ALBANY, N.Y. (AP) — The New York Health Exchange set to open online Tuesday will offer insurance plans with premiums as low as $134 a month for the most limited coverage in the Rochester area to nearly $900 for platinum coverage on Long Island.
The marketplace lists plans by 16 nonprofit and commercial insurers as the state moves to extend regular health care to 2.7 million uninsured New Yorkers under the federal Affordable Care Act.
Premiums are only part of the equation for shoppers, who will be able to compare plans online and enroll. It depends also on how healthy they expect to be next year.
"The way to think about health insurance is you can get something more comprehensive, and that means you're paying more on a monthly basis, but you'll be paying a lot less when you get sick," said Elisabeth Benjamin, a founder of Health Care for All New York Campaign. "It's pay it now versus pay it later."
Coverage starts with minimal "catastrophic" plans, providing up to three free doctor visits a year and then a $6,400 deductible before insurance payments start for illness or injury. That's an option for those under 30 or those who can't afford more, and tax subsidies don't apply. Those up to age 26 may also have the option of staying on their parents' insurance plans.
After that, plans range from bronze to silver, gold and platinum, projected to cover 60, 70, 80 or 90 percent of medical costs. Premiums generally rise at each level, but subsidies can be applied to reduce the cost. At each basic level, carriers have to provide the same terms for easy comparisons that differ only by company, providers and premiums. After that, they can also offer variations meant to appeal to particular consumers such as no co-payments for mental health visits.
All must cover essential benefits and cannot refuse customers based on pre-existing medical conditions. Essentials are emergency room, outpatient, hospitalization, maternity, mental health, prescription drug, laboratory, rehabilitation, preventive care and pediatric services, including vision and dental care for children.
An estimated 1.1 million uninsured are expected to sign up over three years. They face possible federal tax penalties if they don't and could get the tax-credit subsidies if they do, depending on income.
For example, young adults earning $30,000 a year on Long Island could enroll in New York Fidelis for $175.19 a month, the lowest premium in the area. They could pay $284 for Fidelis' bronze plan, but with a nearly $156 tax credit, the actual monthly cost would be $128.
Fidelis, a nonprofit affiliated with the Catholic Bishops of New York that now covers 910,000 people, most on Medicaid, expects 85 percent of some 57,000 providers to participate in the exchange insurance it will initially make available in 44 of New York's 62 counties.
The new nonprofit Health Republic Insurance, initially sponsored by the Freelancers Union, has the lowest average monthly individual premiums, ranging from $252 for bronze to $423 for platinum and coverage in most regions through the MagnaCare network of providers.
Another new insurer, Oscar, was launched by three young entrepreneurs and 30 investors who said its plans include "unlimited telemedicine" visits with physicians on call within about a half-hour of requesting one, a central database with a patient's complete medical record and no-cost generic drugs. It has a network of 41,000 providers and 83 hospitals in New York City, Long Island and Westchester and Rockland counties.
Not all plans are available in all regions, where premium prices differ substantially. Some plans are limited to only certain counties within those regions where they have networks of providers.
Shoppers can also call for information and to enroll at 855-355-5777.
NY State of Health is opening a separate online marketplace Tuesday for small businesses with 50 or fewer employees, also offering coverages starting next year.
At the same time, advocates hope almost 500,000 Medicaid-eligible low-income residents will join 5.1 million others already in that government-funded health care program, which will expand slightly in New York under "Obamacare." The state already provides most of the expanded Medicaid coverage required by the federal law, though its Family Health Plus program will end.
Health Exchange: http://www.HealthBenefitExchange.ny.gov
Approved rates by the Department of Financial Services: http://bit.ly/16bbsOz
Coverage map: http://www.nystateofhealth.ny.gov/PlansMap