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NYStateHealthplans.com Frequently Asked Questions

Below are some of the most common questions people have about Obamacare and this website:

Is NYStateHealthplans.com a government site?

No. NYStateHealthplans.com is a privately-owned site, and is not affiliated with or endorsed by the government. NYStateHealthplans.com connects you to the leading carriers and brokers who offer off-exchange Obamacare plans.

How can I purchase an Obamacare plan?

Depending on your preference, you can purchase an Obamacare plan either through the government or from an insurance company or brokerage. Purchasing through the government or state exchange site is known as buying "on-exchange." Purchasing directly through an insurer or broker is considered buying "off-exchange" or "outside the marketplace."

When shopping off-exchange, you may not see every plan that is available to you. However, many find it faster and easier to find and purchase an Obamacare plan off-exchange, and directly through the insurer or broker. NYStateHealthplans.com connects you to many of the leading insurers and brokers, allowing you to compare multiple off-exchange Obamacare plans, all in one place.

Is there government assistance to help me pay for my health care?

Yes. Known as "subsidies", there are two forms of government assistance available for those who meet certain income requirements.

The first is the Premium Tax Credit. The government will help pay for, or subsidize, your monthly insurance rate if your income is at or below 4x the Federal Poverty Line. Learn more about the Premium Tax Credit and how to qualify here.

The second is the Cost Sharing Reduction, or when the government helps pay for your out-of-pocket costs. To qualify, you must choose a Silver plan, and your income must be at or below 2.5x the Federal Poverty Line. Learn more about the Cost Sharing Reductions and how to qualify here.

Can I still get government assistance if I purchase a plan off-exchange?

No, only on-exchange plans qualify for subsidies. For those eligible, NYStateHealthplans.com displays plans with an estimate of your subsidized rate already factored into your pricing. You can also confirm your subsidy eligibility with federal marketplace or your state’s exchange site.

What is the Affordable Care Act?

The Affordable Care Act is a set of health care reform legislation. It comprises of the Patient Protection and Affordable Care Act and the Health Care and Reconciliation Act, both of which were signed into law in March of 2010. Commonly, the Affordable Care Act is known as "Obamacare."

The purpose of the Affordable Care Act was to provide all Americans, including those with lower incomes, with affordable, accessible, and quality health coverage. It accomplishes these by lowering health care costs and premiums; expanding access to Medicaid; applying stricter regulations to insurers; and ensuring that all reformed plans meet a certain high-standard of quality health care (see next section for more).

Prior to reform, millions of Americans were unable to purchase health insurance because it was either too expensive or unavailable. The costs of premiums were steadily increasing as insurers would either increase rates for those with preexisting conditions or deny them coverage completely. Insurers would also set maximum lifetime benefits, resulting in many Americans losing their coverage once they became too expensive to insure. Now, with health care reform, the government not only helps pay for the monthly premiums of those with lower incomes, but also makes certain that for everyone, insurers can no longer deny coverage for preexisting conditions, or drop your coverage when you become too costly to insure.

What is Minimum Essential Coverage?

Minimum Essential Coverage is when a health plan meets the coverage requirements set forth by the Affordable Care Act.

By law, a qualifying health plan must at minimum meet all of these following Ten Essential Health Benefits:

  1. Ambulatory care
  2. Emergency services
  3. Hospital coverage
  4. Pregnancy/maternity and newborn care
  5. Pediatric services (including dental and vision)
  6. Mental health and addiction treatment
  7. Prescription drug benefits
  8. Rehabilitative coverage
  9. Laboratory services
  10. Preventative services and chronic disease management

All four types of plans provide the same quality care. The difference among plans is how much you pay per month versus how much you pay when using the insurance. Bronze plans have lower monthly premiums, but higher out-of-pocket costs when needing medical care. Platinum plans are the exact opposite, where you pay more per month, but have a lower out-of-pocket rate. There is also a fifth type, known as a Catastrophic plan, but you must be under the age of 30 or must be facing certain hardships to qualify. Catastrophic plans have the lowest monthly premium, yet have high out-of-pocket costs.

Learn more about the different types of Obamacare plans, and which plan may be right for you here.

Do I have to buy an Obamacare plan?

Even if you have coverage through your employer, you are still free to shop around and purchase an Obamacare plan. However, you will not be eligible for a subsidy, unless your employer’s plan costs more than 9.5% of your annual income.

When can I enroll in an Obamacare plan?

To purchase an Obamacare plan, or renew or update an existing one, you must sign up during the Open Enrollment Period. The current Open Enrollment Period is November 1, 2024 to January 15, 2025.

The only way to obtain an Obamacare plan outside of the Open Enrollment period is during the Special Enrollment. Those who have certain life changes, known as "Qualifying Life Events", are eligible for Special Enrollment. The Special Enrollment Period lasts for 60 days following a Qualifying Life Event.

Learn more about the different enrollment periods here.

Why did I not see any plans?

We only show plans if we think you are eligible for an Obamacare plan based on the information you entered. If you did not see any plans, please confirm your eligibility with the federal marketplace or your state’s exchange site.

To start comparing Obamacare plans, please submit your zip code or call (866) 991-8214 to speak with an agent.

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NYStateHealthplans.com is operated by QuoteLab, LLC, which is an independent broker and is not a federal or state Marketplace website. This website is owned and operated by QuoteLab, LLC, a licensed insurance agency, NPN #19911386. Invitations for application for health insurance on QuoteLab, LLC, only where licensed and appointed. License numbers are available upon request and are provided where required by law. QuoteLab's license information can be found at https://www.quotelab.com/licenses.html.

This website does not provide information about specific Medicare plans, or enable visitors to obtain quotes, on this website. However, if you provide your information and consent, we will transfer your information to Medicare Advantage organizations and/or their third party marketing organizations (TPMOs) that may contact you to offer Medicare Advantage and/or Part D plans, and we will receive compensation for such transfer. The advertisements appearing on this website are placed by clients from which QuoteLab, LLC receives compensation, and such compensation may impact whether such advertisements appear on this website and the order in which they appear.

This site uses cookies and tech to collect data needed for our services to work including to process your requests, personalize your experience, and measure the effectiveness of content we show you, among other business purposes (Learn More). We share this data with the business partners we connect you with, who may combine it with data you provide to them or they collect from you (Learn More). To learn more about cookies and how to disable them, read our Privacy Policy.

Federal Contracting Statement: The Medicare plans represented are PDP, HMO, D-SNP, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. No Obligation to enroll.

TPMO Disclaimer: We do not offer every plan available in your area. Currently we represent [73] organizations which offer [5110] products in your area. Please contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Please note that these numbers provided are not specific to your area but rather represent the number of organizations and the number of products available on a national basis. We will connect you with licensed insurance agents who can provide information about the number of organizations they represent and the number of products they offer in your service area.

Submitting this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage plan, Medicare Prescription Drug plan, Medicare Supplement Plan, or any other Medicare plan. QuoteLab, LLC is independent of the Medicare program and is neither associated with nor endorsed by The Centers for Medicare & Medicaid Services (CMS) or any other governmental agency.

The plans represented on NYStateHealthplans.com are Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. If you are paying Medicare Part B premium, you must continue to pay it to maintain coverage.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

Based on median Medicare Advantage benefit amounts for dental available across multiple plans and metro areas. Not all benefits available in specific plans or regions.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

[Benefits, premiums and/or copayments/coinsurance] may change on January 1 of each year.

Enrollment in a plan may be limited to certain times of the year unless you qualify for a special [election/enrollment] period or you are in your Medicare Initial Election Period.

Advertised Pricing:

There are several factors that impact your monthly premium; including your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

NYStateHealthplans.com is operated by QuoteLab, LLC, which is an independent broker and is not a federal or state insurance Marketplace or other website. It does not provide access to any federal or state marketplace or exchange. This website is owned and operated by QuoteLab, LLC, a licensed insurance agency, NPN #19911386. Invitations for application for health insurance are made through QuoteLab, LLC, only where licensed and appointed. License numbers are available upon request and are provided where required by law. QuoteLab's license information can be found at https://www.quotelab.com/licenses.html.

This website does not provide information about specific health plans, or enable visitors to obtain insurance quotes, on this website. However, if you provide your information and consent, we will transfer your information to insurance carriers and brokers that may contact you to offer Affordable Care Act (ACA) plans, short-term plans, medical indemnity plans and/or healthcare sharing ministry plans, and we will receive compensation for such transfer. The advertisements appearing on this website are placed by clients from which QuoteLab, LLC receives compensation, and such compensation may impact whether such advertisements appear on this website and the order in which they appear.

NYStateHealthplans.com is required to comply with all applicable federal law, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website does not provide a complete listing of, or display all data on all Qualified Health Plans being offered in your state or service area through the Marketplace website or the federal Medicare program. To see all available data on Qualified Health Plan options in your state, visit your state Marketplace website, go to the Health Insurance Marketplace website at https://www.healthcare.gov.

This site uses cookies and tech to collect data needed for our services to work including to process your requests, personalize your experience, and measure the effectiveness of content we show you, among other business purposes (Learn More). We share this data with the business partners we connect you with, who may combine it with data you provide to them or they collect from you (Learn More). To learn more about cookies and how to disable them, read our Privacy Policy.

Note that even with a $0 premium Medicare Advantage plan, you'll still pay a monthly premium for Part B, and a Part D premium if your Medicare Advantage plan does not include prescription drug coverage (MA-PD).

Allowance Disclaimer: Allowance amounts cannot be combined with other benefit allowances. Limitations and restrictions may apply.

** Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved groceries and utilities. Unused amounts will expire at the end of the month or quarter.

*The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan’s Evidence of Coverage.

Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.

1Transportation services are issued as one-way trips and provided on an annual basis. Benefits vary by plan.