Attorney General Eric T. Schneiderman today issued an updated brochure offering tips to New Yorkers buying health insurance coverage for 2017. The pamphlet, titled “Shopping For Health Insurance Coverage,” is being released in advance of the New York State of Health Marketplace’s open enrollment period starting Nov. 1, and can be used to evaluate all health insurance options, both on and off the Marketplace. Attorney General Schneiderman encourages consumers to take advantage of open enrollment to evaluate how their current health plan has met their needs, to evaluate whether their current health plan will change in a way that impacts the benefits they expect to use, and to consider what other options are available.
“Choosing a health plan is an incredibly important decision, and I encourage families to take time to find coverage to meet their needs,” Schneiderman said. “Exploring the New York Marketplace is a great way to start making health care enrollment decisions by comparing plans and analyzing costs. I encourage all New Yorkers to see what options are available starting November 1.”
Open enrollment through New York State of Health begins on November 1, 2016, and New Yorkers seeking coverage effective January 1, 2017 must enroll by December 15. Once open enrollment for the Marketplace begins, New Yorkers will be able to review all health insurance plans available through the Marketplace, as well as determine what premium subsidy you may be eligible for to reduce the cost of your monthly premiums. Coverage is also available off of the Marketplace, and those plans may have different enrollment deadlines. Premium subsidies, however, are not available for plans purchased outside the Marketplace.
The Attorney General’s brochure offers important information for all New Yorkers shopping for health insurance – whether they are considering purchasing health coverage for the first time, re-enrolling in their existing plan, or switching into a new health plan. Prior to enrolling, take some time to identify your health needs for the upcoming year, consider your budget, and compare the available plans to evaluate how they satisfy your health and budget needs.
The Attorney General’s Office encourages all New Yorkers when shopping for health insurance to:
(1) Determine whether a premium subsidy is available through the Marketplace to make coverage more affordable (such subsidies are only available through the Marketplace);
(2) Check and confirm your provider’s participation status within the health plan, using the steps set out in the brochure;
(3) If you take prescription medications, check whether they are included in the health plan’s formulary, as well as what your out-of-pocket expense will be and whether there any pre-authorization requirements; and
(4) Check what the co-payment or co-insurance will be for any medical services you expect to use during the plan year, such as for physical therapy or mental health services.
Enrollment in Medicaid, Child Health Plus, and the Essential Plan is open year-round. This means that if you are, or become, eligible for one of these programs during the course of the year, you can enroll at any time. These programs offer low-cost, comprehensive health insurance coverage to lower-income New Yorkers. Child Health Plus is a New York State insurance plan for children, and children who are not eligible for Medicaid may be eligible to enroll in Child Health Plus. The Essential Plan offers coverage for up to $20 per month for lower-income individuals who do not qualify for Medicaid or Child Health Plus.
To learn more about these programs and the qualifications for enrollment, visit these websites:
- Medicaid: https://www.health.ny.gov/
- Child Health Plus: https://www.health.ny.gov/
- Essential Plan: http://info.nystateofhealth.
If you have any questions about a health plan’s coverage, including whether your provider is participating, you should call the insurance company directly and take detailed notes, including when you called, with the name of the person with whom you spoke, what you discussed, and what you were advised.
If you encounter inaccurate provider listings once you are enrolled in a plan and cannot access needed care from that provider, or otherwise believe you were given inaccurate information during open enrollment, contact the Health Care Bureau Helpline for assistance: 1-800-428-9071. For questions about the New York State of Health Marketplace, you can contact the Marketplace directly at 1-855-355-5777.