the cost of enrolling in the plan. You can pick plans for yourself and all of your eligible family members whether they qualify for Medicaid, Child Health Plus, the Essential Plan, or a Qualified Health Plan through NY State of Health.

Overview

What is the Individual marketplace?

New York State of Health, the Official Health Plan Marketplace, is a new way for people to shop for, compare and enroll in health coverage. It is also the only place to get financial assistance provided by the federal government to lower the cost of your health coverage.

To shop in the Marketplace, you:

  • Must live in New York
  • Must be a U.S. citizen, national or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid or the Essential Plan based on your income)
  • Cannot be currently incarcerated. (Different rules may apply if you are eligible for Medicaid based on your income.)
  • Cannot be applying for coverage of nursing home care or care provided in a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled.

What is available through the individual marketplace?

The Marketplace gives you an easy way to compare health insurance plans so you can choose the one that's right for your health needs and your budget. Health insurance offered through the Marketplace will include a comprehensive set of benefits and coverage.

What kind of assistance is available?

In the Marketplace, you can apply for help to lower the cost of your health coverage.

The Marketplace will also see if you qualify for free or low-cost coverage from Medicaid, the Essential Plan or Child Health Plus.

Enter your zip code in the View Plans Now section above to see if you qualify for financial assistance and the types of plans available to you.

What are Insurance Affordability Programs?

Insurance Affordability Programs include Medicaid, Child Health Plus, the Essential Plan, Advance Premium Tax Credits, and Cost-Sharing Reductions. The Marketplace will determine if you qualify for any of these programs, which can lower the cost of your coverage.

When can consumers enroll?

When you can enroll depends on which program you are eligible for, which is based on age, income and other factors. Enrollment is open all year if you are eligible for: Medicaid, Child Health Plus, and the Essential Plan. You can enroll in a Qualified Health Plan during the annual Open Enrollment Period, or a Special Enrollment Period, if you are eligible.

What health insurance is available to consumers who are incarcerated?

If you are incarcerated (except for pending disposition), you are not eligible to purchase health insurance through the Marketplace. You may, however, be eligible for public health insurance programs, such as Medicaid during this time. During incarceration, Medicaid coverage is limited to inpatient hospitalizations provided off the grounds of the correctional facility. The correctional facility is responsible for all other medical care and treatment provided to you.

What if you need coverage for nursing home care?

You cannot apply for coverage of nursing home care through the Marketplace. You need to apply for Medicaid coverage of nursing home care through your local department of social services. If you need help finding contact information for your local department of social services, please call the NY State Medicaid Help Line at 1-800-541-2831 or visit the NY State Department of Health website at http://www.health.ny.gov/health_care/medicaid/ldss.htm.

Please Note:If you already have coverage through Medicaid or Essential Plan through NY State of Health, you may qualify for coverage of nursing home care for a limited time through your health plan. Please contact your health plan for more information.

What if you need coverage in a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled?

A Medicaid application can be completed after you are admitted to a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled. For application assistance, please contact the director of the facility in which you are placed.

Frequently Asked Questions

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 or the Essential Plan based on your income)
  • Cannot be currently incarcerated. (Different rules may apply if you are eligible for Medicaid based on your income.)
  • Cannot be applying for coverage of nursing home care or care provided in a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled.

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 job 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 or visit https://nystateofhealth.ny.gov/language_support.html 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.

Am I eligible for health insurance if I am incarcerated?

If you are incarcerated (except for pending disposition), you are not eligible to purchase health insurance through the Marketplace. You may, however, be eligible for public health insurance programs, such as Medicaid during this time. During incarceration, Medicaid coverage is limited to inpatient hospitalizations provided off the grounds of the correctional facility. The correctional facility is responsible for all other medical care and treatment provided to you.

What if I need coverage for nursing home care?

You cannot apply for coverage of nursing home care through the Marketplace. You need to apply for Medicaid coverage of nursing home care through your local department of social services. If you need help finding contact information for your local department of social services, please call the NY State Medicaid Help Line at 1-800-541-2831 or visit the NY State Department of Health website at http://www.health.ny.gov/health_care/medicaid/ldss.htm.

Please Note: If you already have coverage through Medicaid or Essential Plan through NY State of Health, you may qualify for coverage of nursing home care for a limited time through your health plan. Please contact your health plan for more information.

What if I need coverage in a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled?

A Medicaid application can be completed after you are admitted to a Residential Treatment Facility for Children and Youth, Developmental Center or Intermediate Care Facility for the Developmentally Disabled. For application assistance, please contact the director of the facility in which you are placed.

News & Updates

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Getting Assistance

There are people in your community who are trained to help you apply for health coverage, understand your coverage options, and help you to enroll in a plan that is best for you and your family. There are different ways to get help applying for health coverage through NY State of Health. You can get help with your application from:

  • Navigators
  • Certified Application Counselors/Marketplace Facilitated Enrollers
  • Brokers

Navigators

Navigators are certified and trained to educate and provide enrollment assistance to individuals and small businesses through NY State of Health. They speak over 40 different languages and are available weekdays, evenings, and even on weekends. Navigators are available in convenient community-based locations in every county and all help is free. Click here to find a Navigator in your community or click here to view a directory of Navigator agencies.

Certified Application Counselors/Marketplace Facilitated Enrollers

Certified Application Counselors and Marketplace Facilitated Enrollers are trained to educate and provide enrollment assistance to individuals and families applying for coverage through NY State of Health. Certified Application Counselors may work for entities such as hospitals, healthcare providers, or community-based organizations. Marketplace Facilitated Enrollers work for health plans. Call 1-855-355-5777 or click here to find an assistor in your community.

Brokers

"Certified brokers" are licensed professionals that have been certified by the Marketplace to provide enrollment assistance to individuals and small businesses about the health insurance options available through Marketplace. Help applying for coverage and enrolling in a plan is free. Click here to find a broker who is suited specifically to your business or familys needs.

Authorized Representative

You may have a trusted friend, relative, partner, or lawyer help you and act for you on matters related to your application. This person is called an authorized representative. You need to give permission to the Marketplace to speak with your authorized representative. Click here for information on how to name someone as your authorized representative.