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Finding health insurance in the state of New York is in many ways different than finding insurance in other states. New York is a "guaranteed issue state" meaning that medical underwriting is not allowed on the individual market there. In other words, unlike in most other states, when you apply for an individual plan in New York, you cannot be denied or excluded based on previous medical conditions, with some exceptions. Unfortunately, insurance regulations in New York prevent insurance agents like the insurance specialists at Health Plan One from assisting New Yorkers in choosing individual plans. New Yorkers must go directly to the carriers in their state to obtain individual coverage. If you have serious medical issues or don't think you can afford private health insurance in New York you could qualify you for free or low-cost health care programs offered by the government, such as Medicaid, Child Health Plus, Family Health Plus, Healthy NY, or PCAP. Eligibility requirements for each of these options are available on this page.
What Every New Yorker Should Know About Health Insurance
The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer, the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you. Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits.
It is important not to have a break in coverage of more than about 31 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important. As a result, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government, you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy. With individual coverage, you choose the health insurance carrier and benefits you want. You should investigate the plans open to you and your family from all the different carriers available in New York so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. However, there are some special circumstances in the state of New York you should be aware of.
What's Unique About New York?
Insurance in the state of New York is one of the most expensive in the country because medical underwriting is not allowed even on the individual market. Because insurance companies are not allowed to adjust prices on most products for age, gender, smoking habits, and health status, prices tend to be very expensive even for the young and healthy.
The first option you should look into when trying to get health insurance in New York is whether you qualify for a small group plan. Small group plans are for people who own and operate a small business. These small group plans require a minimum of 2 employees in the group who each work at least 20 hours per week. These plans also are not medically underwritten. In order to apply for such plans, you must be able to prove that you are in fact a small group by either having evidence of payroll for the employees or getting a letter from a CPA firm attesting to the fact that you have an employer group. Some carriers will also allow sole proprietors (those who are the sole owner and operator of their business) to purchase small group plans. To get free quotes and more information on small group plans for your small-business, simply call Health Plan One at (877) 567-5267.
There is no short-term health insurance available in New York, because short-term health insurance is a medically underwritten product which is not permitted in the state.
If you're healthy and are between jobs, unhappy with the health insurance offered by your employer, or not offered benefits by your company in New York, you should call the insurance carriers which serve your area.
If you're not healthy, there are still many programs in New York available to you. See below for details on the options which best fit your medical and financial situation.
Medicaid and Medicare in New York State
Medicaid is a program for New Yorkers who cannot afford medical care. You may qualify if you have high medical bills, receive SSI benefits, or meet certain income, resource, age, or disability requirements. There are income ceilings for enrollees, as well as additional requirements which are available herehttp://www.health.state.ny.us/health_care/medicaid/index.htm At this web page you can also learn about benefits of the program and the application process. Some of the benefits covered include: lab and x-ray services, prenatal care, medications, family planning services, hospital inpatient and outpatient services, and much more.
Click here to view New York Medicare Advantage plans.
Healthy NY is a health insurance program open to working adults in the state (or spouses of those who work and adults who have recently worked) whose company does not offer health insurance or who are self-employed and meet certain criteria. Full enrollment, eligibility, and benefit details are available on the program's website at http://www.ins.state.ny.us/website2/hny/english/hny.htm
Child Health Plus
Child Health Plus (part of the federal CHIP program) covers New Yorkers age 18 or younger who are legal permanent residents or US citizens. CHIP was designed to give children whose family's incomes are higher than the qualifications for Children's Medicaid access to health insurance. Children's Medicaid health coverage is provided at no cost to the children of qualifying families. CHIP, as previously stated, is designed to target families who earn too much to qualify for Medicaid, but cannot afford private health insurance. Premiums for those who qualify through CHIP are based on income. The benefits include regular checkups and office visits, dentist visits (cleanings and fillings), vaccines, mental health care, and eye exams (and glasses). To see whether your child could be eligible for Child Health Plus visit http://www.health.state.ny.us/nysdoh/chplus/who_is_eligible.htm
Family Health Plus
Family Health Plus is a public health insurance program available to adults ages 19 to 64 who have income too high to qualify for Medicaid. The program is open to single adults, couples without children, and parents who are residents of the state and are US citizens or legal immigrants. The plan provides comprehensive coverage, including preventive and primary care, hospitalization, prescriptions, and other services with only minimal copayments. For more information about the program and to see if you qualify visit their website at http://www.health.state.ny.us/nysdoh/fhplus/index.htm
Prenatal Care Assistance Program (PCAP)
The Prenatal Care Assistance Program is a comprehensive prenatal care program that offers pregnancy care to women in New York State whose income is under 200% of the federal poverty level. The program offers routine pregnancy check-ups, hospital care during pregnancy and delivery, full health care for the mother until at least 2 months after delivery, and coverage for the baby up to one year of age. For more information on PCAP call (800) 522-5006.
There is no high risk pool available to residents of New York because all insurance sold in the state is guaranteed issue.
For more information on purchasing health insurance in New York visit the state's Department of Insurance website athttp://www.ins.state.ny.us/health/chlthinf.htm
For a complete list of health insurance programs available through the state click herehttp://www.nyhealth.gov/health_care/
Information about COBRA/Continuation Extension in New York
Governor Patterson signed into law the Extension of the Consolidated Omnibus Reconciliation Act of 1985 (COBRA)/State Continuation for Employees on July 31, 2009. The law is effective July 2, 2009 for groups that renew or become effective on or after this date. This new law will increase the COBRA coverage period from 18 to 36 months for fully-insured groups but does not apply to Self-Funded or Administrative Services Only groups.
Individuals are not entitled to the extension if COBRA/SC was exhausted prior to the groups renewal and members can only be reinstated with no lapse in coverage. The qualifying event does not have to occur after the sale or renewal, the only qualifying even eligible for the extension is termination of employment.
Individuals who are on COBRA/State Continuation when their group coverage begins or renews on or after July 1, 2009 are entitled to 36 months of coverage. The qualifying event does not have to occur after the sale or renewal.