Hey New York! It’s that time of the year when many people will be changing their health insurance plan or enrolling in a new one for the upcoming year. Do you know what you need?
Health insurance enrollment mistakes are costly. Enrolling in the wrong plan can end up costing thousands out-of-pocket, especially when doctors are out-of-network and must-have medications are not covered.
Don’t let this happen to you. Get the enrollment guidance from a source that’ll help you compare plans and recommend options that make sense based on your unique needs.
What is Marketplace open enrollment?
This is generally the one-time a year individuals can enroll in a plan either through New York State of Health (NYSOH) or with an insurance company. For 2021, the open enrollment period runs from November 1 through January 31, 2021.
[NOTE: If you’re reading this post and live outside New York, check Healthcare.gov for your state open enrollment deadline.]
If you’re looking for coverage to begin January 1st, you must enroll in a plan by December 15th. If you enroll after, coverage will take effect on February 1 or March 1, depending on when you apply.
If you miss this deadline, you could be without health insurance for the year unless you have a qualifying event to enroll through a Special Enrollment Period.
Do you need to buy health insurance on your own?
No job-based coverage. Not eligible for Medicare, Medicaid, Child Health Plus, Essential Plan, Veteran, or other government programs. Chances are you’ll need to buy private health insurance on your own. This open enrollment is for you.
Here in New York, you’ve got two (2) paths:
- Get a Qualified Health Plan (QHP) through New York State Of Health (NYSOH), the state’s official health insurance exchange. This is sometimes referred to as the Marketplace, On-Exchange, or Obamacare plans. These government-sponsored plans also provide premium subsidies and cost-sharing reductions for persons who qualify.
- Get an Off-Exchange plan. These are health insurance plans that you can purchase directly from an insurance company, or through agents and brokers, outside this state’s exchange. They offer many of the same benefits found in QHPs and in many ways are identical plans. The one key exception—and it’s a big one—there are no subsidies or reductions.
Here’s what you need to know
The NYSOH marketplace does more than you think. This is not just a place to shop and compare plans. NYSOH coordinates enrollment for Medicaid, Child Health Plus, the Essential Plan, and the QHPs, and makes a determination about whether you qualify for any premium subsidy and/or cost-sharing reduction to lower out-of-pocket costs. So, if you’re in the market for health insurance coverage, that’s probably where you’d want to start your search.
TIP: If you qualify for a premium subsidy or cost-sharing reduction, enroll in an on-exchange plan. Those can only be used with QHPs (i.e., the NYSOH Marketplace plans). If you choose an off-exchange plan, you will be responsible for the full price.
Get help enrolling in a health insurance plan
There is no need for anyone to go at this alone. Take advantage of the free enrollment assistance that’s available.
- Assistors and Navigators provide enrollment assistance to individuals, families, small businesses and their employees who would like help applying for health insurance through the Marketplace.
- Agents and brokers who are certified by NYSOH to help explain plan details and assist consumers with determining eligibility. As licensed insurance professionals, most of these individuals can make recommendations for both On-Exchange and Off-Exchange plans.
Learn more about the NYSOH. Also, check out Healthcare.gov.
For help applying for coverage, call (516) 223-0704 to speak with a licensed agent today!
