A how-to: N.Y. Marketplace health insurance

Open enrollment for health insurance coverage through the New York State of Health Marketplace ends on Jan. 31.

State health insurance exchanges were started through the U.S. Affordable Care Act. New York’s opened in 2013.

The marketplace announced on Friday that more than 254,000 New Yorkers have enrolled in a plan through the exchange. This exceeds the number of total enrollment at the end of the 2018 open enrollment period.

Twenty-two percent are new customers, with 78 percent returning to the marketplace for insurance this year.

It is important that you sign up for health insurance — for the obvious reasons of injury or illness, but also because you may have to a pay a fee if you are uninsured.

Step one is to log onto https://nystateofhealth.ny.gov or call 1-855-355-5777. Signing up and calling for assistance is free. It will take about an hour.

During the application process you will have to supply your name, address, phone number, Social Security number, information about your income, martial status, family size and number of dependents, as well as whether you have access to other forms of insurance.

This information is used to determine what kind of health insurance cost reductions your income may qualify you for, as well as what kind of tax credits you are eligible to receive based on your family status, as well as other factors.

These tax credits can be used to pay down premiums, or the monthly or quarterly payments you have to make in order to be covered by your plan.

You may still have to pay a deductible, even if your premium is covered by a tax credit. A health insurance deductible is the amount someone must pay before their plan kicks in.

For instance, if you had a deductible of $1,000 for an individual plan for yourself, you’d have to pay $1,000, outside of some exceptions like annual check-ups, before your insurance company would start making payments on your behalf for medical services.

Once you’re signed up, you’ll be shown plans in the marketplace that you qualify for. Plans will be defined by categories like coverage type — family dental, medical, or adult medical and dental — and the number of individuals covered. Plans can be for an individual, a parent and child, a couple or a family.

Quality of a plan is measured in a five-star system based upon reviews of care available in the network. When you buy a plan, you’ll also be buying into a network — these are the medical professional and services covered under your insurance. As cool as it would be that, if you’re hurting, you can just go see any doctor for help, this is not the way it works. If you go to a health care professional outside of your network for care, you may have to pay higher out-of-pocket costs.

You can search for a particular doctor or practice on the online marketplace to find out whether they are included in a particular plan’s network.

The second criteria along which health insurance is rated is metal level. These are measures of coinsurance, or the split between you and your insurance provider for a bill of service in health care.

Plans rated “bronze” will pay for 60 percent of eligible health care costs, leaving the remaining fee for the average consumer. A “silver” plan will pay 70 percent. A “gold” will pay 80 percent. A “platinum” plan will pay for 90 percent of eligible health care costs. Premiums are often higher for plans with more coinsurance.

The lowest tier, not named after a metal at all, is “catastrophic.” A plan rated “catastrophic” is generally meant only to be used in catastrophes such as of rare and serious illness — for an individual that does not get sick often, or cannot afford more reliable coverage. A “catastrophic” plan will typically cost less in premiums, but out-of-pocket costs for health care services will be much higher.

Plans include a maximum deductible, or out-of-pocket number — this is the maximum you can pay, per year, for eligible medical expenses before insurance may pay for the rest. This is a number to keep an eye on when comparing plans.

Even if you’re signed up for health insurance through an employer, sign up on the marketplace and compare. According to the marketplace, most plans cost less than half of what people used to pay on their own. It could be worth it — as there are credits for certain family situations and income levels. The only way to know is to sign up.

If you or someone you know are moving to New York within the next 90 days, but may not be here before open enrollment ends, you can still buy health insurance. However, you cannot enroll in your plan until you have a state address.

Create a marketplace account at https://nystateofhealth.ny.gov or call 1-855-355-5777.

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