NY State of Health: What does it mean?
CAPITAL REGION Eligible New Yorkers can start shopping for health insurance in the state’s new marketplace on Tuesday.
When individuals, families and small businesses start exploring the state’s online marketplace, they’ll be able to compare different plans by cost and coverage, said New York State Department of Health spokesman Jeffrey Hammond. All plans sold in New York’s market will guarantee 10 essential areas of coverage and will still cost less than what individuals used to pay when they bought health insurance on their own.
“Costs are so much lower now because of the large number of people expected to buy insurance in the marketplace,” he said. “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.”
Plans purchased in New York’s health exchange will go into effect in 2014.
Below are excerpts from a conversation with Hammond:
Q: Who is eligible to shop in the health exchange market?
A: NY 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. NY State of Health opens on Oct. 1, 2013.
Q: What kind of plans and prices will consumers find in the health exchange market?
A: 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.
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.
Q: How do consumers determine the right option for them in the market?
A: They should use the NY State of Health marketplace to shop for, compare and buy a health plan online, in person or over the phone.
Q: What did the state have to do to set up the health exchange market?
A: Gov. Cuomo issued an executive order to create New York’s health exchange, the NY State of Health.
Q: What minimum standards did the state set for plans in the health exchange market?
A: These are the 10 key health services that must be covered by every health plan. All health plans sold at NY State of Health must include them. Most plans sold elsewhere for individuals and small businesses must also include them. The 10 essential services are: care at a doctor’s office; emergency services; hospital care; pregnant mother and baby care; mental health and addiction treatment; prescription drugs; rehab and skill development services and devices; lab services; prevention and wellness services and long-lasting disease management; and dental and vision care for children.
Q: How does New York’s health exchange market compare to other states?
A: NY 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.
NY 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.