New York is one of the most densely populated states in the nation, home to the largest metropolis in all 50 states, and responsible for being at the forefront of all industries and quite an epicenter for international business. New York is also very fond of our home state of Florida, it seems, as a large majority of the population is comprised of New Yorkers. The rest of the state is large and diverse, reaching up to the Canadian border with a host of recreational activities on lakes and mountains throughout the year.
If you are a resident of New York, you have to cooperate with some very unfortunate high premiums, though everything costing more is commonplace for city-dwellers. Health insurance companies offered in New York are Empire Blue Cross Blue Shield, EmblemHealth, Oxford Health Plans from UnitedHealthcare, and Easy Choice Health Plan of New York. To compare rates and get a quote for your demographic and region, enter your zip code below.
New York as a whole has a moderately healthy population, which has been improving over the past few years. Though the whole country is currently struggling with declining health, certain areas have been getting better for New Yorkers. In the past year, preventable hospitalizations has decreased among Medicare beneficiaries, and in the past five years smoking has become less frequent. Now 15.5% of all adults are smokers instead of 20.5%, which does mean 2.3 million residents of New York still smoke. Obesity has increased in prevalence in New York as well, now affecting almost 3.7 million adults throughout the state. Related issues are also the growing number of individuals with diabetes, most recently calculated at 1.3 million.
New York does have a solid health care system, with its public health funding contributing to a more positive number from UnitedHealth Foundation’s rankings. The availability of primary care doctors is also very ample in New York, with plenty of physicians to treat the population. There is also a moderate rate of death caused by cancer in New York, and a low infant mortality rate. Despite high premiums throughout the state, it is important to consider getting health insurance or a public health plan to make sure conditions can be treated if they exist. Also, making positive lifestyle changes by nutritious eating and exercise are great benefits that can help the overall health of New Yorkers in the future.
Health Insurance Plans
- GHI Healthy NY EPO HDHP offers coverage to New York residents in Brooklyn, Nassau, Manhattan, Bronx, Queens, Richmond, Suffolk, Rockland and Westchester. Residents of these boroughs can receive care for a $1,200 individual deductible, with several immediate benefits offered. Doctor’s office visits are a $20 copay, as well as diagnostic lab work and X-rays. After you meet the deductible, you can receive most major hospital care for 20% coinsurance. With the exception of emergency care, out-of-network is not covered.
- GHI Healthy NY HMO HDHP plans also have a $1,200 individual deductible, and $2,400 for families, with a $6,050 individual out-of-pocket maximum. These plans cover many areas of New York, and have no coverage for non-network care and require referrals from a PCP. In-network benefits are very well priced and include office visits, lab work and X-rays, physical therapy, and home health care for a $20 copay. Surgical and delivery services are covered at 80% or $200, whichever is less, and prescriptions are covered for a copay at retail pharmacies or mail-order.
- Alliance Value plans have lower premiums and give members access to the PPO network with more than 98,000 providers. Coverage is also available for out-of-network care. These plans cover hospital care, maternity, outpatient surgery, home health care, and preventive care in full. Physician’s office visits are not covered for non-preventive care such as injury or illness, though pharmacy benefits are included.
- GHI Direct Pay HMO plans offer HMO coverage with immediate benefits and no deductible with a network of over 44,000 providers throughout the state. Copayments of varying levels are offered for doctor’s office visits, hospital care, hospice, surgery, home health care, lab work, and other major medical services. These plans also have mental health care coverage for both inpatient and outpatient treatment. Prescription drugs are covered in-network with Direct Pay HMO plans as well as preventive care for no cost as soon as your plan starts.
Oxford Health Plans
- New York Personal POS plans from UnitedHealthcare Oxford connect you to the Liberty Network of providers and offer non-network care as well. These plans have a $1,000 individual deductible and cover most of your major medical expenses before you meet the deductible amount. Uniquely, this plan has a $10 copayment for nearly every imaginable in-network service, including doctor’s office visits, surgery, diabetes care and supplies, inpatient hospitalization, allergy testing, physical therapy, X-rays and more. Out-of-network care is available for 20% coinsurance after you meet the deductible.
- New York Personal HMO plans are part of the Liberty Network of HMO providers, and offer services for a $1,500 deductible for individuals. These plans have a $3,000 out-of-pocket maximum, and all in-network covered services are offered for a $15 copay. As these plans are an HMO, they do not give members access to coverage for out-of-network care. You also are required to designated a primary care physician as your gatekeeper who will write referrals for you to see other providers. Other care, such as inpatient hospital stays and hospice care are a $500 copay per continuous confinement, and emergency room visits are $50 per visit.
Easy Choice Health Plan of New York
- Plan HMO plans from Easy Choice come in several different copayment options based on the cost of office visits, and they are offered in 25/40E, 20E, or 20 plan types. The first offers primary care office visits for $25 and specialist visits for 40, and is enhanced with no copayment for hospitalization. Plan 20 Enhanced covers office visits for a $20 copay with a $250 copay for hospital care, and Plan 20 is a basic plan with a $20 copay for office visits.
- Low Option plans come in two types, including Low Option Plan 25/40, with a $25 copay for all doctor’s office services, and a $500 copay on hospital care. Outpatient services are a $75 copay, and chiropractic care is $40. The other type is Low Option Plan 20 with doctor’s office visits and home health care for a $20 copay, hospital care for $500, and outpatient care for $75. Covered services include physical therapy, mental health care, medical equipment, surgery, X-ray and lab work, and more.
Public Health Options
The state of New York has a many health plans to assist its uninsured and low-income residents. Most commonly is of course, Medicaid, which gives medical insurance to families and children, elderly and disabled, pregnant women and other individuals who cannot afford it. Another program that has greatly helped the nation is the Pre-Existing Condition Insurance Program (PCIP), providing high-risk adults with health insurance policies. Other state-funded services for those who do not have health care coverage include family planning, immunizations, disease prevention, and wellness services. For a complete list of programs in the state of New York, visit the New York Department of Health.
- Medicaid: medical insurance for uninsured residents of New York who meet eligibility criteria. To find out more about who qualifies, read our Medicaid Eligibility by State article.
- NY Bridge plan: New York’s PCIP program administered by EmblemHealth, giving coverage to individuals who have been denied by private insurers for their health.
- New York Child Health Plus: health insurance for uninsured children under the age of 19 with a family income that exceeds Medicaid limits.
- Elderly Pharmaceutical Insurance Coverage (EPIC): free prescription drugs coverage for residents of New York over age 65 to assist in Medicare Part D expenses.
Health Insurance Laws
New York health insurance companies have laws permitting insurance companies to place boundaries on who they accept for health insurance and how they regard pre-existing conditions. Individual health insurance laws mostly deal with this in particular. New York insurers define a pre-existing condition by the objective standard, which includes any condition you have received care for in the six months before applying for health insurance. Once you have been decided as an individual with a pre-existing condition, insurance companies are allowed to add an exclusion period of up to 12 months where they will not pay for any treatment of that condition. If you are changing health insurance companies, however, your previous coverage can be used as a credit to pay for not covered services during the exclusion period.
As mentioned above, there is an alternative to private health insurance for individuals with pre-existing conditions in New York who have been denied a policy due to their condition. This is called the NY Bridge Plan, or PCIP, and is funded by the state to provide coverage to such persons. These plans were created by the Affordable Care Act as a bridge between current laws and when the ACA will take effect in January 2014. At the beginning of the year in 2014, PCIP plans will no longer be in operation, as all insurers on the private market will have to accept all adults regardless of their past or current conditions. There will also be a state health exchange set up to offer subsidized plans to New York residents with essential benefits.
A law that is crucial for the insured individual is the guaranteed renewability provision. This provision states that all individuals who have insurance must be asked by their insurers if they wish to renew their plan for another term before theirs ends. In order to avoid coverage gaps and keep the insurance companies on point, this law makes sure that all persons who pay for insurance and do not commit fraud or violate their policy get what they pay for. Also, this provision helps by making it illegal for an insurance company to rescind someone’s plan if they get sick after their benefits have begun. Guaranteed renewal is part of HIPAA, therefore it is set up with the intent of protecting the patient.