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Types of Health Insurance in New York

Unlike in many other states, insurance companies in New York State use community rating when calculating health insurance premiums, typically in the small business market. Community rating means that everyone in the same community (usually several adjacent counties) pays the same premium, regardless of age or health condition. This also leads to non-uniformity in terms of the types of policies that are available across the state. However, in general, several policy types are available in New York.

  1. Workers' Compensation Preferred Provider Organizations

    • A Preferred Provider Organization offers inexpensive premiums for using a preferred list of doctors within a network. If your doctor isn't on the list of exclusive service providers, then you may still be covered, but at a higher out-of-pocket cost. In New York, chapter 635 of the Laws of 1996 provides additional assistance to those claiming workers' compensation. The Department of Health administers the plan.

    Family Health Plus

    • Family Health Plus is a New York state health insurance program that allows low-income individuals and families to obtain health insurance. People qualifying for Family Health Plus typically are disqualified from Medicaid due to their higher income, but do not make enough money to purchase private or employer-sponsored health plans. The actual health care services are provided through participating managed care plans in the area in which you live in New York.

    Elderly Pharmaceutical Insurance Coverage

    • Elderly Pharmaceutical Insurance Coverage, or EPIC, provides financial assistance in the form of health insurance to senior citizens living in New York State so that they can pay for pharmaceutical drugs. EPIC also helps pay some portion of Medicare Part D premiums.

    Healthy NY-HDHP

    • High-deductible health plans are "consumer driven." Insured individuals control how much money they save towards paying for future medical costs. Consumers often put their money into health savings accounts. This money is not subject to income tax and can be used for medical expenses. In this way, consumers are encouraged to shop for the best rates on medical services since deductibles are high and services are not covered until the insured meets the deductible. Healthy NY offers an option for high-deductible plans to help lower the cost of health insurance for those who cannot afford private or group HDHP.

    Healthy NY-Standard

    • Health NY is New York state's subsidized health insurance plan. It insures those who cannot otherwise afford health insurance. The program subsidizes 15 percent of the premium (as of 2010) and another 5 percent if the individual submits to a health examination and risk assessment.

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