Healthy New York Insurance Plan

Health insurance is one of the most important pieces of insurance you can buy, protecting you and your family from the high cost of health care and ensuring that a sudden illness doesn't lead to a serious financial problem. In addition to the federal government's Medicare and Medicaid programs, some states offer their own solutions. This is the case in New York, where the Healthy New York, or Healthy NY, program covers some workers who might have few other options.

Program Overview

• Healthy New York is a state-run program that provides low-cost health insurance for eligible employers to pass on to their employees, or themselves, as an employee benefit. Healthy New York requires co-payments from policyholders when they receive treatment but otherwise only charges up to a $100 deductible each year to policyholders, with employers and paycheck deductions covering the rest of the cost, as of February 2011. The New York State Insurance Department administers the Healthy NY program, although the state's department helps make residents aware of the plan and its benefits.

Eligibility

• Healthy NY is available to two groups: employers with small work forces and sole proprietors who own businesses in which they are the sole employees. Small business employers must have fewer than 50 employees, 30 percent of whom make less than $36,500 annually. In addition, small business employers must not have offered comprehensive medical plans in the past year and must contribute at least half the cost of buying Healthy NY for their employees. Sole proprietors must be New York state residents who have worked in the past year but make less than two-and-a-half times the federal poverty level.

Coverage

• Every Healthy NY plan covers the majority of common medical treatments and services. These include disease screening, inpatient and outpatient hospital services, physical therapy, surgery, X-rays, home health care following a hospital stay and blood testing. Some Healthy NY plans offer prescription drug coverage, which includes coverage for both generic and brand name prescriptions up to a $3,000 annual limit, as of February 2011.

Costs and Sources

• New York State requires all health maintenance organizations, or HMOs, that do business in the state to offer Healthy NY to eligible residents. HMOs set their own rates and can restrict policyholders to doctors and hospitals in their network. However, the co-payments for Healthy NY are the same for each plan. They include a $500 co-pay for hospital stays, a 20 percent co-pay with a $200 limit for surgeries, a $50 co-pay for an emergency room visit and a $20 co-pay for most other types of services, as of February 2011. Some HMOs offer high-deductible plans that replace the standard $100 annual deductible with a significantly higher deductible but a lower annual premium.