The Empire State has towering skyscrapers, dreamy fall foliage, and something a bit more overlooked- extensive health care options. New York has the 15th best health care in the US with regards to access, quality, and overall public health.
Health care options in New York
According to the New York Department of Financial Services, residents can get coverage through several options:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most New Yorkers get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 49% | ||
| Individual or family | 6% | ||
| Medicaid | 26% | ||
| Medicare | 13% | ||
| Military | 1% | ||
| Uninsured | 5% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Five percent of New Yorkers are uninsured, meaning the state falls significantly below the nine percent national average of uninsured residents. That's good for policyholders, because a high rate of uninsured people leads to higher rates for insured people.
Best New York health insurance companies
Where do New Yorkers get their health coverage? Residents have several options for providers offering individual and family plans in New York. Here are the top health insurance companies in NY:
- Capital District Physicians’ Health Plan (CDPHP)
- Emblem (Health Insurance Plan of Greater New York)
- Health Plus HP (Empire)
- Excellus
- Fidelis (New York Quality Health Care Corp
- Healthfirst PHSP
- HealthNow New York (BCBS of Western NY and Blue Shield of Northeastern NY)
- Independent Health Benefits Corporation
- Metro Plus Health Plan
- MVP Health Plan
- Oscar
- UnitedHealthcare of New York
Coverage options vary based on which county you live in. Check out insurer websites to find out what policies you qualify for. You should also visit the New York Marketplace for more options.
New York health insurance costs and rate factors
On average, New Yorkers spend $9,788 on health care expenditures per year, about $1,700 more than the national average. What determines the cost of health care in New York? Factors depend significantly on the individual, so costs vary person to person. Mainly, here's what insurers are looking at when pricing your policy:
Plan type
The more medical coverage you want, the higher your premiums will be. Marketplace plans are organized in metal tiers: bronze, silver, gold, and platinum. Each tier offers different coverage levels.
Curious about what you'll be paying for health insurance in the Empire State? Here are the average monthly premiums for a 40-year-old New Yorker in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $418 | $588 | $706 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
You may have noticed the significant jump in cost from a bronze plan to a gold plan. In New York, going from one end of the tier to the other is about a 69 percent increase in cost. This price leap could be worth it if you end up needing to use your insurance. Coverage from the bronze level will help you with 60 percent of costs, whereas a gold plan will cover 80 percent of costs.
The lowest level of coverage is a catastrophic plan. You may qualify for this coverage if you are under 30 or have other exemptions. However, the deductible is $8,150 for one of these plans. Even though it has low monthly premiums, a catastrophic plan may not save you money in the long run if you actually need to use your health insurance.
Body mass index
Statistically, numerous health problems stem from obesity. Because of this, insurers often review your BMI before pricing your policy. A higher BMI can lead to higher premiums.
New York has a 27.6 percent obesity rate, meaning only eight states have a lower obesity rate. Out of the many New York residents who use QuoteWizard to shop for health insurance, only 21 percent have a BMI in the obese range.
Tobacco use
Smoking has harmful effects on you heart, lungs, and brain. If you're a smoker, you'll pay more for coverage because of these substantial risks. About 14.1 percent of New Yorkers are smokers, the ninth lowest rate in the country.
Age
Health care plans often cost three times as much for older people than for younger people. NY residents who used QuoteWizard to compare health insurance plans are, on average, 40 years old.
Location
Location is a bigger factor in deciding health insurance rates than many people think. Costs are dependent on the laws, regulations, and health care providers within your state.
Health care costs are also community-rated, meaning your costs are influenced by how many claims your neighbor files. If people in your area file claims at a higher rate, your premiums could spike.
Because of this, living a healthier state could keep your costs low. Good news, New Yorkers -- according to America's Health Rankings, New York is the tenth healthiest state.
New York health insurance laws
The Affordable Care Act limits what restrictions and exclusions insurance companies can use to price your policy.
- Pre-existing conditions: Pre-existing conditions can't be considered by insurance companies. People used to pay more for health insurance if they had a pre-existing condition, but the ACA now limits insurance companies from charging higher rates.
- Gender: According to a study by Health Services Research, women historically pay more for health care. The ACA mandates that insurance companies can't charge men and women different prices for the same plan.
- Insurance and medical history: Before the ACA, people with previous medical problems or lapses in insurance coverage would often have to pay more for coverage. That’s no longer the case.
New York has a Family Planning Benefit Program, which requires insurance providers to offer some coverage for the following services for families:
- Pregnancy testing and counseling
- Screening and treatment for sexually transmitted infections (STIs)
- HIV counseling and testing
- Most FDA approved birth control methods, devices, and supplies
- Emergency contraception services and follow-up care
- Transportation to family planning visits
Read the entire list on the New York State Department of Health website.
Medicare and Medicaid in New York
Medicare and Medicaid are government-funded health care programs that offer coverage for different groups of people. Medicare assists senior citizens, and Medicaid aids low-income families and children.
Medicare
Medicare offers care to people over the age of 65. Within the Medicare program, there are many types of coverage including types A, B, C, D, and supplemental coverage plans. There are also four types of Medicare Savings Programs in New York, and this is the minimum income limi:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
New York has a program called Medicaid for residents who cannot afford medical coverage. These are the state's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $17,609 |
| 2 | $23,792 |
| 3 | $29,974 |
| 4 | $36,156 |
| 5 | $42,339 |
| 6 | $48,521 |
| 7 | $54,704 |
| 8 | $60,886 |
New York Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Maria T. Vullo
- Insurance Hotline:
- (800) 342 – 3736
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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