Healthy New York
Healthy NY State-Sponsored Health Insurance Program
The Healthy NY program is designed to provide basic health insurance to individuals and families that do not qualify for Medicaid. Your entire family can get coverage through this plan in some circumstances. The eligibility requirements are fairly straightforward:
- You must reside in New York.
- You must work or have held a full-time job within the prior 12 months.
- You are not eligible for insurance through an employer.
- You have not had health insurance for the prior 12 months or you lost insurance due to a qualifying event.
There are several types of qualifying events, one of which is loss of job. Even if you qualify for or currently have COBRA coverage, you can still apply for Healthy NY. Just be sure to terminate your COBRA coverage (if you have it) before you apply.
How It Works
Healthy NY is state subsidized but administered directly by participating private providers. Applicants can choose from a list of HMOs, each of which offers the same exact benefits package, and apply directly. Once approved, the relationship (including payment and reimbursement) is handled directly with the provider. Choose carefully: although the benefits are the same, the rates are different. For a list of providers, click here.
Benefits
The benefits package is streamlined but fairly comprehensive. Again, the benefits are the exact same no matter which provider you choose. To begin, let’s look at what is NOT covered:
- Dental
- Vision
- Ambulance
- Hospice
- Chiropractic
- Metal health
Other than that, services are comparable to many private plans. Below is a partial list, but complete details are published here.
- Diagnostic screening and preventative services
- Inpatient and outpatient hospital care
- Physician visits
- Home health care for post-surgery and post-hospital visits
- X-ray and laboratory
- Emergency services
- Therapeutic services
- Maternity care
Options
Applicants can choose a high deductible health plan (HDHP) option if they would prefer to use a health savings account (tax-sheltered account that can be used to purchase health care that would not otherwise be covered). In addition, applicants can elect to add prescription drug coverage up to $3000 per year to their plans.
Cost
Rates vary based upon your county, the provider that you choose, and your election of HDHP or prescription options. For an individual HDHP without drugs, this can be as little as $99 per month.
