The NYS Health Benefit Exchange is Coming Soon! What You Need to Know Right Now

What is the NYS Health Benefit Exchange?

The NYS Health Benefit Exchange is a marketplace where New Yorkers, both individuals and small businesses, can shop for, compare and enroll in new, affordable health insurance options. Exchanges are being administered in every state as part of President Obama’s federal health care reform law. Over 1 million New Yorkers are estimated to receive coverage through the Exchange.

You will have a choice of health plans; help finding the plan that best meets your needs; and, for eligible persons, financial assistance to help pay for coverage. Health insurance offered on the Exchange will include a comprehensive set of benefits, including equal coverage of mental health and substance abuse benefits.

Who Can Get Coverage?

You will be eligible to purchase a health plan through the Exchange if you:

•  Live in New York
• Are a citizen or lawfully present immigrant (different immigration rules may apply if you are eligible for Child Health Plus or Medicaid)
• Own or work for a small business with 50 or fewer eligible employees 

You will be eligible to receive federal financial assistance for a health plan through the Exchange if you:

• For private commercial insurance: have household income from 138 to 400% of poverty level ($45,900 for individual, $94,200 for a family of 4).
• For Medicaid: have income up to 138% of poverty level ($15,856 for individual, $32,499 for family of 4).
• For Child Health Plus (CHP): Children up to 400% of poverty level ($45, 900 a year, or $94,200 a year for a family of 4).
• Individuals and families will be able to use the Exchange to check if they are eligible for these free or low-cost programs and can enroll in these programs directly through the Exchange. 

Will Mental Health Be Covered?

• Every option on the Exchange will include access to mental health and substance use benefits covered equally with medical and surgical benefits.  An overview of these benefits can be found by clicking here.  
• Mental health is needed for good overall health. These benefits are critical to sustaining overall health and wellness and should be utilized if treatment for mental health related issues is necessary. 

How Much Will Coverage Cost?

Your monthly premium will be based on a couple of things, including your household composition, your income, and the plan you choose: 

• Financial premium subsidies to buy private commercial insurance may be available for individuals who earn up to $45,900 a year, or $94,200 a year for a family of 4, and additional cost-sharing subsidies to help cover out-of-pocket costs may be available for individuals who earn up to $28,725 a year, or $58,875 a year for a family of 4.
• You may qualify for free or low-cost coverage through  Medicaid  if you are an individual who earns up to $15,856 a year, or a family of 4 who earns up to $32,499. Your children may qualify for Child Health Plus (CHP) up to 400% of the federal poverty level, which is $45, 900 a year, or $94,200 a year for a family of 4. 
• You can choose from 4 categories of insurance plans – Bronze, Silver, Gold, or Platinum. The plans within each category will have standardized contract terms and product offerings, making it easy for you to compare plans. The category is based on how you and the plan expect to share the costs of care: a Bronze plan offers lower premiums with higher out-of-pocket costs, while the Platinum plan offers higher premiums with lower out-of-pockets costs.
• Department of Financial Services announced approved rates for Exchange plans. Please click here to view document of approved plan rates (these rates do not take into account any financial subsidies you may be eligible for).       

When Can I Apply?

• October 1, 2013 – Enrollment in the Exchange begins; Exchange begins accepting health insurance coverage applications.
• January 1, 2014 – Coverage through the Exchange becomes effective.

How Can I Apply?

• Online:  

– Through the Exchange web portal starting on October 1  

– Webchat for assistance 

• In Person:  

– In-person assistors/navigators. Please locate the list by borough by clicking here.

– Assistance will be available in most languages.  

• Phone:  

–  Call center will be available starting in September.

 – Assistance will be available in most languages.   

• Mail:

  – Upon request  

Important Contact Information   

• More information, including consumer-friendly fact sheets that you can print and share, is available on the Exchange website at www.HealthBenefitExchange.ny.gov. The website will be available in different languages in the future.
• Sign up for updates on the website or email questions to

exchange@health.state.ny.us.

• Navigators/In-Person Assistors (IPAs) will begin enrolling people October 1 and will be available to speak and meet with individuals should they need it. To access a list of navigators by borough, please go to: http://www.healthbenefitexchange.ny.gov

** NAMI-NYC Metro will continue to update and provide important information to its members before NYS Exchange October launch date. Please be on the lookout for additional Exchange e-blasts, as well as updates via monthly newsletters, NAMI-NYC Facebook/Twitter, and NAMI-NYC website.

Helpline
(212) 684-3264
NAMI Calendar

www.naminycmetro.org

Click here to be directed to the NYS Health Benefit Exchange website
Click here to email the NYS Health Benefit Exchange with any questions
Click here to access a Subsidy Calculator. This tool will enable you to estimate how much premium you will have to pay
Click here to tune into the August 20 Department of Health (DOH) webinar. This webinar provides an overview of the NYS Exchange and announces plan options.
 
Click here to access a map of navigators/in-person assistors by borough  

Click here to view Gov Cuomo’s announcement of approved health insurance plan rates on the Exchange
Click here to view a document of  approved Exchange plan rates (these rates do not take into account any financial subsidies you may be eligible for)