familyWhat is the Individual marketplace?

New York State of Health, the Official Health Plan Marketplace, is a new way for people to shop for, compare and enroll in health coverage. It is also the only place to get a new kind of financial assistance provided by the federal government to lower the cost of your health coverage.

To shop in the Marketplace, you:

  • Must live in New York
  • Must be a U.S. citizen, national or lawfully present immigrant (Different immigration rules may apply.)
  • Cannot be currently incarcerated.

What is available through the individual marketplace?

The Marketplace gives you an easy way to compare health insurance plans so you can choose the one that’s right for your health needs and your budget. Health insurance offered through the Marketplace will include a comprehensive set of benefits and coverage. Open enrollment begins October 1, 2013 for coverage that will start as early as January 1, 2014.

What kind of assistance is available?

In the Marketplace, you can apply for help to lower the cost of your health coverage.

You may qualify for new tax credits to help pay for your monthly health insurance premiums. You may qualify for tax credits if you are an individual earning up to $45,900 a year or a family of four earning up to $94,200 a year. You may also be eligible for assistance to help pay for copays, deductibles, and other out-of-pocket costs.

The Marketplace will also see if you qualify for free or low-cost coverage from Medicaid or Child Health Plus.

What are Insurance Affordability Programs?

Insurance Affordability Programs include Medicaid, Child Health Plus, Advance Premium Tax Credits, and Cost-Sharing Reductions. The Marketplace will determine if you qualify for any of these programs, which can lower the cost of your coverage.

What is an exemption?

Starting in January 2014, most people will be required to have insurance if they don’t already have it. Most people who do not have insurance in 2014 will have to pay a penalty to the Internal Revenue Service (IRS) when they file their taxes. Some people will not have to pay this penalty if they qualify for a special circumstance. These special circumstances are called exemptions. Click here to learn more about exemptions and how to apply for an exemption.



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