NY State of Health

What Is New York’s Health Exchange?

When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. The state of New York's exchange is called NY State of Health. If you do not have health insurance or your health insurance costs too much, you can enroll in health coverage via the NY State of Health website.

Participating Companies

NY State of Health has 15 insurance companies offering plans. These include:

  • Affinity Health Plan, American Progressive (Today's Options NY)
  • Blue Cross Blue Shield of Western NY
  • Blue Shield of Northern Eastern NY
  • Capital District Physicians Health Plan
  • EmblemHealth
  • Empire BlueCross/Empire Blue Cross Blue Shield
  • Excellus Blue Cross Blue Shield
  • Fidelis Care, Health Republic Insurance (NY CO-OP)
  • Healthfirst New York
  • Independent Health
  • MetroPlus Health Plan (Market Plus)
  • MVP Health Plan, Inc.
  • North Shore LIJ
  • Oscar Insurance Corporation
  • United Healthcare
  • Qualified dental insurers and plans include:
  • Blue Cross Blue Shield of Western NY
  • Blue Shield of Northern Eastern NY
  • Delta Dental Insurance Company
  • Dentcare
  • Dentegra Insurance Company
  • Emblem
  • Empire BlueCross/Empire Blue Cross BlueShield
  • Guardian
  • Healthplex
  • MetLife
  • Solstice

Specific hospitals and clinics, called providers, that work with NY State of Health can be found on New York state’s department of health website.

What’s Covered

All plans must offer the following essential services:

  • physician office visits
  • emergency medical services
  • inpatient hospital services
  • labor and delivery care
  • newborn care
  • mental healthcare prescriptions
  • rehabilitative and habilitative care (includes speech, occupational, and physical therapy)
  • diagnostic laboratory services
  • chronic disease management
  • pediatric care
  • substance abuse rehab services

Check out the helpful FAQs on the official NY State of Health website for more information about the basics of the marketplace.


There are four basic plans available through the exchange. These have varying coverage levels. They include:

  • bronze (60 percent of expenses paid)
  • silver (70 percent)
  • gold (80 percent)
  • platinum (90 percent)

Lower percentage plans have lower premiums (the base amount you pay for coverage), but higher out-of-pocket costs (includes deductibles, copays, and coinsurance). A catastrophic plan, with a high deductible (the amount you must pay before insurance covers costs), is available for those under the age of 30.

New Yorkers can now view available plans and estimated costs using the Tax Credit and Premium Estimator. There is also an interactive map of offered health plans that shows New York residents the plan options available in their area.


Many people will want to know how much of a subsidy they qualify for, but the real question is, how much will you pay? Your ultimate decision should be based on your income versus how often you might need to use the coverage.

As a guide, the estimated range in monthly payments for a silver plan for an individual, with no dependents, who is earning $35,000 per year, across three New York counties is:

  • Broome: $260 to $418 monthly
  • Erie: $278 to $497 monthly
  • Kings (Brooklyn) and New York (Manhattan): $279 to $451 monthly

In 2015, the government capped maximum annual out-of-pocket costs at $6,600 for individuals and $13,200 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.

The challenge is to compare the costs of each plan and decide which offers the best value. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.

Credits and Subsidies

Depending on your income, you may qualify for financial aid to help offset the costs of coverage. This may come in the form of:

  • Medicaid coverage
  • tax credits
  • subsidies

Adults living at or below 133 percent of the federal poverty level (FPL) may qualify for Medicaid in New York. Pregnant women living at or below 218 percent of the FPL may also qualify. The FPL for 2015, according to the health insurance marketplace, is:

  • $11,770 for individuals
  • $15,930 for a family of two
  • $24,250 for a family of four
  • $40,890 for a family of eight

There are also two kinds of subsidies people may use for healthcare costs. Federal poverty levels from 2014 are used to calculate eligibility for these savings in 2015. The first type of subsidy is a cost-sharing subsidy. This is for silver plans only and reduces the total out-of-pocket cost of a plan. People who have household incomes between 100 and 250 percent of the poverty level may be eligible.

The second type of subsidy is the premium tax credit. If your income is less than 400 percent of the federal poverty level but you do not qualify for Medicaid, you may qualify for this credit. This is a subsidy that would help pay for part of your insurance. On average, individuals who earn about $46,680 a year or less qualify. For a family of four, the eligible income level increases to about $95,400 or less.

The percentage of your costs that this subsidy would cover depends on income level and the cost of a second-tier silver plan where you live. This silver plan is used as a baseline because the ACA was designed so everyone could afford a silver plan, regardless of how expensive the healthcare rates may be where you live.

For example, if your income is $33,000 a year (283 percent of the poverty level), the most you’ll have to pay for a second-tier silver plan is about 9 percent of your income. This averages about $2,972 a year, or $248 a month. You can choose a plan other than the second-tier silver plan and use your tax credit but the subsidy amount will stay the same. This means a gold plan would cost you more, even if you use a subsidy to cover some of the cost.

Signing Up

To learn more about NY State of Health, please visit http://www.nystateofhealth.ny.gov. You can also call 1-855-355-5777. 

The open enrollment period begins November 1, 2015 and ends January 31, 2016.

Those who experience a life-changing event, such as birth of a child or loss of employer coverage, may purchase health insurance outside of the open enrollment period.

These fact sheets provide individuals, families, small businesses, immigrants, and young adults with important information about the program.

Doing your research before the open enrollment period can help ensure that you get the right health insurance plan for you and your family. 

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